There are no data that prove that follow-up in an asymptomatic individual will improve survival. Most guidance on post-treatment surveillance is based upon retrospective data or expert opinion. Imaging for patients on post therapy follow up/surveillance should only be performed based upon clinical need (e.g., patient symptoms, clinical exam findings or rising CA125) as routing imaging has not been proven to impact cure or response to salvage therapy [64].
The role of CA-125 surveillance is also noted to be controversial and the use of CA125 for surveillance is considered optional. The use of CA15-3 and CA19-9 as surveillance is not validated and is not recommended (note: CA15-3 and/or CA19-9 may be elevated in rare ovarian cancer histologies, therefore, may be useful to assess if recurrence is suspected during follow up).
Below is a suggested guide for post-treatment surveillance:
Note: follow-up consists of general exam and pelvi-rectal exam. Annual Pap smear screening is not required in women who have undergone a hysterectomy as part of their treatment. Women who have not had a hysterectomy should have cervical screening as per BC Cancer recommendations, unless they have experienced recurrence of their ovarian cancer, is which case no additional screening for cancer is required.
Other investigations, such as tumor markers, are not required in otherwise asymptomatic patients. Monitoring of CA125 has been shown to result in early intervention with chemotherapy, without any improvement in overall survival but an adverse effect on quality of life [65].
There may be exceptions to these guidelines, such as extended follow up for those with an indolent type of cancer including advanced granulosa cell tumor or low grade serous carcinoma, at the discretion of the clinician and patient.
Issues pertaining to survivorship in ovarian cancer are not well-studied. This may be due to the overall poor prognosis of patients with ovarian cancer and smaller populations surviving without recurrence. While some studies of ovarian cancer survivors define difficulties, there are few data to guide management. Nevertheless, survivorship-related issues are important to address in this growing population of patients.
64. Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol. 2017 Jul;146(1):3-10. doi: 10.1016/j.ygyno.2017.03.022. Epub 2017 Mar 31. PMID: 28372871.
65. Rustin GJ, van der Burg ME, Griffin CL, Guthrie D, Lamont A, Jayson GC, Kristensen G, Mediola C, Coens C, Qian W, Parmar MK, Swart AM; MRC OV05; EORTC 55955 investigators. Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet. 2010 Oct 2;376(9747):1155-63. doi: 10.1016/S0140-6736(10)61268-8. PMID: 20888993.
