Follow-Up Plan for Ovarian Cancer After Surgery and Chemotherapy
After completing surgery and chemotherapy for ovarian cancer, patients should undergo clinical examination including pelvic examination every 3 months for 2 years, every 4 months during year 3, and every 6 months during years 4-5, with CA-125 measurement at each visit. 1, 2
Surveillance Schedule
Clinical Visits
- Years 1-2: Every 3 months 1, 2
- Year 3: Every 4 months 1, 2
- Years 4-5: Every 6 months 1, 2
- Continue until progression is documented 1
Components of Each Visit
- History and physical examination including pelvic examination at every visit 1, 2
- CA-125 measurement at each follow-up visit, as it can accurately predict tumor relapse 1, 2
Imaging Strategy
CT scans should only be performed when clinically indicated—specifically when there is clinical evidence of disease or rising CA-125 levels, not routinely. 1, 2
When to Order Imaging
- If clinical signs or symptoms suggest recurrence 1
- If CA-125 levels are rising 1, 2
- Not as routine surveillance in asymptomatic patients with normal CA-125 1, 3
Confirming CA-125 Elevation
- If CA-125 rises from a previously normal level, repeat the assay after 2-3 weeks to confirm the increase and calculate doubling time 1
- A confirmed elevation warrants CT scan of abdomen and pelvis as the first investigation 1
Disease Stage-Specific Considerations
Stage I Disease
- Observation with follow-up is recommended for patients with no signs of new disease 1
- Follow the standard surveillance schedule above 2
Stage II-IV Disease
- Same surveillance schedule applies 1, 2
- Imaging should be performed as clinically indicated to screen for new metastases 1
- Patients in complete remission, partial remission, or stable disease after primary therapy should be monitored according to the standard schedule 1
Management of Rising CA-125 or Clinical Suspicion of Recurrence
Platinum-Sensitive Recurrence (>6 months from chemotherapy)
- Offer platinum-based combination chemotherapy (carboplatin + paclitaxel or carboplatin + gemcitabine) 1, 4
- Consider surgical resection if recurrence occurs >1 year from primary surgery 1, 4
Platinum-Resistant Recurrence (<6 months from chemotherapy)
- Consider palliative chemotherapy with pegylated liposomal doxorubicin, gemcitabine, or topotecan 1
Common Pitfalls to Avoid
The most important pitfall is over-imaging asymptomatic patients with normal CA-125 levels. 1, 3 This approach:
- Does not improve survival outcomes 3
- Increases healthcare costs unnecessarily 5
- May cause patient anxiety without therapeutic benefit 3
Do not routinely perform:
- Chest X-rays 5
- CT scans in asymptomatic patients 1, 3
- MRI surveillance 1
- Transvaginal ultrasound (unless monitoring hepatic/splenic metastases) 1
Evidence Quality Note
While there is consensus on the surveillance schedule from multiple European Society for Medical Oncology guidelines 1, 2, the Medical Research Council OVO5/EORTC 55955 trial demonstrated that early detection of recurrence through CA-125 monitoring does not improve survival compared to waiting for symptomatic recurrence 3. Despite this, CA-125 monitoring remains standard practice because it provides prognostic information and allows for treatment planning 1, 2.