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OVARIAN CANCER
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.

    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, chest x-ray
    • 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 5 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 x-ray and abdominal/pelvic CT
      • 2nd year: Every 2 months with PE, tumor markers1; radiographic imaging2; every 4-6 months with chest x-ray and abdominal/pelvic CT
      • 3rd, 4th and 5 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
    • Radiographic imaging2 only in patients with symptoms, elevated biomarkers or suspicious findings in PE
    1CA-125, beta-human chorionic gonadotropin (β-hCG), alpha-fetoprotein (AFP), inhibin, lactate dehydrogenase (LDH), carcinoembryonicantigen (CEA), CA 19-9
    2Chest X-ray, CT scan, MRI, PET-CT, or PET with contrast unless contraindicated
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