NCCN Guidelines for Patients
Ovarian Cancer, Version 1.2017
Follow-up after initial treatment
Genetic counseling is also recommended if it was
not done before treatment. Genetic counseling is
a discussion with a health expert about the risk
for a disease caused by changes in genes. This
is recommended because some health problems,
including ovarian cancer, can run in families. New
targeted therapies may also be available for woman
with certain genetic mutations. Thus, it is important
for you to know if you have any genetic mutations.
(on page 59) shows the options for
ovarian cancer that has come back after prior
treatment. The return of cancer after treatment is
called a recurrence or relapse. The treatment options
are based on the type of relapse and whether or not
you’ve had chemotherapy before.
A biochemical relapse is when CA-125 levels are
increased, but you don’t have any symptoms and
imaging tests show no signs that cancer has come
back. A radiographic relapse is when imaging
tests show signs that the cancer has come back.
A clinical relapse is when you have symptoms that
signal the cancer has come back. Symptoms of
a relapse include pain or bloating in your pelvis
or belly, unexplained weight loss, upset stomach,
constipation, trouble eating or feeling full fast, fatigue,
and needing to urinate often or urgently.
Once follow-up tests or symptoms signal a relapse,
you may have imaging tests if they weren’t done
recently. This may include a CT, MRI, PET, or
PET/CT scan of your chest, abdomen, and pelvis.
If cancer comes back and you haven’t had
chemotherapy yet, then the options are the same
as those used for newly diagnosed ovarian cancer.
This means that you will have surgery to remove the
cancer and chemotherapy may be given next. The
type and extent of surgery depends on how far the
cancer has spread. If it looks like the cancer is only in
your pelvis, then surgical staging may be done.
If it looks like the cancer has spread outside your
pelvis, then you will have surgery to remove as much
cancer as possible.
For a biochemical relapse after prior chemotherapy
(elevated CA-125 tumor marker level but no other
evidence of recurrence), there are some options to
choose from. The preferred option is to join a clinical
trial. A clinical trial is a type of research that studies
how safe and helpful a test or treatment is.
For a clinical or radiographic relapse after
chemotherapy, the options depend on long it’s
been since you finished treatment. If you finished
chemotherapy less than 6 months ago, there are
three options to choose from. The first option is to
receive treatment within a clinical trial. The second
option is to start recurrence treatment. The third
option is to receive best supportive care. Supportive
care is treatment given to relieve the symptoms of
cancer or side effects of cancer treatment. It aims
to improve quality of life and relieve any discomfort
you have. Supportive care may be given alone. It
may also be given along with recurrence treatment or
treatment within a clinical trial.
If you finished chemotherapy at least 6 months ago,
then you may have surgery to remove as much of
the cancer as possible. After surgery, or without
surgery, you still have other options to choose from.
One option is to receive treatment within a clinical
trial. The second option is to receive platinum-based
chemotherapy as recurrence treatment. This is the
preferred option especially for the first recurrence.
The third option is to receive a different type of drug
for recurrence treatment. Best supportive care is also
The second option is to wait and not start treatment
until you have symptoms of a relapse. The third
option is to start recurrence treatment right away,
which may not be chemotherapy. Best supportive
care is also recommended.