What questions should I ask my oncologist about locally advanced Ovarian Cancer

Questions to Ask Your Oncologist About Locally Advanced Ovarian Cancer

I'm glad you're preparing for your conversation with your oncologist. Asking informed questions helps you understand your diagnosis and participate in treatment decisions. Here are key questions organized by topic:

UNDERSTANDING YOUR DIAGNOSIS & STAGING

1. Can you explain my specific stage and what "locally advanced" means for my case?

• This helps you understand whether cancer is confined to the pelvis/abdomen or has spread to distant sites

2. What is the histologic type and grade of my cancer?

• According to NCCN Guidelines, this determines treatment approach. High-grade serous, endometrioid, clear cell, and mucinous cancers are treated differently

3. Have you reviewed my pathology report for all the elements recommended in the CAP protocol?

• NCCN Guidelines recommend pathology assessment include tumor site(s), size, surface involvement, specimen integrity, grade, extension, lymph node involvement, and other specific features

4. What imaging studies have been done, and do you recommend any additional imaging?

• NCCN Guidelines recommend chest/abdominal/pelvic CT or MRI with contrast, PET/CT, or ultrasound to evaluate disease extent

MOLECULAR TESTING & BIOMARKERS

5. Have I been tested for BRCA1/2 mutations (germline and somatic)?

• This is critical—NCCN Guidelines emphasize that BRCA status "informs selection of maintenance therapy" after chemotherapy. If you have a BRCA mutation, you may be eligible for PARP inhibitor maintenance therapy

6. If I don't have a BRCA mutation, has my tumor been tested for homologous recombination deficiency (HRD) status?

• NCCN Guidelines note that "in the absence of a BRCA1/2 mutation, homologous recombination deficiency status may provide information on the magnitude of benefit of PARP inhibitor maintenance therapy"

7. What other molecular markers have been tested (HER2, MSI, MMR, TMB, BRAF, FRα/FOLR1)?

• NCCN Guidelines recommend comprehensive molecular testing to identify potential benefit from targeted therapeutics

8. Should I have genetic counseling given my cancer diagnosis?

• NCCN Guidelines recommend genetic risk evaluation for all patients with ovarian cancer

TREATMENT APPROACH

9. Based on my imaging and overall health, am I a candidate for primary debulking surgery (surgery first) or neoadjuvant chemotherapy (chemotherapy first)?

• This is a major decision point. NCCN Guidelines note that "evaluation by a gynecologic oncologist is recommended for all patients with suspected ovarian malignancies" because primary assessment by a gynecologic oncologist results in survival advantage

10. If surgery is recommended, what is your goal for cytoreduction (removing tumor)?

• Optimal cytoreduction is a key prognostic factor in ovarian cancer treatment

11. If neoadjuvant chemotherapy is recommended first, what chemotherapy regimen do you propose, and why?

• NCCN Guidelines recommend platinum-based chemotherapy as standard. Ask about specific drugs and schedule

12. Will bevacizumab (Avastin) be included in my treatment plan?

• This is an anti-angiogenic drug that may be combined with chemotherapy for advanced disease

MAINTENANCE THERAPY

13. After my initial chemotherapy, what maintenance therapy options are available for me?

• This depends on your BRCA/HRD status. NCCN Guidelines recommend:
  • PARP inhibitors (olaparib, niraparib, rucaparib) for BRCA-mutated disease
  • PARP inhibitors or bevacizumab for HRD-positive disease
  • Bevacizumab for other patients

14. How long would maintenance therapy continue, and what are the side effects I should expect?

MONITORING & FOLLOW-UP

15. How will you monitor my response to treatment?

• NCCN Guidelines recommend imaging (CT/MRI/PET), CA-125 tumor marker levels, and physical exams at regular intervals

16. What is the follow-up schedule after treatment ends?

• NCCN Guidelines recommend visits every 2-4 months for 2 years, then 3-6 months for 3 years, then annually

17. If my cancer recurs, what treatment options would be available?

• Understanding this helps you prepare. Treatment depends on whether disease is "platinum-sensitive" (returns ≥6 months after chemotherapy) or "platinum-resistant" (returns <6 months)

SIDE EFFECTS & QUALITY OF LIFE

18. What are the most common side effects of my proposed treatment, and how will we manage them?

19. Are there clinical trials available for my specific type and stage of ovarian cancer?

• Ask your oncologist to help you search ClinicalTrials.gov

20. Should I see a palliative care specialist alongside my cancer treatment?

• NCCN Guidelines recommend palliative care assessment for symptom management and quality of life

BRINGING IT TOGETHER

Before your appointment, consider:

• Write down your questions in order of importance
• Bring a support person to take notes
• Ask for written summaries of your treatment plan
• Request copies of your pathology report, imaging results, and molecular testing results
• Ask about resources like support groups, financial assistance, or nutritional counseling

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Key Takeaway from NCCN Guidelines

According to NCCN Guidelines for Ovarian Cancer, your treatment plan should be individualized based on:

• Your specific cancer stage and histology
• BRCA and HRD testing results
• Your overall health and surgical candidacy
• Whether you receive surgery first or chemotherapy first
• Your response to initial treatment

Your oncologist will determine the most appropriate approach for YOUR specific case based on the complete clinical picture.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.