Published: June 19, 2026
When the diagnosis is stage 4: How Norton Cancer Institute is meeting ovarian cancer’s most aggressive presentations
A patient’s journey through advanced ovarian cancer underscores the value of coordinated oncology care, clinical trial access and multidisciplinary expertise close to home.
For the referring physician, few moments are as difficult as relaying a Stage 4 ovarian cancer diagnosis to a patient who was screened clear just three months prior. For Marcella Brown, a 68-year-old Louisville, Kentucky, resident with a strong family history of ovarian cancer, that was precisely the reality she faced in November 2023 — and it set in motion a treatment journey that underscores both the challenges of advanced ovarian cancer, the breadth of ovarian cancer treatment options and patient resources available at Norton Cancer Institute.
Marcella had undergone annual ovarian cancer testing at the UK HealthCare Markey Cancer Center in Lexington, Kentucky, for two decades, motivated by her mother’s diagnosis with the same disease.
“We lost my mother 20 years ago, and I knew I was at high risk,” Marcella said.
A July 2023 screening returned a normal result. By October of that year, she presented to her primary care physician with general malaise. COVID-19 and flu tests were negative. She was given medication for cough and sent to the drugstore. But by that afternoon, dyspnea had progressed, and Marcella went to a Norton Immediate Care Center.
An abnormal electrocardiogram prompted urgent transfer to an emergency department in Louisville, where imaging revealed a right pleural effusion. More than four liters of fluid were drained.
“I knew when my OB/GYN walked in, it was going to be bad,” Marcella said.
Indeed, cytologic analysis of the pleural fluid identified malignant cells.
Her OB/GYN referred her to Justin W. Gorski, M.D., Ph.D., a specialist in gynecologic oncology at Norton Cancer Institute. Initial workup confirmed Stage 4A epithelial ovarian cancer, with a cancer antigen 125 (CA-125) exceeding 6,000 units per milliliter — far above the normal threshold of 35 units per milliliter. The rapid progression from a negative screen to Stage 4 presentation underscores a well-documented clinical reality: Certain ovarian cancer subtypes, including high-grade serous carcinoma, can advance with striking speed and may evade screening with imaging or blood work.
“I thought I was staying ahead of this thing,” Marcella said. “I had just tested negative three months before.”
Per standard-of-care protocols for newly diagnosed advanced-stage ovarian cancer, Marcella’s clinical oncology care team initiated chemotherapy prior to surgical intervention. Dr. Gorski subsequently performed a complete tumor debulking procedure, during which tissue was preserved — a decision that would prove clinically significant later. The combination of chemotherapy and surgery produced a dramatic response: CA-125 dropped to 23 units per milliliter, and Marcella achieved a remission with no evidence of active disease.
“I got to ring the bell [at the infusion center],” Marcella said.
The ringing of the bell signifies the end of cancer treatment, a goodbye to chemotherapy and hello to a cancer-free life.
However, as is common in platinum-resistant ovarian cancer that has achieved remission, disease recurrence followed within approximately three months. Her CA-125 level began trending upward, eventually climbing to 800 units per milliliter, signaling the need to reassess her ovarian cancer treatment strategy.
Marcella was referred for a consultation at University of Texas MD Anderson Cancer Center in Houston on two occasions — a decision her care team at Norton Cancer Institute supported. The first visit, in spring 2025, confirmed that the current treatment approach recommended by Dr. Gorski represented the optimal course of action. The second visit, in September 2025, came after disease progression on subsequent chemotherapy treatment.
The MD Anderson oncologist’s recommendation aligned precisely with what Dr. Gorski already had raised as a possibility: enrollment in a clinical trial. Notably, the two physicians had collaborated professionally, having co-authored research approximately a decade prior — a connection that reinforced Marcella’s confidence in the consistency of her care across institutions.
“What Dr. Gorski was doing here in Louisville was the best course of action nationwide. That was so reassuring to have the doctors at a place like MD Anderson confirm it,” Marcella said.
Following the September 2025 consultation, Dr. Gorski moved quickly and committed to identifying a trial as soon as possible. He reviewed advanced somatic genetic testing results from tumor tissue preserved from Marcella’s debulking surgery and hypothesized that she would benefit most from a WEE1 inhibitor clinical trial that he is leading at Norton Cancer Institute.
This Phase 2 trial is designed for platinum-resistant ovarian cancer patients whose tumor overexpresses a specific protein, cyclin E1. Based on the genetic information from Marcella’s tumor, he thought she would be a great fit. Interestingly, while obtaining his doctorate in clinical and translational science during fellowship at the University of Kentucky, Dr. Gorski studied this specific chemotherapy resistance mechanism and published a highly cited peer-reviewed article about the future potential of WEE1 inhibitors to have a real clinical impact in the lives of carefully selected ovarian cancer patients.
The Norton Cancer Institute research team confirmed Marcella’s eligibility, and she enrolled in the study in October 2025. The trial involves an oral targeted therapy taken Monday through Friday. She was started on the highest protocol-specified dose and within a month the disease seemed to be stabilizing as confirmed by decreasing CA-125 levels.
Marcella continued to see Dr. Gorski every three weeks, maintaining integrated oversight between her investigational therapy and her broader oncologic management. In a few months, her CA-125 levels dropped from over 800 units per milliliter to 70 units per milliliter, and a partial response to therapy was confirmed with CT scans. The Norton Cancer Institute Resource Centers team provided parallel support throughout the trial.
Unfortunately, after three consecutive appointments showing the CA-125 going up, Dr. Gorski unenrolled Marcella from the clinical trial and she was put on a traditional chemotherapy protocol.
In late April 2026, Marcella experienced what she described as severe dizziness. At first, Marcella’s clinical team thought she may just be experiencing side effects from the new chemotherapy regimen, but the dizziness did not resolve. Marcella’s daughter then observed her mother’s gait and balance were alarmingly off and insisted emergency services be called. She was taken first to Norton Women’s & Children’s Hospital, and an MRI of the brain showed a small lesion in the frontal lobe and a tumor in the occipital region.
Marcella was transferred to Norton Brownsboro Hospital, and she was scheduled for surgery two days later. The procedure was successful in removing the occipital tumor. Pathology revealed the brain tumor had metastasized from the primary ovarian cancer.
“It was disappointing, but the surgery went very well, and I was able to begin rehab right after,” Marcella said. “I was home in time for Mother’s Day.”
In early June, Marcella will begin radiation to eradicate any microscopic cancer cells in both the lesion and occipital tumor sites.
Collaboration between disciplines is critical in these situations. Norton Healthcare providers can move quickly to accommodate almost every aspect of complex cases such as Marcella’s.
Despite the uncertainty, Marcella maintains absolute confidence in the team at Norton Cancer Institute. She finds silver linings around every obstacle. For example, she did not require any speech rehabilitation.
“I know a woman whose husband has to have radiation five days a week for seven weeks,” Marcella said. “I think, ‘Hey, I don’t have to go that much, so I’m lucky.’”
Marcella continues to live a full life despite her diagnosis. Now retired, this mother of three grown children and grandmother to eight grandchildren spends time with family and friends. She is an active member of her church and credits her faith with getting her through difficult times.
When asked if she would like to know her prognosis, she shook her head.
“No, God’s got this. He knew the number of my days before I was born,” she said.
Marcella’s case illustrates several points relevant to referring clinicians: