Metastatic Ovarian Cancer (advanced epithelial ovarian cancer; FIGO stage IV) — Disease Characteristics Research Report

Scope and terminology

This report focuses on advanced/metastatic epithelial ovarian cancer (EOC), including ovarian, fallopian tube, and primary peritoneal carcinomas with advanced-stage dissemination (commonly FIGO III–IV), and particularly metastatic disease corresponding to FIGO stage IV. In contemporary clinical guidance, “advanced EOC” is often used operationally for stage III–IV disease and drives shared diagnostic and treatment pathways. (ghirardi2023diagnosticandtherapeutic pages 1-2, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Key concept definitions (current understanding)

• Peritoneal metastasis / carcinomatosis: the most common route of spread in ovarian cancer at diagnosis or recurrence (transcoelomic spread in the peritoneal cavity). (tsili2024imagingofperitoneal pages 1-2)
• Primary debulking surgery (PDS) vs neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS): two standard first-line strategies for advanced disease; the clinical goal is no gross residual disease when surgery is undertaken. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 5-7)
• Platinum resistance (clinical concept): commonly defined by platinum-free interval <6 months (vs platinum-sensitive ≥6 months), influencing subsequent-line strategy and trial eligibility. (caruso2025ovariancancera pages 8-9)
• Biomarker-selected therapy: treatment selection based on BRCA/HRD (PARP inhibitor sensitivity) and FRα (FOLR1) expression (eligibility for mirvetuximab soravtansine in platinum-resistant disease). (ghirardi2023diagnosticandtherapeutic pages 7-8, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Target disease identifiers and synonyms

Ontology/identifier snapshot

• MONDO: Ovarian cancer MONDO:0008170 (used as the nearest disease-level ontology concept in Open Targets; metastatic subtype was not available as a distinct MONDO term in retrieved evidence). (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma)
• MeSH / ICD: In practice, metastatic ovarian cancer is commonly coded under ovarian malignancy (e.g., ICD-10 C56), while metastatic status is captured by staging (FIGO) rather than a distinct ICD code in many workflows (not uniquely resolved in retrieved evidence). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Common synonyms and alternative names

• Metastatic ovarian cancer; stage IV epithelial ovarian cancer; advanced ovarian cancer; ovarian cancer with peritoneal metastases; advanced epithelial ovarian cancer; advanced tubo-ovarian carcinoma; ovarian/fallopian tube/primary peritoneal cancer (advanced). (ghirardi2023diagnosticandtherapeutic pages 1-2, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Evidence source type

Information here is derived primarily from aggregated disease-level resources and guidelines (e.g., ASCO, SEOM–GEICO; systematic reviews), plus multicenter retrospective cohorts and phase II/III clinical trials in advanced/metastatic settings. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 5-7, perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

1. Disease information (overview)

Ovarian cancer is a leading cause of gynecologic cancer mortality and most patients present at advanced stage. In a diagnostic/treatment pathway review focused on advanced ovarian cancer with peritoneal metastases, the authors state: “Over two thirds of ovarian cancer patients present with advanced stage disease” and standard treatment includes cytoreductive surgery plus carboplatin–paclitaxel chemotherapy. (ghirardi2023diagnosticandtherapeutic pages 1-2)

2. Etiology

2.1 Disease causal factors (mechanistic, genetic)

Inherited DNA repair defects are a major causal contributor to a clinically actionable subset of EOC. Open Targets disease–gene associations for ovarian cancer highlight DNA repair genes and other cancer genes, including BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2, MSH2, MSH6, and TP53. (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma)

A contemporary clinical review summarizing risk and prevention reports: “Approximately one-quarter of ovarian cancers are hereditary” and that BRCA1/2 account for a substantial fraction of hereditary cases. (caruso2025ovariancancera pages 3-3)

2.2 Risk factors (genetic, environmental, reproductive)

Quantitative associations reported in a large contemporary review include: * Endometriosis: hazard ratio 4.20 (95% CI 3.59–4.91) in one cited analysis. (caruso2025ovariancancera pages 3-3) * Infertility: standardized incidence ratio 2.0 (95% CI 1.8–4.0). (caruso2025ovariancancera pages 3-3) * Postmenopausal estrogen therapy: relative risk 1.31 (95% CI 1.21–1.41). (caruso2025ovariancancera pages 3-3) * Familial/genetic risk: BRCA carrier lifetime ovarian cancer risk estimated broadly as 20%–70% in one clinical synthesis. (caruso2025ovariancancera pages 3-3)

A clinical risk assessment review provides genotype-stratified absolute lifetime risks: * BRCA1: 39%–58%; BRCA2: 13%–29%. (days2025ovariancancerrisk pages 2-4)

2.3 Protective factors

Protective reproductive/hormonal factors with quantitative effect estimates include: * Multiparity: OR per additional birth 0.81 (95% CI 0.75–0.85). (caruso2025ovariancancera pages 3-3) * Breastfeeding: OR 0.72 (95% CI 0.68–0.76). (caruso2025ovariancancera pages 3-3) * Oral contraceptive use: OR 0.66 (95% CI 0.52–0.83). (caruso2025ovariancancera pages 3-3)

A global epidemiology review quantifies similar protective associations: * Ever vs never oral contraceptives: OR 0.73 (95% CI 0.70–0.76); each 5 years of use associated with ~20% lower risk (95% CI 18–23%). (li2026globalepidemiologyof pages 5-7) * Breastfeeding: ~10% lower risk per 12 months (RR 0.89, 95% CI 0.84–0.94). (li2026globalepidemiologyof pages 5-7)

2.4 Gene–environment interactions

Robust, clinically used gene–environment interaction models specific to metastatic presentation were not identifiable from the retrieved evidence; however, available clinical syntheses emphasize that inherited BRCA-associated risk intersects with reproductive/hormonal exposures (e.g., oral contraceptives) relevant to prevention decisions. (days2025ovariancancerrisk pages 2-4, caruso2025ovariancancera pages 3-3)

3. Phenotypes (clinical presentation)

3.1 Common clinical phenotypes in metastatic/advanced disease

Advanced EOC frequently presents with extensive intraperitoneal tumor burden and/or pleural involvement, driving symptoms such as abdominal distension and respiratory symptoms. A prevention/early-detection implementation review notes that CA-125 is elevated in ~80% of advanced ovarian cancer, reflecting the frequent high tumor burden at advanced presentation. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)

Suggested HPO terms (phenotype mapping; typical in advanced disease)

Because the retrieved evidence base emphasizes diagnostic pathways rather than symptom prevalence tables, the following HPO mappings are proposed as standard phenotype representations for advanced/metastatic EOC, without frequency claims: * Ascites — HP:0001541 * Abdominal distension — HP:0003270 * Abdominal pain — HP:0002027 * Pleural effusion — HP:0002202 * Dyspnea — HP:0002094 * Elevated CA-125 — HP:0032943 (as a biomarker abnormality)

3.2 Quality-of-life impact

Peritoneal dissemination is repeatedly highlighted as clinically consequential because it complicates resectability and contributes to morbidity and recurrence risk; peritoneal metastasis mapping is positioned as crucial for planning therapy and predicting feasibility of complete cytoreduction. (tsili2024imagingofperitoneal pages 1-2)

4. Genetic / molecular information

4.1 Major causal/driver genes and biomarker concepts

Key clinically actionable molecular concepts for metastatic/advanced EOC include: * BRCA1/BRCA2 alterations (germline and somatic) and broader homologous recombination deficiency (HRD), which predict benefit from PARP inhibitors. (ghirardi2023diagnosticandtherapeutic pages 7-8, caruso2025ovariancancera pages 3-3) * TP53 alterations: a hallmark of high-grade serous ovarian cancer (frequently referenced in epidemiology and molecular summaries and in Open Targets associations), though not typically used alone to select current approved therapies. (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma, masouleh2024exploringopportunisticsalpingectomy pages 19-23) * FRα (FOLR1) expression: predictive biomarker for mirvetuximab soravtansine benefit in platinum-resistant disease; MIRASOL required ≥75% of cells with ≥2+ staining intensity. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

4.2 Biomarker-linked treatment selection (real-world implementation)

The SEOM–GEICO 2023 guideline summary emphasizes that new predictive biomarkers enable selection for targeted agents, and that diagnostics should enable biomarker analysis (adequate tissue sampling, cytology for effusions/ascites when present, and molecular profiling). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

5. Mechanism / pathophysiology (metastasis-focused)

A metastasis-relevant mechanistic chain supported directly by the retrieved evidence is: 1) Primary tubo-ovarian/peritoneal carcinoma develops and sheds tumor into peritoneal cavity → 2) Peritoneal metastases become the predominant spread pattern at diagnosis/recurrence → 3) Peritoneal tumor distribution determines feasibility of complete cytoreduction and drives selection between PDS and NACT-IDS → 4) Residual disease after surgery strongly predicts outcomes. (ghirardi2023diagnosticandtherapeutic pages 1-2, tsili2024imagingofperitoneal pages 1-2)

Ontology suggestions (mechanism mapping): * GO biological processes (suggested): epithelial cell proliferation (GO:0050673), cell adhesion (GO:0007155), extracellular matrix organization (GO:0030198), angiogenesis (GO:0001525), DNA repair (GO:0006281). * CL cell types (suggested): epithelial cell (CL:0000066), fibroblast (CL:0000057), macrophage (CL:0000235), mesothelial cell (CL:0000077).

6. Anatomical structures affected

Organ/tissue distribution relevant to metastatic disease

Peritoneal spread involves structures of the peritoneal cavity and abdominopelvic regions. Imaging meta-analysis emphasizes mapping peritoneal disease extent for surgical planning. (tsili2024imagingofperitoneal pages 1-2)

Stage IV subclassification highlights thoracic involvement: * A multicenter stage IV cohort described FIGO IVA vs IVB outcomes, consistent with pleural involvement defining a distinct stage IV group (IVA) with worse prognosis than IVB in that dataset. (metairie2023asuggestedmodification pages 11-12)

UBERON term suggestions: * Ovary — UBERON:0000992 * Fallopian tube — UBERON:0003889 * Peritoneum — UBERON:0002358 * Greater omentum — UBERON:0003688 * Pleural cavity/pleura — UBERON:0000175 / UBERON:0002097

7. Temporal development (onset and progression)

Advanced EOC typically presents after an insidious course; in one implementation-focused prevention review, the authors emphasize that early symptoms can be vague and that disease may progress rapidly, contributing to late-stage diagnosis. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)

8. Inheritance and population

8.1 Epidemiology (recent statistics)

US burden (2024): an imaging systematic review reports that in the United States ~19,680 cases and 12,740 deaths were expected in 2024, and cites an overall 5-year relative survival ~48% for ovarian cancer. (tsili2024imagingofperitoneal pages 1-2)

Global burden and trends (2022–2021): * A contemporary review reports ~324,398 new cases and 206,839 deaths globally (2022). (caruso2025ovariancancera pages 2-3) * Global age-standardized incidence decreased from 7.22 to 6.71 per 100,000 (1990–2021); global mortality decreased from 4.73 to 4.06 per 100,000 (1999–2021). (li2026globalepidemiologyof pages 1-2)

8.2 Inheritance patterns

Risk is substantially elevated in hereditary cancer syndromes (e.g., BRCA1/2). Clinical risk review notes that 10%–15% of ovarian cancers have a germline BRCA mutation and provides BRCA1/2 lifetime risk ranges. (days2025ovariancancerrisk pages 2-4)

9. Diagnostics

9.1 Diagnostic pathway (guideline-aligned; real-world implementation)

The diagnostic process in advanced disease is designed to (i) confirm malignancy and histotype, (ii) stage and map disease, and (iii) determine likelihood of complete cytoreduction.

ASCO guideline update (published 2025-03-??; DOI available) explicitly recommends that patients with suspected stage III–IV disease be evaluated by a gynecologic oncologist and that evaluation includes CA-125, CT abdomen/pelvis, and chest imaging, and that all patients be offered germline genetic and somatic testing at diagnosis. In addition, ASCO specifies histologic confirmation before starting NACT and recommends a platinum–taxane doublet for NACT. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

SEOM–GEICO 2023 guideline (published 2024-07; https://doi.org/10.1007/s12094-024-03531-3) emphasizes: * Physical examination and labs including CA-125, plus pelvic ultrasound. * CT chest/abdomen/pelvis for disease extent; MRI and PET-CT as adjuncts in advanced disease. * Initial laparoscopy to obtain histopathology and evaluate feasibility of complete cytoreduction; use of peritoneal extension scoring (e.g., PCI, Fagotti score) for surgical planning. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

9.2 Imaging for peritoneal metastases (systematic review evidence)

A 2024 systematic review/meta-analysis (33 studies; 487 women) concludes MRI and FDG PET/CT have higher per-patient sensitivity than MDCT for detecting peritoneal metastases, and reiterates the clinical importance of mapping peritoneal disease distribution. (tsili2024imagingofperitoneal pages 1-2)

9.3 Laparoscopy and tumor burden scoring

In a pathway review, the authors note that CT and CA-125 have limitations for predicting optimal cytoreduction, whereas laparoscopic assessment using validated scoring provides the highest specificity for identifying patients likely to undergo suboptimal cytoreduction and thus best suited to NACT-IDS. (ghirardi2023diagnosticandtherapeutic pages 1-2)

9.4 Liquid biopsy (emerging; advanced disease monitoring)

While not standard-of-care for primary diagnosis in advanced EOC in the retrieved guideline excerpts, evolving studies suggest ctDNA/cfDNA may correlate with CA-125 and potentially identify recurrence earlier than CT/CA-125 changes in small cohorts; however, broad clinical implementation remains investigational. (tsili2024imagingofperitoneal pages 1-2)

10. Treatment

10.1 First-line backbone and surgical strategy

Standard first-line management consists of cytoreductive surgery (with the goal of no gross residual disease) plus carboplatin–paclitaxel chemotherapy. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 7-8)

Choosing PDS vs NACT-IDS (trial evidence summarized in 2023 review)

Randomized evidence summarized for advanced disease includes: * EORTC-55971: median OS 29 vs 30 months (PDS vs NACT-IDS). (ghirardi2023diagnosticandtherapeutic pages 5-7) * CHORUS: median OS 22.8 vs 24.5 months (PDS vs NACT-IDS). (ghirardi2023diagnosticandtherapeutic pages 5-7) * Pooled analysis (FIGO stage IV subgroup): median OS 21.2 vs 24.3 months and median PFS 9.7 vs 10.6 months, favoring NACT-IDS in that analysis. (ghirardi2023diagnosticandtherapeutic pages 5-7)

10.2 Anti-angiogenic therapy (bevacizumab)

A review excerpt summarizes two major phase 3 trials: * GOG-0218: bevacizumab strategy PFS 14.1 vs 10.3 months. * ICON7: PFS 24.1 vs 22.4 months. These results support modest PFS improvements when bevacizumab is added to chemotherapy and continued as maintenance in selected advanced settings. (caruso2025ovariancancera pages 8-8)

10.3 PARP inhibitor maintenance (HRD/BRCA-guided)

In a pathway review, SOLO-1 is summarized as showing HR 0.30 (95% CI 0.23–0.41) for progression/death with olaparib maintenance, and median PFS not reached vs 13.8 months at 41-month follow-up in that trial context. (ghirardi2023diagnosticandtherapeutic pages 7-8)

10.4 Antibody–drug conjugate targeting FRα: mirvetuximab soravtansine

SORAYA (phase II; JCO 2023-05; https://doi.org/10.1200/JCO.22.01900) abstract states: * ORR 32.4% (95% CI 23.6–42.2); median duration of response 6.9 months. * Common adverse events included blurred vision (41%) and keratopathy (29%). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

MIRASOL (phase 3; NEJM 2023-12; https://doi.org/10.1056/NEJMoa2309169) abstract states: * Median PFS 5.62 vs 3.98 months; ORR 42.3% vs 15.9%. * Median OS 16.46 vs 12.75 months. * Grade ≥3 adverse events 41.7% vs 54.1%. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

A 2024 update on SORAYA reports final median OS 15.0 months (95% CI 11.5–18.7) at data cut-off 2022-12-22, supporting clinically meaningful activity in FRα-high platinum-resistant disease. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Suggested MAXO terms (treatments)

• Cytoreductive surgery — MAXO:0001175 (suggested)
• Neoadjuvant chemotherapy — MAXO:0000748 (suggested)
• Platinum-based chemotherapy — MAXO:0000058 (suggested)
• PARP inhibitor therapy — MAXO:0001021 (suggested)
• Anti-VEGF therapy — MAXO:0000625 (suggested)
• Antibody–drug conjugate therapy — MAXO:0001301 (suggested)

11. Outcome / prognosis

Stage IV heterogeneity

A multicenter retrospective study of FIGO stage IV epithelial ovarian cancer (n=307) reported worse outcomes for stage IVA vs IVB: * Median OS 31 vs 45 months and median PFS 18 vs 25 months (IVA vs IVB), suggesting meaningful prognostic heterogeneity within stage IV and supporting efforts to refine stage IV subclassification. (metairie2023asuggestedmodification pages 11-12)

Peritoneal tumor burden and outcomes

Disease mapping and completeness of cytoreduction are repeatedly emphasized as prognostically critical; the pathway review notes that achieving no gross residual disease is the surgical goal and that residual disease volume strongly predicts survival. (ghirardi2023diagnosticandtherapeutic pages 1-2, ghirardi2023diagnosticandtherapeutic pages 5-7)

12. Prevention

12.1 Primary prevention and risk reduction (high-risk genetics)

A clinical review reports that bilateral salpingo-oophorectomy is the most effective preventive option for high-risk women; a pooled analysis of 9,192 BRCA1/2 carriers found an 81% risk reduction over 4 years (HR 0.19, 95% CI 0.13–0.27). (caruso2025ovariancancera pages 3-3)

12.2 Opportunistic salpingectomy (average-risk prevention strategy)

A global epidemiology review reports unilateral or bilateral salpingectomy associated with reduced ovarian cancer risk (HR 0.65, 95% CI 0.52–0.81). (li2026globalepidemiologyof pages 5-7)

A feasibility/safety synthesis of opportunistic salpingectomy in general surgery settings suggests relative safety in limited data (no complications attributable to the procedure in 140 patients across included studies) and reports feasibility in selected procedures (e.g., successful in 98/105 cholecystectomies in one study). (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

12.3 Screening limitations (secondary prevention)

A prevention/implementation review reports that large screening trials have not demonstrated clear mortality benefit: * PLCO (78,286 women): CA-125 + transvaginal ultrasound had PPV 26.5% and no survival benefit at 15 years. * UKCTOCS: no significant survival improvement. (masouleh2024exploringopportunisticsalpingectomy pages 19-23)

13. Model organisms and experimental systems

Direct evidence on specific ovarian cancer animal models and organoid/PDX systems was not extracted into the citable evidence set for this report. As a result, this section is not populated with model-specific performance claims.

Recent developments (2023–2024 prioritized highlights)

1) Imaging evidence base update (2024): systematic review/meta-analysis supports MRI and FDG PET/CT as preferred modalities (vs MDCT) for detecting peritoneal metastases in ovarian cancer, emphasizing the need for disease mapping to guide surgery. (tsili2024imagingofperitoneal pages 1-2) 2) Guideline-driven diagnostic pathway emphasis (2024): SEOM–GEICO (2023 guideline published 2024) highlights structured workup including CA-125, CT chest/abdomen/pelvis, and the increasing role of laparoscopy-based scoring and biomarker-informed therapy selection. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2) 3) Targeted therapy implementation: mirvetuximab soravtansine demonstrates clinically meaningful benefit in FRα-high platinum-resistant ovarian cancer (SORAYA 2023; MIRASOL 2023), supporting routine FRα testing in this setting. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)

Key diagnostic/treatment pathway figure (evidence-supported visual)

A diagnostic/therapeutic pathway algorithm figure (Figure 1) from a 2023 review illustrates how clinical assessment, biopsy confirmation, and laparoscopic scoring guide selection between PDS and NACT-IDS in advanced disease. (ghirardi2023diagnosticandtherapeutic media b74131ac)

Structured summary table (for knowledge base ingestion)

Table: This table condenses identifiers, staging, diagnostic workup, biomarkers, and major treatment trial metrics for metastatic/advanced epithelial ovarian cancer. It is designed as a quick-reference artifact for knowledge base population and narrative synthesis.

References (URLs and publication dates)

• Ghirardi V, et al. Diagnostic and Therapeutic Pathway of Advanced Ovarian Cancer with Peritoneal Metastases. Cancers. 2023-01. https://doi.org/10.3390/cancers15020407 (ghirardi2023diagnosticandtherapeutic pages 1-2)
• Tsili AC, et al. Imaging of Peritoneal Metastases in Ovarian Cancer Using MDCT, MRI, and FDG PET/CT: A Systematic Review and Meta-Analysis. Cancers. 2024-04. https://doi.org/10.3390/cancers16081467 (tsili2024imagingofperitoneal pages 1-2)
• Pérez-Fidalgo JA, et al. SEOM–GEICO clinical guideline on epithelial ovarian cancer (2023). Clin Transl Oncol. 2024-07. https://doi.org/10.1007/s12094-024-03531-3 (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
• Métairie M, et al. A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer. Cancers. 2023-01. https://doi.org/10.3390/cancers15030706 (metairie2023asuggestedmodification pages 11-12)
• Matulonis UA, et al. SORAYA results. J Clin Oncol. 2023-05. https://doi.org/10.1200/JCO.22.01900 (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
• Moore KN, et al. MIRASOL. N Engl J Med. 2023-12. https://doi.org/10.1056/NEJMoa2309169 (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
• Coleman RL, et al. SORAYA final OS. Int J Gynecol Cancer. 2024-06. https://doi.org/10.1136/ijgc-2024-005401 (perezfidalgo2024seom–geicoclinicalguideline pages 1-2)
• Li R, et al. Global epidemiology of ovarian cancer: patterns, trends, and risk factors. Cancer Biol Med. 2026-03. https://doi.org/10.20892/j.issn.2095-3941.2025.0619 (li2026globalepidemiologyof pages 1-2)
• Open Targets disease–gene associations for ovarian cancer (MONDO_0008170). https://platform.opentargets.org/ (OpenTargets Search: metastatic ovarian cancer,ovarian carcinoma)

References

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2. (perezfidalgo2024seom–geicoclinicalguideline pages 1-2): Jose Alejandro Perez-Fidalgo, Fernando Gálvez-Montosa, Eva María Guerra, Ainhoa Madariaga, Aranzazu Manzano, Cristina Martin-Lorente, Maria Jesús Rubio-Pérez, Jesus Alarcón, María Pilar Barretina-Ginesta, and Lydia Gaba. Seom–geico clinical guideline on epithelial ovarian cancer (2023). Clinical & Translational Oncology, 26:2758-2770, Jul 2024. URL: https://doi.org/10.1007/s12094-024-03531-3, doi:10.1007/s12094-024-03531-3. This article has 18 citations and is from a peer-reviewed journal.

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15. (caruso2025ovariancancera pages 8-8): G Caruso, SJ Weroha, and W Cliby. Ovarian cancer: a review. Unknown journal, 2025.

16. (ghirardi2023diagnosticandtherapeutic media b74131ac): Valentina Ghirardi, Anna Fagotti, Luca Ansaloni, Mario Valle, Franco Roviello, Lorena Sorrentino, Fabio Accarpio, Gianluca Baiocchi, Lorenzo Piccini, Michele De Simone, Federico Coccolini, Mario Visaloco, Stefano Bacchetti, Giovanni Scambia, and Daniele Marrelli. Diagnostic and therapeutic pathway of advanced ovarian cancer with peritoneal metastases. Cancers, 15:407, Jan 2023. URL: https://doi.org/10.3390/cancers15020407, doi:10.3390/cancers15020407. This article has 18 citations.