Stage IIIC Ovarian Cancer Found During Preoperative Screening

What happened, in summary

A woman in her late 40s with a previous history of triple-negative bilateral breast cancer was referred for gynecologic screening because hereditary breast and ovarian cancer was strongly suspected. She had previously declined BRCA testing because she was afraid of learning that another cancer might develop. Preoperative assessment raised concern for a left ovarian malignancy, changing the planned risk-reducing procedure to an open operation.

During laparotomy, intraoperative examination showed carcinomatous peritonitis from high-grade serous carcinoma of ovarian origin. The finding established stage IIIC disease. She underwent total hysterectomy, removal of both ovaries and fallopian tubes, and omentectomy. Final pathology confirmed stage IIIC high-grade serous carcinoma of the left ovary, classified as pT3cNxM0.

Postoperative homologous recombination deficiency testing identified a BRCA1 pathogenic variant, and subsequent genetic testing confirmed that the BRCA1 variant was germline. She received adjuvant paclitaxel, carboplatin, and bevacizumab, followed by maintenance olaparib and bevacizumab. At approximately 1 year after surgery, she was alive without evidence of recurrence while maintenance therapy continued. She later reflected on whether earlier genetic testing and preventive surgery might have changed her course, while continuing ovarian-cancer treatment with her gynecology team.