NCCN Guidelines for Patients® | Ovarian Cancer - page 65

Part 7: Recurrence treatment
NCCN Guidelines for Patients
: Ovarian cancer
Version 1.2013
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Clinical trial:
on a test or treatment to
assess its safety or how
well it works
A period of
testing after treatment to
check that treatment worked
Staging procedures:
Procedures during surgery
that are used to find out how
far the cancer has spread
See Part 2 on
page 14 for more
test details and
The chart to the left describes the treatment recommendations for ovarian
cancer that has come back after a complete response or that continued to grow
or spread during initial treatment. Once tests or symptoms signal a relapse, you
may have imaging tests if they weren’t done recently during follow-up. This
may include CT, MRI, PET, or PET-CT of your chest, abdomen, and pelvis.
(See page 14 for details on imaging tests.) The recurrence treatment
recommendations are based on the type of relapse and whether you’ve had
chemotherapy before.
If the cancer relapses and you haven’t had chemotherapy before, then you will
have surgery to remove the cancer, possibly followed by chemotherapy. If it
looks like the cancer hasn’t spread outside the area between your hip bones
(pelvis), then surgical treatment will likely involve staging procedures. If it looks
like the cancer has spread outside the pelvis, then you will have debulking
surgery to remove as much of the cancer as possible. For details, see New
suspected ovarian cancer—staging and surgery on pages 31–33.
If you have a biochemical relapse and you have had chemotherapy before,
then the preferred treatment option is a clinical trial. See page 51 for information
about clinical trials. Another option is to wait and not start treatment until you
have physical signs or symptoms of cancer recurrence. The third option is to
start recurrence treatment right away.
If you have a clinical or radiographic relapse and you have had chemotherapy
before, the treatment options depend on how long it has been since you
completed chemotherapy treatment. Cancer that comes back less than 6
months after completing chemotherapy treatment is called “platinum-resistant.”
This means that the cancer didn’t respond well to the initial treatment with
platinum-based chemotherapy such as cisplatin or carboplatin. Therefore, the
treatment options are a clinical trial, recurrence treatment with a different type
of chemotherapy, or observation with follow-up tests.
CA-125 =
Cancer antigen
CT =
Computed tomography
Magnetic resonance
Positron emission
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