ovarian%20cancer
OVARIAN CANCER
Treatment Guideline Chart
Ovarian cancer is a type of cancer that begins in the ovaries.
It is the 7th most common cancer in women (excluding skin cancer) and the leading cause of death from gynecologic cancer in developed countries.
The 3 histologic types of ovarian cancer are epithelial (primarily seen in women >50 years of age), germ cell (most commonly seen in women <20 years of age) and sex cord stromal (rare and produces steroid hormones).
The median age at the time of diagnosis is 63 years old and >70% present with advanced disease.

    Ovarian%20cancer Management

    Follow Up

    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
    Germ Cell Ovarian Carcinoma
    • 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
    Sex Cord-Stromal Ovarian Carcinoma
    • 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
    Prognosis
    • Patients who progress after 2 consecutive chemotherapy regimens without sustaining a clinical benefit and patients whose disease recurs <6 months have poor prognosis
    1CA-125, beta-human chorionic gonadotropin (β-hCG), alpha-fetoprotein (AFP), inhibin, lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), CA 19-9
    2Chest X-ray, CT scan, MRI, PET-CT, or PET with contrast unless contraindicated

    Observation

    • 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
    Editor's Recommendations
    Special Reports