Advanced Ovarian Cancer

Case: A 54-Year-Old Woman Diagnosed With Advanced Ovarian Cancer

H & P

• A 54-year-old woman presents after referral from her gynecologist for widespread tenderness, abdominal discomfort, and urinary symptoms. Pelvic exam performed by the gynecologist revealed a suspicious mass on her right ovary.
• Postmenopausal with two children
• PE: reveals an obese woman (BMI = 31 kg/m²) with mild hypertension and pre-diabetes; abdomen shows dullness to percussion
  • BP = 130/85 mm Hg
  • Fasting glucose = 115 mg/dL
  • Waist: hip ratio = 0.90

Imaging

• CT with contrast of the pelvis, abdomen, and chest reveals widespread peritoneal lesions and abdominal lymph node involvement
• Malignant ascites present

Biopsy and labs:

• Pathology, high-grade serous adenocarcinoma, ovarian primary
• BRCA1/2 status: negative
• CA-125: 785 U/mL

Treatment

• She underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking; residual disease after cytoreduction = 1.1 cm
• Diagnosis, stage IIIC ovarian cancer, grade 3
• Started on every-3-week carboplatin and paclitaxel IV plus bevacizumab every 3 weeks