Overview of Advanced Ovarian Cancer


Robert L Coleman, MD, FACOG, FACS, and Bradley J Monk, MD, FACOG, FACS, provide an overview of advanced ovarian cancer and discuss its prevalence and diagnosis process.


Robert L. Coleman, MD, FACOG, FACS: Welcome. My name is Dr Rob Coleman, I’m a gynecologic oncologist in Houston, Texas. I’m pleased to be here with my great friend and world-renowned expert on ovarian cancer, Dr Bradley Monk. Brad, please introduce yourself.

Bradley J. Monk, MD, FACOG, FACS: Thanks for having me, Rob. Good seeing you, my friend. I want to thank you for what you’re doing in ovarian cancer. A lot of what we’re going to talk about today is your passion, your life’s work, and quite frankly, how you’ve evolved the standard of care. I’m here in Phoenix, Arizona. I do clinical trials, see patients, and am a professor at both our medical schools here, University of Arizona and Creighton [University]. It’s good to be with you, I’ve been looking forward to this for a long time.

Robert L. Coleman, MD, FACOG, FACS: Me too. Thank you so much. I should have mentioned that a lot of what we’ll be discussing today is work that Dr Monk has also been doing. It’s been a great pleasure to be working together on this process as we’ve navigated through ovarian cancer management. We’re going to cover a lot of stuff today, so we’re excited about this. Let’s start, Brad, by giving the audience a brief overview of what advanced ovarian cancer is, what that term means, and how we diagnose it.

Bradley J. Monk, MD, FACOG, FACS: Thank you for that. We’re going to talk about epithelial ovarian cancer, tubal and peritoneal, and what we mean is high-grade serous cancer, which is about 85% of patients. These patients are generally diagnosed in advanced stages. The earlier stage tumors are more clear cell and endometrioid, and about half to three-quarters of them are tubal in origin, and they just happen, it’s nobody’s fault. Patients present with widely metastatic disease generally and undergo a debulking surgery, if they can, in the beginning. That’s how the diagnosis is made. What do you think is the percentage of patients who have advanced ovarian cancer who show up in the ED [emergency department] vs go to the OB-GYN [obstetrician-gynecologist] doctor?

Robert L. Coleman, MD, FACOG, FACS: It’s funny you mentioned that because I just had a phone consult with a patient who showed up in the ED with a pelvic mass. I think it happens quite a bit. We know that these are not usually findings on incidental exams, it’s usually symptoms that bring people in. Usually for people who can’t access doctors, or don‘t have one, they will show up in the emergency department or urgent care center.

Bradley J. Monk, MD, FACOG, FACS: One of the things that you‘ve taught me is that the number of ovarian cancer cases is falling, but the prevalence, the number of women finding it, is dramatically increasing. A lot of that is what we’re going to talk about today, doing risk-reducing surgery in women with germline mutations, not only BRCA, but other genes. Also in salpingectomy, in the past, when a woman wanted surgical sterilization, we’d interrupt or tie the tubes, but now we take them out. At the same time, these medicines that the group is developing are helping patients live longer and live better.

Robert L. Coleman, MD, FACOG, FACS: Absolutely.

Transcript edited for clarity.

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