Case 1 – Stage IV low-grade serous ovarian carcinoma management in an elderly patient

Abstract

Recurrent low-grade serous ovarian cancer (LGSOC) is considered relatively chemoresistant; until more effective chemotherapy approaches become available, surgical management remains the mainstay of treatment. However, some subtypes of LGSOC behave distinctly differently from high-grade SOC. The upregulation of estrogen and progesterone receptors in ovarian cancer suggests hormone therapy as a possible treatment modality. Our patient was a 75-year-old woman with advanced low-grade papillary serous ovarian cancer. In consultation, supported by appropriate histopathological examination and immunohistochemical study to guide the treatment decisions, our Gynaecological Oncology Multi-Disciplinary Team recommended primary debulking surgery. The patient underwent surgery followed by hormone therapy with letrozole, after declining bevacizumab-containing adjuvant chemotherapy. Eighteen months of ongoing monitoring has shown no signs of progressive disease and stable tumor markers. This case highlights the importance of initial assessment by a multidisciplinary team experienced in gynecological oncology, together with knowledge of the tumor biology, to determine effective treatment strategies for the management of advanced LGSOC.