Medical News: Group Issues Gyn Cancer Follow-Up Guidance - MedPage Today

For ovarian (epithelial)  cancer, the committee recommended:

• Physical exam and review of symptoms: Every three months for two years, followed by increasing intervals
• Pap test: Not indicated
• CA-125: Optional
• Radiographic imaging: Insufficient data to support routine use
• Suspected recurrence: CT and/or PET, plus CA-125

The recommendations differ for non-epithelial ovarian cancer:

• Physical exam and review of symptoms: Every two to four months for two years, then every six months or annually depending on histology
• Serum tumor markers: Every two to four months for two years, then every six months for sex-cord stromal tumors but no longer indicated for germ-cell tumors
• Radiographic imaging: Generally, not indicated or data lacking to support routine use
• Suspected recurrence: CT and tumor markers

Noting a trend toward transitioning more patients from oncologists to primary care physicians, the committee pointed to evidence that many primary care physicians do not feel comfortable with post-treatment surveillance, particularly during the first two years after treatment. (blogger's note: search blog for past papers on these issues, also the 2 years post treatment is based on old data)


Moreover, a survey of primary care providers showed that respondents believed transition of oncology patients could be improved with individualized patient summaries, guidelines for surveillance, and expedited referral for suspected recurrence, the committee members noted.

"Thus, the provision of up-to-date information and the education of both patients and physicians are mandatory," they wrote.

"Action Points

Point out that this report indicates that there is very little evidence that either routine cytologic procedures or imaging are sufficiently useful to detect ovarian and endometrial cancer recurrence and alter response rates to salvage therapy.

Note that this report suggests that the most effective method to detect recurrences is a taking a thorough history, performing a detailed physical examination, and educating patients about relevant symptoms."