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Ovarian Cancer: Follow-up Monitoring

Is Treatment Working? Is It Gone? Is It Back?

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Updated April 15, 2008

After treatment is completed, if the CA-125 blood test is still elevated it means that there is a high chance that you still have cancer cells in your body. Unfortunately, if it is normal, there is still a 50/50 chance that you still have cancer left behind that was resistant to treatment. Computerized Tomography (C.T.) and/or Positron Emission Tomography (P.E.T.) scans can be performed to help determine if you are cancer free. These are two radiology tests which look at whether or not anatomy is abnormal or if there are radioactive hot spots that might suggest cancer is still present.

Second Look Surgery

In the past, or currently in some cases if you are on a research trial, we used to perform a “second look” surgery on virtually all patients to see if the cancer was gone. However, we found out that performing this surgery caused complications (a definite risk), including serious ones, but did not result in patients living any longer(no benefit), no matter what was found.

If the cancer is still there, while additional treatment is an option, it does not result in cure in the overwhelming majority of patients. On the other hand, those who have all of their biopsies at second look return negative, still have a 50/50 chance of the cancer coming back sooner or later. In a very small subset of patients, literally one out of a 100 or less, in whom only a few microscopic nests of cancer are found, additional chemotherapy might result in a cure or long-term remission.

In approximately 99% of patients, a second look operation does not produce any real benefit, but comes with significant surgical risks. It has been abandoned in the vast majority of cases, but is still an occasional option to consider, especially if you have young children and desire the best possible indicator for life planning. A fairly accurate second look surgery can be done via minimally invasive laparoscopy, and, although not quite as accurate as a laparotomy (big incision surgery), may be a better risk/benefit choice for you.

Source:

National Institutes of Health Consensus Development Conference Statement. Ovarian Cancer: screening, treatment, and follow-up. Gynecol Oncol 2002;84:399-403.

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