Book chapter
Chapter 19 - Monitoring for recurrence: Follow-up care and surveillance
Ovarian Cancer, pp.455-472
Elsevier
2025
DOI: 10.1016/B978-0-443-33536-5.00010-9
Abstract
Ovarian cancer (OC) is associated with a high recurrence rate, and effective surveillance strategies are critical for improving patient outcomes. This chapter provides a comprehensive overview of current methods for detecting recurrent OC, thereby highlighting their advantages and limitations. While physical examination remains the simplest surveillance method, its limited reliability necessitates complementary approaches. Biomarker assays, including cancer antigen (CA)-125, human epididymal protein 4 (HE4), circulating tumor DNA (ctDNA), osteopontin, soluble folate receptor alpha, and paraneoplastic agents, play a significant role in recurrence detection. Cancer antigen 125 (CA125), a widely recognized marker, is elevated in OC patients but does not directly improve overall survival. HE4 offers higher sensitivity and specificity compared to CA125, and their combined use enhances diagnostic accuracy. ctDNA, with its superior sensitivity, has emerged as a promising predictor of recurrence and aids in clinical decision-making. Other biomarkers require further research to establish their utility in routine practice. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans are vital components of surveillance. While CT scans are valuable for treatment planning, their sensitivity and specificity for early recurrence detection are suboptimal. MRI, particularly diffusion-weighted imaging (i.e., DWI-MRI), provides enhanced diagnostic accuracy. PET scans demonstrate the highest sensitivity and specificity among imaging techniques, thus making them highly effective for detecting recurrence. Second-look surgery, historically used for recurrence assessment, lacks evidence for improving survival outcomes and is not routinely recommended. In conclusion, surveillance strategies for recurrent OC should be individualized, thereby balancing the strengths and limitations of each method while incorporating patient preferences. Early detection remains critical for effective disease management and improving patient prognosis.
Details
- Title: Subtitle
- Chapter 19 - Monitoring for recurrence: Follow-up care and surveillance
- Creators
- Avinash Khadela - B.J. Medical CollegeMili Patel - B.J. Medical CollegePooja Patel - B.J. Medical CollegeHitaishee Yagnik - B.J. Medical CollegeManthan Merja - Gujarat Cancer & Research InstituteRushabh Kothari - Gujarat Cancer & Research InstituteMehul R. Chorawala - B.J. Medical CollegeNeha R. Raghani - Kadi Sarva VishwavidyalayaRakesh B. Patel - University of Iowa, Internal Medicine
- Resource Type
- Book chapter
- Publication Details
- Ovarian Cancer, pp.455-472
- DOI
- 10.1016/B978-0-443-33536-5.00010-9
- Publisher
- Elsevier; Amsterdam, Netherlands
- Language
- English
- Date published
- 2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985132075302771
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