Ovarian Cancer Metastatic to an Axillary Lymph Node Without Breast Disease

What happened, in summary

A 54-year-old woman was diagnosed with ovarian cancer in April 2022 after imaging showed bilateral adnexal masses, peritoneal and omental deposits, retroperitoneal and pelvic lymph nodes, and an enlarged right axillary lymph node. Her CA-125 level was 2,563 at diagnosis. She received neoadjuvant carboplatin and paclitaxel, followed by interval cytoreductive surgery in July 2022 and additional carboplatin and paclitaxel. She then received maintenance bevacizumab. When CA-125 remained elevated and imaging continued to show retroperitoneal and right axillary lymph-node activity, she received second-line liposomal doxorubicin. Biopsy of the persistent right axillary node confirmed metastatic high-grade serous ovarian carcinoma. Mammography did not show a breast tumor, and BRCA1/2 testing was negative. Further persistent disease was treated with oral etoposide, cyclophosphamide, and pazopanib. In April 2025, she underwent secondary cytoreductive surgery, including removal of pelvic and retroperitoneal disease, an umbilical nodule, and the right axillary node, together with heated intraperitoneal cisplatin. No visible residual disease remained at the end of the operation, and she was discharged without complications. Because the axillary node was proven to contain ovarian cancer, the latest and highest documented disease status is Stage IV.