US There is no evidence to support a role for US in initial staging evaluation of ovarian cancer. Transvaginal US is mainly useful for determining the site of origin of a pelvic mass and to characterize the lesion [30]. Variant 2: Extent of disease in suspected or known recurrence of ovarian cancer. Imaging of the chest, abdomen, and pelvis plays a key role in evaluation for recurrence and the extent of disease. Rising CA-125, symptoms, or other clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. If imaging or clinical examination confirms a recurrent tumor, the extent of disease and timing of disease recurrence then determines the choice(s) of treatments, including surgery, chemotherapy, and radiation therapy. The choices for treatment depend upon the time that has passed since chemotherapy was completed. In general, surgical resection of the recurrent tumor is an option when chemotherapy was completed more than 6 months before recurrence and with the option for additional radiation therapy or chemotherapy after surgery. The role for routine surveillance with imaging is unclear in patients considered to be in clinical remission. Imaging has been shown to have limited sensitivity for detection of small tumor deposits in the abdomen and pelvis, with or without monitoring of CA-125 [3,84]. Furthermore, the MRC OV05/EORTC trial did not show a difference in overall survival when patients were treated based on elevated CA-125 versus clinical evidence of recurrence (including imaging findings) [85], despite recognition that CA-125 is generally elevated in cases of recurrence before clinical or imaging signs become evident. The National Comprehensive Cancer Network guidelines for follow-up of primary chemotherapy with complete response include imaging tests as needed, using CT, FDG-PET, FDG-PET/CT, MRI, or chest radiographs [11].
Staging and Follow up of Ovarian Cancer. US There is no evidence to support a role for US in initial staging evaluation of ovarian cancer. Transvaginal US is mainly useful for determining the site of origin of a pelvic mass and to characterize the lesion [30]. Variant 2: Extent of disease in suspected or known recurrence of ovarian cancer. Imaging of the chest, abdomen, and pelvis plays a key role in evaluation for recurrence and the extent of disease. Rising CA-125, symptoms, or other clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. If imaging or clinical examination confirms a recurrent tumor, the extent of disease and timing of disease recurrence then determines the choice(s) of treatments, including surgery, chemotherapy, and radiation therapy. The choices for treatment depend upon the time that has passed since chemotherapy was completed. In general, surgical resection of the recurrent tumor is an option when chemotherapy was completed more than 6 months before recurrence and with the option for additional radiation therapy or chemotherapy after surgery. The role for routine surveillance with imaging is unclear in patients considered to be in clinical remission. Imaging has been shown to have limited sensitivity for detection of small tumor deposits in the abdomen and pelvis, with or without monitoring of CA-125 [3,84]. Furthermore, the MRC OV05/EORTC trial did not show a difference in overall survival when patients were treated based on elevated CA-125 versus clinical evidence of recurrence (including imaging findings) [85], despite recognition that CA-125 is generally elevated in cases of recurrence before clinical or imaging signs become evident. The National Comprehensive Cancer Network guidelines for follow-up of primary chemotherapy with complete response include imaging tests as needed, using CT, FDG-PET, FDG-PET/CT, MRI, or chest radiographs [11].