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 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:

• Dysgerminoma
  • First year: Every 2-3 months with physical examination, tumor markers¹; radiographic imaging²; every 3-4 months with abdominal or pelvic CT
  • Second year: Every 3-4 months with physical examination, tumor markers¹; radiographic imaging²; every 6 months with abdominal or pelvic CT 
  • Third, fourth, and fifth years: Every 6 months with physical examination, tumor markers¹; radiographic imaging^2; every year with abdominal or pelvic CT
  • Beyond 5 years: Every year with physical examination, tumor markers¹; radiographic imaging² as clinically indicated
• Non-dysgerminoma
  • First: year: Every 2 months with physical examination, tumor markers¹; radiographic imaging²; every 3-4 months with chest or abdominal or pelvic CT
  • Second year: Every 2 months with physical examination, tumor markers¹; radiographic imaging²; every 4-6 months with chest or abdominal or pelvic CT
  • Third year: Every 4-6 months with physical examination, tumor markers¹; radiographic imaging²; every 6-12 months with abdominal or pelvic CT
  • Fourth and fifth years: Every 6 months with physical examination, tumor markers¹; radiographic imaging²; every 6-12 months with abdominal or pelvic CT
  • Beyond 5 years: Every year with physical examination, tumor markers¹; radiographic imaging² as clinically indicated

Sex Cord-Stromal Ovarian Carcinoma  

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

• Physical examination 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 physical examination

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.