Follow-Up Care
Patients with early-stage ovarian cancer usually have a low recurrence rate, providing they had full surgical staging and received appropriate therapy. Exceptions include patients with clear-cell cancers of the ovary. Because of the low recurrence rate, patients should be followed with a gynecologic examination and a serum CA 125 test every 3 months for the first year, every 4 months for the second year, and every 6 months for the next 3 years. After 5 years, annual examinations are recommended. Annual Pap tests are recommended. There is no proven benefit of diagnostic radiography and computed tomography in asymptomatic patients with a normal serum CA 125 level.
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Patients with advanced ovarian cancer have a very high recurrence rate, approaching 75% after a complete clinical response and 50% after a complete pathologic response (negative second-look laparotomy). For these patients, follow-up should be more intensive. They should have a gynecologic examination and a serum CA 125 test every 3 months for the first 2 years. Follow-up at 6-month intervals is recommended for the next 3 years. The use of routine computed tomographic scans is debatable, although many experts recommend scans for follow-up of patients who did not have a second-look laparotomy. The optimum frequency for such scans has not been established.
The value of the serum CA 125 test in the follow-up of patients depends in large part on whether the patient had an elevated serum level before therapy, even though CA 125 levels do not always correlate with tumor volume. The serum test does, however, appear to be the best follow-up test available.