Ovarian Cancer Follow Up

Monitoring

Epithelial Ovarian Carcinoma  

Clinical evaluation every 2-4 months x 2 years, then every 3-6 months x 3 years; annually after 5 years is recommended. Monitoring includes physical examination (PE) with a pelvic exam, genetic risk evaluation if not done yet, and CA-125 every visit if elevated initially. As indicated, CBC, chemistry profile, CT scan, MRI, PET-CT, and PET scan may also be requested. Long-term wellness care is also advised.  

Germ Cell Ovarian Carcinoma  

The following are the recommended monitoring for germ cell ovarian carcinoma:

• First year: Every 2 months with tumor markers¹; every 3 months with PE, pelvic ultrasound, chest/abdominal/pelvic CT
• Second year: Every 3 months with PE, tumor markers¹; pelvic ultrasound, chest/abdominal/pelvic CT
• Third year: Every 6 months with PE, tumor markers¹, pelvic ultrasound; every 6 to 12 months with chest/abdominal/pelvic CT
• Fourth and fifth years: Every 6 months radiographic imaging²; every year with PE and tumor markers¹; chest/abdominal/pelvic CT as clinically indicated
• Beyond 5 years: Every year with PE and tumor markers¹ (up to 10 years); radiographic imaging² and chest/abdominal/pelvic CT as clinically indicated

Sex Cord-Stromal Ovarian Carcinoma  

The following are the recommended monitoring for sex cord-stromal ovarian carcinoma:

• PE when clinically indicated based on stage
  • Early stage or low risk: 6-12 months
  • High risk: 4-6 months
• Tumor markers¹ when clinically indicated or if applicable
  • Early stage/low risk: 6-12 months 
  • High risk: 4-6 months
• Radiographic imaging² only in patients with symptoms, elevated biomarkers or suspicious findings in PE

¹CA-125, β-hCG, AFP, inhibin, LDH, CEA, CA 19-9, HE4
²Chest X-ray, CT scan, MRI, PET-CT, or PET with contrast unless contraindicated  

Prognosis

Patients who progress after two consecutive chemotherapy regimens without sustaining a clinical benefit and patients whose disease recurs <6 months have poor prognosis.