A 52-year-old postmenopausal woman presents with abdominal distension, early satiety, and a pelvic mass on imaging. CA-125 is elevated at 450 U/mL. She undergoes staging laparotomy and is found to have stage IIIC epithelial ovarian cancer. Regarding the management and prognosis of epithelial ovarian cancer, all of the following are correct EXCEPT:

Explanation

## Analysis of Epithelial Ovarian Cancer Management ### Key Concept This question tests knowledge of evidence-based management principles and epidemiology of advanced epithelial ovarian cancer (EOC). Three statements are correct; one contains a factually incorrect claim. ### Evaluation of Each Option **Option 1: Optimal Cytoreduction (CORRECT)** - Cytoreduction to <1 cm residual disease (or ideally no visible residual disease) is a well-established prognostic factor and surgical goal in advanced ovarian cancer [cite:Park 26e Ch 16] - Studies demonstrate improved overall survival with optimal cytoreduction - This is standard of care in stage III–IV disease **Option 2: Platinum-Based Chemotherapy (CORRECT)** - Carboplatin is indeed preferred over cisplatin in most patients due to superior tolerability and equivalent efficacy [cite:Harrison 21e Ch 110] - Standard regimen: carboplatin + paclitaxel (TC) for 6 cycles - Cisplatin reserved for specific scenarios (e.g., high-dose regimens in selected cases) **Option 3: BRCA Mutations — THE INCORRECT STATEMENT** **Key Point:** BRCA1/BRCA2 mutations are present in approximately **10–15%** of epithelial ovarian cancers, NOT 40–50% - The 40–50% figure is a common distractor and represents the proportion of *hereditary* ovarian cancers attributable to BRCA mutations - Overall EOC prevalence of BRCA mutations: 10–15% (higher in serous and high-grade subtypes) - BRCA mutations do predict sensitivity to platinum agents and PARP inhibitors **Option 4: Bevacizumab (CORRECT)** - Bevacizumab (anti-VEGF monoclonal antibody) added to chemotherapy improves progression-free survival in advanced ovarian cancer [cite:Park 26e Ch 16] - GOG-218 and ICON7 trials demonstrated PFS benefit - Typically used in combination with carboplatin-paclitaxel and as maintenance therapy ### High-Yield Summary Table | Feature | Correct Information | |---------|---------------------| | Cytoreduction goal | <1 cm residual (or no visible disease) | | First-line chemotherapy | Carboplatin + paclitaxel | | BRCA mutation prevalence in EOC | 10–15% (not 40–50%) | | Bevacizumab role | Improves PFS in advanced disease | **High-Yield:** The 40–50% BRCA prevalence is a classic exam trap—it refers to hereditary ovarian cancer, not all EOC.