Guideline 75: Epithelial ovarian cancer

Epithelial ovarian cancer
Section 6: Follow up

Absence of symptoms does not indicate absence of disease. Approximately 40% of women with no clinical or ultrasound evidence of disease are found to have disease at second look laparotomy.⁸⁸

The primary aims of regular routine follow up are to provide reassurance and to identify disease recurrence before symptoms occur and performance status deteriorates. The process of attending clinics and awaiting results of investigations generates anxiety.

Four studies assessed different follow up modalities including clinical examination, ultrasound, CA125, and MRI scanning. A confirmed rise in CA125 to more than twice the upper limit of normal accurately predicts relapse with a sensitivity of 86% and a positive predictive value of 95%.^{131,
132} Lead times between two to four months prior to clinical progression were observed. MRI scanning has a 90% sensitivity in detecting recurrence as defined by second look laparotomy.¹³³ In a study looking at follow up of stage I borderline ovarian tumours in a series of 24 recurrences, it was found that ultrasound had a 100% sensitivity in detecting the pathology, CA125 had a 53% sensitivity and physical examination a 26% sensitivity.¹³⁴ Evidence level 3

CA125 measurement and MRI have a role in detecting presymptomatic disease. Standard therapy for relapsed disease is primarily for symptom control. It is unclear whether early treatment for relapse in those who are asymptomatic offers any benefit over waiting until the symptomatic stage. A Medical Research Council and European Organisation for Research and Treatment of Cancer randomised control trial (OVO5) is addressing this issue.

There are no RCTs specific to ovarian cancer that assess whether follow up at a multidisciplinary clinic reduces the risk of death. A descriptive study demonstrates that an independent prognostic factor for improved survival is follow up at a multidisciplinary clinic.¹³⁵ Evidence level 3

Patients who are not in clinical trials should be followed up within local multidisciplinary specialist clinics.

The primary care team should be made aware of the follow up protocol for those patients not in trials.