Epithelial ovarian cancer — structured oral station (12 minutes)

Opening prompt — "Stage this disease and tell me why it matters."

Model response — staging verbatim: ^[1]

• "This is FIGO Stage IIIC: macroscopic peritoneal metastasis beyond the pelvis more than 2 cm in greatest dimension, with or without retroperitoneal nodal metastasis. Since 2014 FIGO has staged ovarian, fallopian tube and peritoneal cancer in the same system."^[1]
• "Stage at diagnosis independently affects prognosis, and about two-thirds of epithelial ovarian cancers are Stage III or IV at diagnosis."^[1]
• "Residual disease matters: in EORTC 55971, complete resection of all macroscopic disease was the strongest independent variable predicting overall survival."^[2]

Probe 1 — "How will you decide between primary debulking and neoadjuvant chemotherapy?"

• "FIGO allows 3 to 4 cycles of neoadjuvant chemotherapy followed by interval debulking in selected patients with cytologically proven Stage IIIC and IV disease who may not be good surgical candidates, particularly with poor performance status, significant comorbidities, visceral metastases, or large pleural effusions or gross ascites."^[1]
• "EORTC 55971 found neoadjuvant chemotherapy non-inferior: HR for death 0.98."^[2]
• "CHORUS also found it non-inferior, with fewer grade 3/4 postoperative adverse events (14 percent vs 24 percent) and lower 28-day mortality (under 1 percent vs 6 percent)."^[3]

Probe 2 — "Her germline BRCA1 test is positive. What does this change?"

• "She is eligible for first-line olaparib maintenance after response to platinum (SOLO-1): 3-year PFS 60 percent vs 27 percent, HR 0.30."^[4]
• "Patients with BRCA mutations have the greatest benefit from PARP inhibitors."^[1]
• "Her relatives: FIGO advises that women with a strong family history of epithelial ovarian, fallopian tube or peritoneal cancer, particularly with a documented germline BRCA mutation, have risk-reducing bilateral salpingo-oophorectomy after appropriate counselling and at the completion of childbearing."^[1]

Probe 3 — "What if she relapses at 8 months?"

• "A treatment-free interval of more than 6 months makes her platinum sensitive, and these patients are commonly treated with platinum-based chemotherapy."^[1]
• "After response, niraparib maintenance in NOVA gave a median PFS of 21.0 vs 5.5 months in the gBRCA cohort (HR 0.27), and 12.9 vs 3.8 months in HRD-positive non-gBRCA tumours (HR 0.38)."^[5]

Probe 4 — "Her 35-year-old daughter asks whether she should be screened."

• "There are no documented effective screening methods that reduce ovarian cancer mortality, and the USPSTF recommends against screening asymptomatic women."^[1]
• "With a documented germline BRCA mutation in the family, she should be counselled about risk-reducing bilateral salpingo-oophorectomy at the completion of childbearing, which FIGO advises for women with a strong family history, particularly with a documented germline BRCA mutation."^[1]

Probe 5 — "She is frightened. What do you say?"

Communication domain — demonstrate it out loud: ^[1]

• Move to her eye level, use her name, acknowledge the fear: "Ovarian cancer at this stage is serious, but treatable. The plan is chemotherapy first to shrink the disease, then surgery to remove what remains, then a tablet — a PARP inhibitor — to keep the disease away, because your BRCA test means it is very likely to work well for you. I'll explain every step and every result as we go."^[1]
• Offer a clear plan, a timeline, and a named specialist nurse contact.