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60

NCCN Guidelines for Patients

®

:

Ovarian Cancer, Version 1.2017

5

Treatment guide

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.

Guide 11

(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.

Treatment options

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

recommended.

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.