Ovarian Cancer
Ovarian Carcinoma · Fallopian Tube Cancer · Peritoneal Cancer · EOC
8th most common cancer in women — ~314,000 new cases/year
Ovarian cancer is the deadliest gynaecological cancer — ~70% present at advanced stage (III-IV) because early-stage disease is often asymptomatic. High-grade serous ovarian carcinoma (HGSOC) is the most common and aggressive subtype. BRCA1/2 and HRD (homologous recombination deficiency) testing is mandatory — these define PARP inhibitor eligibility, which has transformed maintenance therapy outcomes. Cytoreductive surgery ('debulking') followed by platinum-based chemotherapy is the cornerstone of treatment.
4
Subtypes
9
Diagnostic Tests
10
Treatment Options
For Informational Purposes Only
Content on this page is for educational purposes only and does not constitute medical advice.
🗺 What Do I Do Next? — Your Roadmap
Just diagnosed with Ovarian Cancer? Here are your essential next steps.
Get the Full Diagnostic Workup
Before any treatment begins, you need 9 key tests — imaging, blood markers, biopsy, and molecular profiling. See the Diagnostic Workup section below. Do NOT start treatment without molecular testing — it determines which therapies work for your specific subtype.
Know Your Molecular Subtype
Ovarian Cancer is not one disease — it has 4 distinct subtypes defined by biomarkers (BRCA1, BRCA2, HRD, CA-125, and more). Your subtype determines which treatments apply to you. See Subtypes & Mutations below.
Assemble Your Care Team
You need a multidisciplinary team: oncologist (medical, surgical, radiation), pathologist, radiologist, and ideally a molecular tumour board review. Seek a second opinion at a major cancer centre for any Stage III-IV diagnosis.
Review All Treatment Options
Treatment for Ovarian Cancer spans Surgery, Chemotherapy, Targeted Therapy, Immunotherapy. See the full Treatment Options section below. Ask your oncologist which options apply to your specific subtype and stage.
Ask About Clinical Trials
Many of the most effective treatments started as clinical trials. Ask your oncologist about eligibility. Search clinicaltrials.gov with your cancer type + molecular profile. Academic centres have the most trials.
Key Biomarkers & Mutations
Subtypes & Molecular Profiles
Best response to platinum-based chemotherapy of all ovarian subtypes. PARP inhibitors in maintenance dramatically extend PFS — olaparib adjuvant maintenance in BRCA1/2 mutant: 5-year DFS benefit of >50% vs placebo (SOLO-1). Consider risk-reducing salpingo-oophorectomy after completed childbearing for germline BRCA carriers.
KEY THERAPIES FOR THIS SUBTYPE
Diagnostic Workup
9 testsIMAGING
CT Chest / Abdomen / Pelvis
At diagnosisFull staging — peritoneal disease, omental caking, diaphragm involvement, lymphadenopathy, pleural effusion.
MRI Pelvis
At diagnosis for pelvic assessmentPrimary tumour characterisation, uterine invasion, pelvic extent of disease. Helpful when CT equivocal.
PET-CT
Selected cases — pre-surgical planningDetect extra-abdominal metastases before primary surgery. Identifies unresectable disease.
BLOOD & TUMOUR MARKERS
CA-125
At diagnosis, then every 3 months during treatmentElevated in ~80% of ovarian cancer. Monitoring response and recurrence. Note: elevated in endometriosis, PID, liver disease — non-specific in premenopausal.
HE4 (Human Epididymis Protein 4)
At diagnosisMore specific than CA-125 alone. ROMA (Risk of Ovarian Malignancy Algorithm) combines CA-125 + HE4.
ENDOSCOPY & PROCEDURE
Laparotomy / Laparoscopy (Surgical Staging)
Primary surgery or diagnostic laparoscopyDefinitive staging and debulking — total peritoneal assessment only possible at surgery. FIGO staging requires surgical exploration.
GENETIC & MOLECULAR
Germline BRCA1/2 / HRR Testing
At diagnosis — all patientsAll ovarian cancer patients — BRCA1/2 determines PARP inhibitor maintenance eligibility (olaparib, niraparib). Germline result also guides family members.
Somatic HRD Testing (Myriad myChoice / FoundationOne)
On tumour tissue — all patientsHRD status in BRCA-wild-type patients — determines whether niraparib or olaparib+bevacizumab maintenance is appropriate.
BIOPSY & PATHOLOGY
Histology / Immunohistochemistry Panel
On surgical or biopsy specimenDistinguish HGSOC vs clear cell vs endometrioid vs mucinous — major prognostic and treatment implications.
Treatment Options
10 optionsSURGERY
Primary Debulking Surgery (PDS)
Total hysterectomy + bilateral salpingo-oophorectomy + omentectomy + peritoneal debulking. Goal: no visible residual disease (R0). PDS preferred when complete resection achievable.
Interval Debulking Surgery (IDS)
After 3 cycles of neoadjuvant chemotherapy — for patients with unresectable disease at presentation. EORTC 55971 showed equivalent OS to PDS if R0 achieved.
CHEMOTHERAPY
Carboplatin + Paclitaxel
Standard first-line chemotherapy for all ovarian cancer subtypes. Weekly paclitaxel equally effective and better tolerated. IV or intraperitoneal (IP) routes.
Intraperitoneal (IP) Chemotherapy
Optimally debulked Stage III — cisplatin IP + paclitaxel IV. Significant OS benefit (GOG172) but toxicity limits use. IP ports required.
TARGETED THERAPY
Bevacizumab (Avastin) + Chemotherapy then Maintenance
Stage III-IV — GOG0218 and ICON7 trials. Added to carboplatin/paclitaxel then continued as maintenance. Benefit clearest in high-risk Stage III and Stage IV.
Olaparib Maintenance (Lynparza) — SOLO-1
BRCA1/2 mutant advanced ovarian cancer after complete/partial response to first-line platinum — SOLO-1 trial: 5-year PFS benefit.
Niraparib Maintenance (Zejula) — PRIMA
All-comers (HRD+ and HRD-) after first-line platinum-based chemo. Greatest benefit in HRD+ BRCA-wt disease.
Olaparib + Bevacizumab Maintenance — PAOLA-1
HRD-positive tumours (BRCA mutant or BRCA-wt HRD+) after bevacizumab-containing first-line — PAOLA-1 trial.
Mirvetuximab Soravtansine (ELAHERE)
FOLR1-high, platinum-resistant recurrent ovarian cancer — FDA-approved ADC. First new mechanism of action approved in platinum-resistant disease.
IMMUNOTHERAPY
Pembrolizumab
MSI-H ovarian cancer — tumour-agnostic. Rare but responsive. PD-L1+ combination trials ongoing.