Monitoring

After completion of first-line therapy, and where no evidence of disease persists either clinically (computed tomography [CT] scan or examination) or biochemically (CA-125), patients are generally followed with a history, physical examination (including pelvic examination), and optional CA-125 level every 2-4 months for 2 years, then 3-6 months for 3 years, then annually after 5 years.​[17][88]​​​​​

Patients with a BRCA mutation may benefit from longer-term follow-up.[88]​​ CT scanning or other imaging modalities (e.g., positron emission tomography-CT [PET-CT], magnetic resonance imaging [MRI]) may be considered if clinically indicated (e.g., symptoms suggest recurrent disease, or CA-125 level increases).[17][88]​​

National Comprehensive Cancer Network (NCCN) guidelines recommend monitoring CA-125, or other tumor markers, if initially elevated, after primary treatment.[17] Typically, a rise in the CA-125 level will occur before a visible lesion is seen on imaging. Therefore, CA-125 levels, history, and physical exam appear to be the most appropriate tools to monitor most patients. This is the current practice pattern in the US.

There is limited evidence to suggest that routine surveillance with CA-125 in asymptomatic patients, and treatment at CA-125 relapse, does not appear to confer a survival advantage when compared with treatment at symptomatic relapse.[263] Other reviews have concluded that, presently, there is no compelling evidence of a positive effect on survival in women followed up after primary treatment of ovarian cancer.[264][265]

The Society of Gynecologic Oncologists advises patients and physicians "to actively discuss the pros and cons of CA-125 monitoring and the implications for subsequent treatment and quality of life."[266]

There is no clear consensus on the use of imaging studies, as the detection of an asymptomatic recurrence does not necessarily confer a survival advantage. Some advocate imaging if suspicious symptoms appear, whereas others obtain CT scans at predetermined intervals. Patients who have had fertility-sparing surgery should be monitored by ultrasound examination of the abdomen and pelvis if indicated.

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