A 68-Year-Old Woman With Stage IV Ovarian Cancer

Video

Ramez Eskander, MD, presents the case of a 68-year-old woman with stage IV ovarian cancer, and discusses the management approach for this patient and similar cases.

Case Overview:

Initial Presentation

  • A 68-year-old postmenopausal woman presented with fatigue, urinary frequency, early satiety, abdominal bloating and distention
  • PMH: HTN, medically treated with lisinopril
  • SH: retired; grandmother of 3; never-smoker; social alcohol use
  • PE: abdominal distention, bloating, and a positive fluid wave test; otherwise unremarkable


Clinical work-up

  • Pelvic exam with transvaginal ultrasound showed a right ovarian mass
  • Chest/abdomen/pelvis CT with contrast revealed a right adnexal 5.3-cm complex mass, a suspicious intraparenchymal liver lesion, retroperitoneal lymph node enlargement and concurrent pleural effusion
  • Lymph node and adnexal mass biopsy confirmed high-grade, epithelial ovarian cancer; positive cytology of pleural effusion
    • T1N1M1
  • Germline molecular testing showed BRCA1/2 wild-type, HRD+
  • CA-125, 438 U/mL
  • ECOG: 1

Treatment

  • Patient underwent TAH/BSO, lymph node dissection, with suboptimal debulking; residual disease 1.3 cm
  • Paclitaxel/carboplatin/bevacizumab + maintenance bevacizumab
    • After 3 cycles, patient underwent second debulking surgery, R0
  • Continued on bevacizumab for 6 more cycles
    • Achieved partial response, post treatment CA-125, 40 U/mL
       

Follow-up

  • At 3 months
    • CA-125, 18 U/mL
    • Chest/abdomen/pelvis CT showed no gross pelvic masses or nodes
    • Pelvic exam was unremarkable
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1 expert in this video
1 expert in this video
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
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