Often diagnosed at an advanced stage. The quality of the initial surgery is the most important prognostic factor.
Being told you have ovarian cancer is overwhelming — especially as it is often discovered late. But treatments have improved enormously, and lasting remissions are now achieved in many cases.
Ovarian cancer accounts for approximately 5,348 new cases per year in France (INCa). In nearly 70% of cases, it is discovered at an advanced stage, because symptoms appear late and are non-specific. This is not inevitable: cytoreductive surgery for ovarian cancer, performed at an experienced centre, remains the most decisive treatment for prognosis. Advances over the past decade — PARP inhibitors, better understanding of genetic profiles — have profoundly changed what can be achieved, including at stages III and IV.
The stage is defined according to FIGO classification: Stage I — confined to the ovaries; Stage II — pelvic extension; Stage III — abdominal extension or retroperitoneal lymph nodes (most common at diagnosis); Stage IV — distant metastases (pleura, liver, spleen). Stage guides strategy, but is not the only prognostic factor — the quality of surgical resection and genetic profile matter equally.
Have you just received a diagnosis, or do you wish for a second opinion? A consultation will clarify your situation and the options available.
The symptoms of ovarian cancer are generally not very specific at first. They are diffuse signals, easily attributed to something else — which explains the late diagnosis in nearly 70% of cases.
Have you had several of these signs for more than 3 weeks? Don't let it pass — an assessment can quickly clarify the situation.
Ovarian cancer is not diagnosed by percutaneous biopsy — a suspicious ovarian tumour is not punctured. The workup includes imaging, blood tests, and most commonly a laparoscopy which confirms the diagnosis and determines the stage. The reference French guidelines are those of the Institut National du Cancer (INCa).
What it is. Diagnostic laparoscopy is a keyhole surgical procedure performed under general anaesthesia. A camera is introduced into the abdomen to directly visualise the extent of disease and assess whether a complete resection (leaving no visible residue) is feasible upfront.
Why it is necessary. It is impossible to accurately assess the extent of ovarian cancer from imaging alone. Laparoscopy allows the surgeon to see what imaging cannot — small peritoneal implants, liver surface involvement, diaphragm disease. This information determines the strategy: upfront surgery or chemotherapy first.
Biopsies are taken during laparoscopy to confirm the histological diagnosis. The peritoneal fluid is also sent for analysis.
It is both diagnostic and decisive. The laparoscopy score (PI score) quantifies the extent of peritoneal disease. A PI score above a certain threshold indicates that upfront complete resection is not achievable — chemotherapy first is then the recommended strategy.
The histological type — the nature of the cancerous cells analysed under the microscope — sometimes profoundly changes management. Having a high-grade serous carcinoma is not the same as having a borderline tumour.
The most frequent type of ovarian cancer. It often originates from the fallopian tube rather than the ovary itself. It is frequently detected at an advanced stage (III or IV), and is often sensitive to platinum-based chemotherapy. BRCA mutation is found in 15–20% of cases and significantly influences maintenance treatment. Despite its aggressive nature, it responds well to the combination of surgery + chemotherapy + PARP inhibitors.
A rare type, accounting for less than 5% of cases. It often presents at stage I, with a good prognosis at early stages but poor sensitivity to platinum-based chemotherapy if advanced. A metastasis from the digestive tract (colon, appendix, stomach) must be systematically excluded. Surgery is the cornerstone of treatment.
Accounts for approximately 10% of ovarian cancers. Frequently associated with endometriosis. It is more resistant to platinum-based chemotherapy than serous carcinoma. Often presents at stage I. When detected early, surgical prognosis is good. At advanced stages, the limited sensitivity to standard chemotherapy means other treatment strategies must be explored.
Borderline tumours (also called low malignant potential tumours) are a specific category — they are not true cancers in the traditional sense. They do not invade adjacent tissues in the same way, and are generally treated by surgery alone, without chemotherapy. Prognosis is excellent in the vast majority of cases. Fertility preservation is often possible. They deserve a dedicated page — their management is very different from invasive ovarian cancer.
Surgery, chemotherapy, maintenance treatment — each modality has a precise role. Here is what each represents in practice.
The objective. To remove all visible tumour deposits — what is called a complete cytoreduction (CC-0: no visible residue). This is the most powerful prognostic factor for ovarian cancer. A complete resection multiplies the chances of lasting remission.
It requires an experienced centre. Ovarian cancer surgery in France must be performed in an authorised B5 centre. Complex cytoreduction requires a multidisciplinary surgical team: gynaecological oncologist, digestive surgeon when needed, and an expert anaesthesia team.
Before or after chemotherapy? This is the central decision, made after diagnostic laparoscopy. If complete resection is achievable upfront, surgery comes first. If not, 3 to 4 cycles of chemotherapy reduce the disease before interval surgery. Both strategies are valid — it is the feasibility of complete resection that dictates the choice.
The standard regimen. Carboplatin + paclitaxel, every 3 weeks, for 6 cycles. This combination is the international reference for ovarian cancer. Bevacizumab (an anti-angiogenic agent) may be added depending on the indication and in the absence of contraindications.
Neoadjuvant chemotherapy (before surgery) reduces the tumour burden before the operation, making complete resection more achievable. Interval surgery is performed after 3 to 4 cycles.
Adjuvant chemotherapy (after surgery) eliminates residual microscopic cells. It is given regardless of whether surgery was performed upfront or as interval surgery.
What it is. After chemotherapy, maintenance treatment aims to prolong remission. The main drugs are PARP inhibitors (olaparib, niraparib, rucaparib), taken as tablets for several months to years.
Who benefits? BRCA-mutated patients benefit most from olaparib. Patients with HRD (homologous recombination deficiency), even without BRCA mutation, also benefit. The treatment is prescribed according to a precise algorithm based on BRCA/HRD status and the treatment received.
Bevacizumab may also be used as maintenance treatment, alone or in combination with a PARP inhibitor, depending on the clinical situation.
Clinical trials give access to innovative treatments not yet available in standard practice. In ovarian cancer, many trials are open — at diagnosis, after first-line treatment, and at relapse. Participation in a trial should be discussed at the MDT at every key decision point. Clinique Hartmann and its partner centres have access to the main national and European trials.
From the first symptom to long-term follow-up. Every decision is made in consultation with you.
Ovarian cancer surgery in Paris must be performed at an authorised B5 centre. The objective is always the same: to leave no visible tumour residue (CC-0). This complete resection is the most powerful prognostic factor.
The standard procedure includes: removal of both ovaries and fallopian tubes (bilateral adnexectomy), total hysterectomy, omentectomy (removal of the fatty apron covering the intestines, which frequently harbours tumour deposits), and appendectomy.
Extended procedures may be necessary depending on tumour spread: peritoneal stripping (removal of the peritoneal lining of the abdomen), diaphragm stripping or resection, bowel resection with or without stoma, splenectomy. These procedures are performed when they allow complete resection (CC-0) to be achieved.
The extent is decided during the operation, based on what is found. The objective remains the same whatever: leave no visible residue.
Two equivalent strategies in terms of survival — provided complete resection is achieved in both cases.
Upfront surgery is proposed when laparoscopy shows that complete resection is achievable without major morbidity. It avoids any delay in local control of the disease.
Neoadjuvant chemotherapy first (3–4 cycles, then interval surgery) is proposed when the extent of disease makes complete upfront resection impossible or too risky. Chemotherapy reduces tumour burden and makes complete resection more accessible at interval surgery.
The laparoscopy score (PI score) objectively guides this decision. Above a certain threshold, neoadjuvant chemotherapy is systematically recommended.
What it is. HIPEC involves instilling heated chemotherapy (cisplatin) directly into the abdominal cavity at the end of cytoreductive surgery. The heat increases the penetration and cytotoxicity of the drug on the peritoneal surface.
In which situations? HIPEC is discussed primarily in relapse situations, when a new complete cytoreduction is feasible. Its role in first-line treatment remains debated. The decision is made at the MDT, at experienced centres only.
It is not a systematic procedure — it concerns specific patients, selected according to strict criteria (extent of relapse, interval since first-line treatment, performance status).
Do you have a question about the surgery proposed, or has a strategy been suggested that you do not fully understand? I explain everything during a consultation — not just the medical aspects.
In ovarian cancer, BRCA status and HRD are key markers that guide maintenance treatment. These terms can be frightening — here is what they mean in practice and why they sometimes profoundly change management.
BRCA1 and BRCA2 are genes involved in DNA repair. A mutation in one of these genes increases the risk of ovarian and breast cancer. In ovarian cancer, a BRCA mutation is found in 15–20% of cases.
For your treatment. A BRCA mutation predicts better sensitivity to platinum-based chemotherapy and particularly good response to PARP inhibitors (olaparib as first choice). This opens access to effective maintenance treatment.
For your family. If a somatic BRCA mutation is found in your tumour, a constitutional genetic test will be offered to determine whether this mutation is hereditary. If so, your first-degree relatives (mother, sisters, daughters) can benefit from testing and, if they carry the mutation, enhanced surveillance or preventive measures.
A genetic consultation is systematically organised in this context — you do not have to manage this information alone.
BRCA-mutated + HRD positive: olaparib ± bevacizumab. The most effective maintenance combination in this configuration.
HRD positive but BRCA wild-type: niraparib or olaparib + bevacizumab depending on the protocol. PARP inhibitors remain beneficial even without BRCA mutation when HRD is present.
HRD negative (BRCA wild-type, HRD negative): bevacizumab alone if used in induction. PARP inhibitors offer less benefit in this configuration. Clinical trial participation is particularly relevant here.
The GIS (Genomic Instability Score) measures HRD. A positive result — even without BRCA mutation — opens access to PARP inhibitors as maintenance treatment. This test is performed on the tumour at diagnosis.
Have you received genetic results you don't understand, or been offered maintenance treatment without a clear explanation? Let's discuss it together in consultation.
The question of fertility arises differently depending on age, tumour type and stage. It must be addressed before treatment begins — not afterwards.
In the vast majority of ovarian cancers, surgery requires removal of both ovaries — which causes immediate menopause. However, in certain specific situations (young patient, stage IA, favourable histological type), unilateral adnexectomy preserving the other ovary and the uterus may be discussed at the MDT.
If you have not yet reached the menopause and wish to have children, say so at the very first consultation. Fertility preservation options (oocyte or embryo cryopreservation before chemotherapy) must be discussed before any treatment begins. An oncofertility consultation can be organised at short notice.
If the ovaries are removed and you are not yet post-menopausal, hormone replacement therapy (HRT) can be discussed to manage the symptoms of surgical menopause — depending on your tumour profile.
Treatment for ovarian cancer is long — between surgery, chemotherapy and maintenance treatment, the active phase often spans 12 to 18 months. Here is what to concretely expect afterwards — follow-up, possible relapse, recovery timescales — so you can prepare.
Ovarian cancer requires expert surgical management at an authorised B5 centre with specific experience in gynaecological oncology. In Paris, Dr Jérémie Zeitoun manages ovarian cancers at Clinique Hartmann (Neuilly-sur-Seine) and consults at 241 rue du Faubourg Saint-Honoré, Paris 8th. Every case is presented at a multidisciplinary meeting before any surgical decision.
In ovarian cancer, hysterectomy is part of complete cytoreductive surgery, alongside bilateral salpingo-oophorectomy, omentectomy and additional procedures based on disease extent. The goal is no residual disease at the end of surgery.
Come with your questions, your results, your concerns. We take the time to discuss everything together.
Dr Zeitoun practises as a private specialist (Sector 2). French national health insurance reimburses on the basis of the standard rate — improved for cancer patients (ALD 30). Complementary health insurance may cover additional fees.
In 15 to 20% of cases, ovarian cancer is linked to an inherited genetic mutation — BRCA1, BRCA2 or other genes. If family members have had breast or ovarian cancer, assessing your profile may be useful.
The Eisinger Score, recommended by the French National Cancer Institute (INCa), identifies in 6 questions whether your family history warrants discussion with a doctor. No data recorded — 100% confidential.
Whether your family history is suggestive of a hereditary predisposition
Whether a genetic oncology consultation could be useful for you or your family
Whether close relatives (sisters, daughters) should benefit from enhanced screening