The follow-up of ovarian cancer.
Few formal guidelines exist regarding the surveillance of patients with epithelial ovarian cancer. The objective of follow-up in patients who have already been treated with primary cytoreductive surgery and first-line chemotherapy is not clear, as recurrent ovarian cancer continues to be a therapeutic dilemma. The vast majority of women with relapses will eventually succumb to their disease. The primary goal of salvage therapy therefore is to maximize disease-free survival and quality of life. Unfortunately, it is not clear whether early detection of recurrent disease is beneficial. Routine physical examinations, testing with serum markers, such as CA-125, radiologic imaging, and second-look surgery have all been employed for the detection of recurrent disease. Evaluation of the efficacy of such post-treatment surveillance methods must look at the sensitivity and specificity of each. Most of the noninvasive techniques have been compared with second-look surgery, which provides the most accurate assessment of disease recurrence available to date. A lack of randomized prospective studies directly evaluating the therapeutic benefits of a second-look procedure restricts its role to research protocols. It is difficult to justify an aggressive approach to follow-up of the asymptomatic patient given the lack of sensitivity of available diagnostic methods and the limitations of current second-line chemotherapy regimens.
Vaidya
Ami P
AP
Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY 10016, USA.
Curtin
John P
JP
D014408:Biomarkers, Tumor / Q000097:blood; D003266:Continuity of Patient Care / Q000592:standards*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D024162:Second-Look Surgery
D014408:Biomarkers, Tumor