Ovarian Cancer

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Ovarian Cancer – How You’ll Be Monitored

Dr. Jonathan Berek Stanford Medicine

So now that you’ve had an initial round of surgery and chemotherapy for ovarian cancer, what’s next?

Maintaining” her health and fitness following treatment — as well as monitoring carefully for the cancer’s return —  is a serious, lifelong commitment for any woman with ovarian cancer. That’s especially true because ovarian cancers, once treated and put into remission, can often come back.

It is essential that women who’ve been treated for ovarian cancer keep in consistent and involved contact with their doctors to ensure that should the cancer return, it is treated immediately. Doctors will use a number of different methods to monitor their patients and detect if the cancer is growing again. Dr. Jonathon Berek, Director of Stanford Women’s Cancer Center, told SurvivorNet about the methods used by doctors to monitor ovarian cancer.

According to Dr. Berek, there are three primary factors of which doctors keep track to detect a recurrence of ovarian cancer. These are:

  1. A Physical Exam – Routine tactile exams of your abdomen and pelvis will help determine whether any solid tumors have developed in the ovaries or fallopian tubes since treatment.
  2. A CA 125 Test – This test measures levels of a protein called CA-125 (Cancer Antigen 125) in your body. CA-125 is a protein that ovarian cancer cells express on their surface, but not all women with ovarian cancer show elevated levels of the protein, according to Dr. Berek. “It’s a non-specific test,” he says. “It doesn’t just pick up ovarian and fallopian tube cancer. It actually is a substance that circulates in the bloodstream and can be elevated in many other malignant and benign conditions.” But 80-90% of women with common types of ovarian cancer show elevated CA-125 levels in their bloodstream, according to Dr. Berek. He says, “What you hope is that by the time you complete several cycles of chemotherapy and surgery, that the CA-125 has returned to a normal level.” So, physicians run tests to see if the levels change following treatment.
  3. A Body Scan (CT or CT-PET) – These imaging tests are used to detect tumors in the ovaries and fallopian tubes. They may be initially conducted every 6-12 months, but become less frequent as time goes on. A CT scan looks for tumors in the uterus, ovary or abdomen. To perform a CT scan, an IV is required to administer contrast dye for the patient. Contrast dye helps to differentiate between types of tissue. The entire process of performing a CT scan takes only a few minutes. The patient is asked to lie down in a device that looks like a donut. The table on which the patient lies down on for the procedure will move in and out of the “donut hole” as the CT scan progresses. The contrast dye will help determine what tissue is receiving blood flow versus what tissue is not.

If these tests to monitor ovarian cancer show no signs of anything out of the ordinary, then Dr. Berek says doctors will just conduct routine follow-ups with the patient until something comes up. “If a patient remains in clinical remission, if there’s no evidence of disease, if there’s no evidence of elevation of CA-125 or any abnormality on the follow-up scan, then you just follow them,” says Dr. Berek. This doesn’t mean that you stop seeing your doctor. Routine follow-up care even after imaging tests and physical exams provide no substantial evidence of cancer is still key to maintaining good health. This type of active monitoring is key to making sure ovarian cancer stays in remission for as long as possible following rounds of treatment, and that it’s tackled quickly and accurately if it comes back. For example, patients usually return every 3 months for the first 2 years followed by every 6 months until the 5th year.

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Dr. Jonathan Berek is the Director of Stanford Women's Cancer Center. Read More

Maintenance for Ovarian Cancer Patients

After initial surgery and chemotherapy, the maintenance period begins for women with ovarian cancer. Maintenance treatment seeks to prevent the cancer from recurring for as long as possible, and can be anything from rigorous surveillance to use of PARP inhibitors.