Ovarian%20cancer Management

Epithelial Ovarian Carcinoma

• Clinical evaluation every 2-4 months x 2 years, then every 3-6 months x 3 years; annually after 5 years
• Monitoring includes:
  • PE with pelvic exam
  • Genetic risk evaluation if not done yet
  • If elevated initially, CA-125 every visit
  • As indicated: CBC, chemistry profile, CT scan, MRI, PET-CT, PET scan
• Long-term wellness care

• Dysgerminoma
  • 1st year: Every 2-3 months with PE, tumor markers¹; radiographic imaging²; every 3-4 months with abdominal/pelvic CT
  • 2nd year: Every 3-4 months with PE, tumor markers¹; radiographic imaging²; every 6 months with abdominal/pelvic CT
  • 3rd, 4th and 5th years: Every 6 months with PE, tumor markers¹; radiographic imaging²; every year with abdominal/pelvic CT
  • Beyond 5 years: Every year with PE, tumor markers¹; radiographic imaging²; abdominal/pelvic CT when clinically indicated
• Non-dysgerminoma
  • 1st year: Every 2 months with PE, tumor markers¹; radiographic imaging²; every 3-4 months with chest/abdominal/pelvic CT
  • 2nd year: Every 2 months with PE, tumor markers¹; radiographic imaging²; every 4-6 months with chest/abdominal/pelvic CT
  • 3rd, 4th and 5th years: Every 4-6 months with PE, tumor markers¹; radiographic imaging²; every 6-12 months with abdominal/pelvic CT
  • Beyond 5 years: Every year with PE, tumor markers¹; radiographic imaging²; abdominal/pelvic CT when clinically indicated

• PE when clinically indicated based on stage
  • Early stage/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

• Patients who progress after 2 consecutive chemotherapy regimens without sustaining a clinical benefit and patients whose disease recurs <6 months have poor prognosis

• Postoperative observation is an option for patients with confirmed stage IA/B disease
• Studies have shown that select patients with stage I ovarian cancer have >90% survival with surgical treatment alone and there are no proven clinical benefit from adjuvant chemotherapy for those who have had complete surgical staging for low-risk disease in certain cancer types
• Should only be considered in patients who have had resection of all disease and complete surgical staging to rule out the possibility of clinically occult disease that would result in upstaging
• May be an option for those with less common epithelial cancer types (eg mucinous, clear cell, grade 1 endometrioid, low-grade serous) wherein adjuvant systemic therapy has shown no benefit
• May be a maintenance option for patients with stage II disease without Bevacizumab during primary treatment and with germline or somatic BRCA1/2 mutation or wild-type or unknown mutation with complete response