What the diagnosis means
Most ovarian cancers are epithelial cancers (usually high-grade serous type) arising from the ovary, fallopian tube or peritoneum; rarer germ-cell and stromal tumours affect younger women and are treated differently. Persistent bloating, feeling full quickly, pelvic pain or needing to pass urine more often — lasting several weeks — are the symptoms most often missed. Staging uses CT, the CA-125 blood marker and, definitively, surgery.
Where medical oncology fits
Ovarian cancer is one of the cancers where surgery and chemotherapy are equal partners:
- Surgery by a gynaecological oncologist aims to remove all visible disease ("complete cytoreduction"), which is one of the strongest predictors of outcome.
- Chemotherapy — usually a platinum-based combination for six cycles — is given after surgery, or three cycles before and three after (interval surgery) when upfront complete removal is not feasible. Medical oncology leads this and the decision on sequence is made jointly.
- Maintenance treatment after chemotherapy: PARP-inhibitor tablets for cancers with BRCA mutations or homologous-recombination deficiency (HRD), and anti-angiogenic antibody in selected cases — prolonging the time before the cancer returns.
- Recurrent disease is common and is treated as a long-term condition with further chemotherapy and targeted options, chosen by the interval since platinum treatment.
Genetic testing
Every woman with high-grade epithelial ovarian cancer should be offered BRCA1/2 testing (and tumour HRD testing where available). The result guides maintenance therapy and identifies relatives who may benefit from prevention.
What to expect
Chemotherapy is given every three weeks as day-care infusions; hair loss, tiredness, nausea, nerve tingling and low blood counts are the main effects. PARP inhibitors are daily tablets with blood monitoring; nausea and tiredness usually settle. CA-125 and scans track response, and follow-up continues for years.
Questions to ask
- Is upfront surgery or chemotherapy first the better sequence for me, and why?
- Has BRCA/HRD testing been arranged, and how will the result change my treatment?
- Will maintenance treatment be recommended after chemotherapy?
- How will fertility and menopause be handled if I am younger?
- What symptoms should prompt an earlier review after treatment?
Preparing for your consultation
Bring CT (and any ultrasound/MRI) with reports, CA-125 results, biopsy or surgical pathology reports, genetic test results if done, and a medicine list. Note any family history of ovarian, breast, prostate or pancreatic cancer.