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Usually found late. PARP inhibitors transformed maintenance therapy, and ADCs against folate receptor and CDH6 are arriving for platinum-resistant disease.
Ovarian cancer is a group of diseases (~320,000 new cases a year) dominated by high-grade serous carcinoma, which arises in the fallopian tube, is almost always TP53-mutant, and is diagnosed at stage III-IV in three-quarters of women because there is no symptom or screening test that catches it early. Roughly half of high-grade serous tumours have homologous recombination deficiency, including ~20% with germline or somatic BRCA1/2 mutations. Low-grade serous, endometrioid, clear-cell, and mucinous carcinomas are biologically distinct and respond differently to treatment.
The standard of care is maximal cytoreductive surgery (primary or interval, after neoadjuvant carboplatin-paclitaxel), sometimes with HIPEC, followed by maintenance therapy chosen by biomarker: olaparib for BRCA-mutated disease (SOLO-1, 7-year OS 67% vs 47%), olaparib plus bevacizumab for HRD-positive disease (PAOLA-1), niraparib for the rest with declining enthusiasm after PRIMA showed no survival gain. Platinum-sensitive relapse is treated with platinum doublets and secondary surgery in selected patients (DESKTOP III); PARP inhibitors are re-used less since later-line safety signals. Platinum-resistant disease, historically the hardest setting, now has three new options with survival benefit: mirvetuximab soravtansine for FRα-high tumours (MIRASOL), relacorilant plus nab-paclitaxel (ROSELLA, approved 2026), and pembrolizumab plus weekly paclitaxel for PD-L1-positive tumours (KEYNOTE-B96, approved February 2026, the first immunotherapy in ovarian cancer). Low-grade serous carcinoma gained its first dedicated therapy in avutometinib plus defactinib (2025).
What comes next: folate-receptor ADCs that work regardless of expression level (rinatabart sesutecan, luveltamab tazevibulin), a CDH6 ADC (raludotatug deruxtecan) in phase 3, ATR and WEE1 inhibitors for PARP-resistant disease, and prevention by opportunistic salpingectomy now that the tubal origin is accepted. Screening remains unsolved after UKCTOCS; multi-cancer blood tests are the only live hope.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Ovarian cancer accounts for ~320,000 cases per year worldwide. PARP-inhibitor maintenance has turned BRCA-mutated disease into one where two-thirds of women are alive at seven years, and three new treatments that extend life arrived for platinum-resistant disease in three years.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsPlatinum chemotherapy with PARP-inhibitor maintenance, HIPEC at interval surgery, and for platinum-resistant disease mirvetuximab (FRα-high), relacorilant-paclitaxel and pembrolizumab-paclitaxel (PD-L1-positive).
Background: Organ tropism: seed and soil, Peritoneal metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Spreads by shedding cells into the abdominal cavity rather than through the blood; ascites is common.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Surgery + platinum-taxane ± bevacizumab ± HIPEC; PARP maintenance by HRD status.
Platinum doublet + PARP maintenance; secondary cytoreduction in selected cases.
Mirvetuximab (FRα-high), relacorilant + nab-paclitaxel, pembrolizumab (PD-L1+), single-agent chemotherapy.
Germline testing for all patients; risk-reducing salpingo-oophorectomy for BRCA carriers (age 35-45); opportunistic salpingectomy at pelvic surgery for average-risk women; oral contraceptives reduce risk. No population screening (UKCTOCS negative).
Complete surgical staging; adjuvant carboplatin-paclitaxel for high-grade or stage IC-II disease; observation for low-risk stage IA-IB grade 1-2.
Primary debulking if complete resection is feasible, else 3 cycles neoadjuvant carboplatin-paclitaxel then interval debulking (with HIPEC in stage III, OVHIPEC-1) and 3 more cycles; add bevacizumab for high-risk or residual disease.
Olaparib 2 years (SOLO-1) or olaparib + bevacizumab (PAOLA-1) or niraparib 3 years (PRIMA).
Olaparib + bevacizumab (PAOLA-1, OS benefit) or niraparib (PRIMA, PFS only).
Bevacizumab continuation if started; niraparib is an option with small PFS benefit and no OS benefit (PRIMA); observation is reasonable.
Secondary cytoreduction if AGO-score positive (DESKTOP III); platinum doublet (carboplatin with PLD, paclitaxel, or gemcitabine) ± bevacizumab; PARP maintenance if PARP-naive and BRCA/HRD-positive.
Mirvetuximab soravtansine (MIRASOL, OS benefit) with ophthalmic prophylaxis.
Pembrolizumab + weekly paclitaxel ± bevacizumab (KEYNOTE-B96, approved Feb 2026).
Relacorilant + nab-paclitaxel (ROSELLA, approved 2026); single-agent weekly paclitaxel, PLD, or topotecan ± bevacizumab (AURELIA); clinical trials of FRα and CDH6 ADCs.
Surgery; endocrine maintenance (letrozole) after chemotherapy or instead of it; at recurrence, avutometinib + defactinib if KRAS-mutated (2025), trametinib, or endocrine therapy.
Clear-cell: platinum-based therapy, trials of immunotherapy and ARID1A-directed agents; mucinous: consider GI regimens and HER2 testing; germ-cell: BEP chemotherapy with >90% cure.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.