A 59-Year-Old Woman with Ovarian Cancer - Episode 1
Chirag A. Shah, MD, presents and reviews the case of a 59-year-old woman with ovarian cancer.
Chirag A. Shah, MD: I’d like to review a case of a 59-year-old female, postmenopausal, who initially presented with abdominal discomfort, some abdominal bloating, but was also noted to have modest weight loss. In terms of her past medical history, she was noted to have hypercholesterolemia that was well managed with medications. She had no known family history of malignancy. On physical examination, she was noted to be 150 lb, and appeared to be a generally healthy female, but had diffused tenderness to abdominal palpation. On her exam, she was also noted to have a firm fixed left ovarian adnexal mass. Her overall performance status was good, ECOG performance status 1. Subsequent clinical work-up involved pelvic ultrasound, which revealed a 5-cm left ovarian mass. She was noted to have a cancer antigen, CA-125, of 460 U/mL. This was followed by a chest, abdomen, and pelvis CT. This noted that same adnexal mass but also noted pelvic lymph nodes. There was no evidence of pleural effusions, but there was significant ascites. After the CT, the patient underwent a paracentesis, which revealed 2300 mL of fluid and on histopathologic evaluation was found to be a high-grade, serous epithelial ovarian cancer.
Following this discovery, she was referred to genetic counseling and underwent germline molecular testing. This revealed BRCA1/2 wild type. She also underwent somatic testing of her tumor cells, and these were found to be HRD [homologous recombination deficiency] positive. Her ultimate diagnosis was stage III, high-grade serous epithelial ovarian cancer. After her diagnosis, she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, lymph node dissection with optimal tumor debulking to no gross residual disease, or R0 resection. At the time of her surgery, she had an intraperitoneal port placed and underwent postoperatively intraperitoneal and intravenous paclitaxel and cisplatin therapy. After 6 cycles, she achieved a complete response. During her therapy, she did experience mild cytopenia during rounds 4 and 5 of her chemotherapy, and had her counts subsequently followed for the initial interim after completion of chemotherapy. Her platelet counts recovered to the normal range within 4 weeks of finishing chemotherapy. After finishing chemotherapy, the patient was started on maintenance therapy with 200 mg oral niraparib given daily. This was initiated 12 weeks after the completion of her last cycle of chemotherapy. She initially had weekly blood count monitoring and then monthly as recommended in the niraparib maintenance protocols.
In describing this case in terms of my initial impressions, I would characterize this as the classic presentation for most women with ovarian cancer. They usually present with abdominal or GI [gastrointestinal] symptoms, the most common being abdominal bloating, early satiety, increased abdominal girth and urinary frequency. Seventy five percent of women who are diagnosed with ovarian cancer present at an advanced stage, similar to our patient in this case. Thankfully, the prognosis for these patients has improved dramatically over the last 20 years. We’ve seen a near doubling in the survival of a patient with newly diagnosed ovarian cancer. The average patient with ovarian cancer can now live for up to 8 years, and a large part of that is due to advances in newer treatment options that have become available in the last 5 to 7 years.
Transcript edited for clarity.