- During the first two years, follow-up visits are every three months.
- From the third until and including the fifth year, follow-up visits are every six months.
- After five years, follow-up visits are annual.
- Physical and clinical examinations. Routine testing of CA 125 and possibly other tumor markers is controversial.
- Work-up with imaging or endoscopy is performed as needed.
- Recurrence should be verified histologically or cytologically before new treatment is started.
Follow-up of non-epithelial ovarian cancer
For non-epithelial ovarian cancer, most recurrences are diagnosed within 1-2 years, however granulosa cell tumors may recur later.
- Gynecological examination and measurement of tumor markers (s-AFP, hCG, CA 125)
- For virilizing tumor, s-testosterone is a tumor marker.
Measurement of s-CA125 is normally not used in follow-up. There may be incidental variations of +/- 70 %, without having any significance. Gynecologic Cancer Intergroup (GCIG) has agreed that an increase of at least 100% must be present to define progression. From a normal value there must be an increase of 70 IU or more before the increase is diagnostic.
If there is a positive increase of s-CA 125, but the gynecological examination, chest X-ray, and CT of the abdomen/pelvis do not show sign of recurrence, an MRI or PET scan will confirm a tumor, if present.
It has long been discussed whether treatment of early recurrence based on CA125 gives better survival than treatment started after clinical detection of recurrence. Results from a randomized prospective study (ICON5) have recently been published showing not difference between the groups, and these results may influence follow-up recommendations.