Ovarian Cancer

Case: A 58-Year-Old Female With Progressive Ovarian Cancer

H & P

• A 58-year-old female presents to the clinic for bloating, pelvic pain, early satiety, and urinary urgency. She reports intolerance to strenuous activity at the gym for the past four months but is still able to carry out daily activities such as work, and house chores.
• PE: controlled HTN, abdominal distension;
  • BP: 130/70 mmHg
  • ECOG: 1

Imaging

• CT with contrast of the pelvis, abdomen, and chest reveals bilateral serous cystadenocarcinomas

Biopsy and Labs

• Pathology: high-grade serous carcinoma, epithelial ovarian cancer
• BRCA1-/2wt
• HRD/+
• CA-125: 280 U/mL

Treatment

• Diagnosis: stage IV ovarian cancer
• Patient underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking
• Received IV paclitaxel and carboplatin and bevacizumab, 6 cycles

Follow-up

• CA-125, 43 U/mL upon completion of 6 cycles chemotherapy
• Ten months later at routine follow up, patient presented with recurring symptoms; CA-125, 565 U/mL
• Started on carboplatin/paclitaxel for 6 cycles plus bevacizumab
• Patient achieved a partial response, started on niraparib maintenance therapy
• Four months later:
  • CBC: WNL, SCr: 0.8, AST: 10 u/L, ALT: 7 u/L, and ANC: 1.7 x 10⁹/L
  • BP, WNL
  • ECOG 1