The first 60 days: High-grade serous ovarian cancer
High-grade serous cancer is the common, aggressive form of ovarian cancer, now known to start in the fallopian tube. It is treated with surgery and platinum chemotherapy, and maintenance PARP inhibitors have changed its course for the half of patients whose tumours cannot repair DNA properly. Below, week by week, is what OnCo's record of High-grade serous ovarian cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: First line, Prevention in carriers.
- Medical oncologistNamed in the standard of care for: First line, Maintenance after first line, Platinum-sensitive relapse, Platinum-resistant relapse.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Risk-reducing salpingo-oophorectomy around age 35 to 45 by gene; opportunistic salpingectomy at other pelvic surgery for everyone.
Complete cytoreductive surgery, primary or after three cycles, with carboplatin-paclitaxel for six cycles; bevacizumab added in stage IV or residual disease.
Secondary cytoreduction in selected patients (DESKTOP III), platinum doublet, PARP inhibitor maintenance if not already used.
Single-agent chemotherapy with or without bevacizumab; mirvetuximab soravtansine for folate receptor alpha-high tumours (MIRASOL); relacorilant with nab-paclitaxel in trials and early approvals.
Olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA), olaparib plus bevacizumab for HRD-positive tumours (PAOLA-1).
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example TP53 mutation, Germline and somatic BRCA1/2, HRD score, Folate receptor alpha, CA-125 for monitoring), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include BRCA1 or BRCA2-mutant, Homologous recombination deficient without BRCA mutation, Homologous recombination proficient.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
First line
- For my situation (first line), which of the standard options do you recommend and why?Guideline options include: Complete cytoreductive surgery, primary or after three cycles, with carboplatin-paclitaxel for six cycles; bevacizumab added in stage IV or residual disease.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Bevacizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Maintenance after first line
- For my situation (maintenance after first line), which of the standard options do you recommend and why?Guideline options include: Olaparib for BRCA-mutant tumours (SOLO-1), niraparib for all comers (PRIMA), olaparib plus bevacizumab for HRD-positive tumours (PAOLA-1).
- Am I a candidate for Olaparib, Niraparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of SOLO-1 and PRIMA / ENGOT-OV26 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Platinum-sensitive relapse
- For my situation (platinum-sensitive relapse), which of the standard options do you recommend and why?Guideline options include: Secondary cytoreduction in selected patients (DESKTOP III), platinum doublet, PARP inhibitor maintenance if not already used.
- Am I a candidate for Rucaparib, Niraparib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of DESKTOP III / ENGOT-ov20 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Platinum-resistant relapse
- For my situation (platinum-resistant relapse), which of the standard options do you recommend and why?Guideline options include: Single-agent chemotherapy with or without bevacizumab; mirvetuximab soravtansine for folate receptor alpha-high tumours (MIRASOL); relacorilant with nab-paclitaxel in trials and early approvals.
- Am I a candidate for Mirvetuximab soravtansine, Relacorilant, Bevacizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Prevention in carriers
- For my situation (prevention in carriers), which of the standard options do you recommend and why?Guideline options include: Risk-reducing salpingo-oophorectomy around age 35 to 45 by gene; opportunistic salpingectomy at other pelvic surgery for everyone.
Any stage
- Are there clinical trials I could join, for example of Mirvetuximab soravtansine, Relacorilant, Folate receptor alpha?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No screening test lowers mortality”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Homologous recombination proficient tumours gain little from PARP inhibitors”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- High-grade serous ovarian cancer: the full pageHigh-grade serous cancer is the common, aggressive form of ovarian cancer, now known to start in the fallopian tube. It is treated with surgery and platinum chemotherapy, and maintenance PARP inhibitors have changed its course for the half of patients whose tumours cannot repair DNA properly.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Homologous recombination deficiency (HRD): A tumour that cannot properly repair double-strand DNA breaks, usually because of BRCA or related gene loss.
Every term links to the glossary.