Post Treatment Surveillance | Chris O'Brien Lifehouse

Gynaecological Oncology Surveillance

As a result of recent advances in the management of gynaecological cancer women now experience improved quality of life and survival. Despite our best efforts some patients suffer a recurrence of their cancer. Most cancers, if they are going to recur, will do so in the first 2 years after treatment. Sometimes, early treatment of these recurrences may still be curative, often however, this is not the case. Follow up is not just about checking whether your cancer has returned. There are a number of reasons why we offer you the option to return to visit our medical and/or nursing staff that include:

  1. To detect recurrent cancer whilst still potentially curable or treatable
  2. To diagnose and manage treatment or disease related complications or problems such as bladder and bowel problems, lymphoedema and issues related to menopause
  3. To provide well-women health care checks by promoting breast awareness, ensuring mammograms are up to date, and if required bone mineral densitometry is done and encourage healthy lifestyle behaviours in relation to weight and physical activity
  4. To provide reassurance to the patient that they remain in remission and to provide psychosocial support
  5. To provide data for clinical audit and research trials

It is important to remember that the performance of a post-treatment surveillance visit is undertaken when patients have no symptoms. Once symptoms are present the tests performed may be very different.

Low Risk Patients

Patients at low risk for recurrence are offered alternating surveillance with one of our Clinical Nurse Consultants or Nurse Practitioner. Visits are scheduled every 6 months. At that visit you will discuss with the practitioner how you have been since your last visit and any specific symptoms or concerns you might have. The doctor or nurse will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination and sometimes a pap smear of the vaginal vault may be performed. Ultrasounds, X-rays and CT scans are not routinely performed, nor are any blood tests.

Intermediate and High Risk Patients

Patients thought to be of intermediate or high risk for recurrence are seen 3 monthly for 2 years and then 6 monthly to complete 5 years of surveillance. At that visit you will discuss with the doctor how you have been since your last visit and any specific symptoms or concerns you might have. The doctor will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination and sometimes a pap smear of the vaginal vault may be performed. Ultrasounds, X-rays and CT scans are not routinely performed, nor are any blood tests. CA125 levels are not routinely performed but may be appropriate in some patients.

Despite the achievement of a complete clinical response or remission, recurrence rates remain high, occurring in 25% of patients with early-stage disease and 80% of patients with advanced disease. Although patients with recurrent ovarian cancer are rarely cured, patients can have significant responses to salvage treatments. At the completion of treatment, often a CT scan and CA125 are done and when normal indicate remission. Patients are seen on a 3 monthly basis initially and then 6 monthly from year 2 to complete 5 years of surveillance. At that visit you will discuss with the doctor how you have been since your last visit and any specific symptoms or concerns you might have. The doctor will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination. Ultrasounds, X-rays and CT scans are not routinely performed, nor are any blood tests. The decision to continue to monitor your CA125 level after it has become normal has advantages and disadvantages and your doctor will discuss these with you.

In general, the prognosis for women with low malignant potential (LMP) tumors is quite good, and most women (especially those with stage I disease) are at a very low risk of recurrence. Recurrences tend to occur late, and, even in advanced stages, 70% of recurrences will be after 5 years, and 30% will be after 10 years. Many patients with recurrent LMP tumors can be salvaged with additional surgery, and only a very small number, eventually progress to invasive cancers. Patients with borderline ovarian tumours are offered alternating surveillance with one of our Clinical Care Consultants or Nurse Practitioner. Visits are scheduled every 6 months. At that visit you will discuss with the practitioner how you have been since your last visit and any specific symptoms or concerns you might have. The doctor or nurse will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination. Serial pelvic ultrasound is offered at each visit to patients who have undergone fertility sparing surgery.

At the completion of treatment, often a CT scan and cancer blood tests (tumour markers) are done and when normal indicate remission. Patients are seen on a 3 monthly basis initially and then 6 monthly from year 2 to complete 5 years of surveillance. At that visit you will discuss with the doctor how you have been since your last visit and any specific symptoms or concerns you might have. The doctor will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination. Ultrasounds, X-rays and CT scans are not routinely performed. The tumour blood tests are likely to be performed at each visit and these may include one or a combination of the following tests: CA125, ß-hCG, AFP, LDH and Inhibin.

Patients are seen 3 monthly for 2 years and then 6 monthly to complete 5 years of surveillance. At that visit you will discuss with the doctor how you have been since your last visit and any specific symptoms or concerns you might have. The doctor will then enquire about specific things such as any bleeding, discharge, bladder or bowel related changes, changes to you overall general health, weight and appetite. A general examination will be performed including feeling for enlarged lymph nodes. This will be followed by a vaginal pelvic examination and sometimes a pap smear of the vaginal vault may be performed. Ultrasounds, X-rays and CT scans are not routinely performed, nor are any blood tests.

Oral contraceptive pill The use of OCPs is associated with a risk reduction in ovarian cancer of almost 50%, with longer duration of use (>3 years) associated with further reductions in risk, and this risk reduction persists after cessation of the OCP. The cardiovascular risks for women in the general population taking the OCP are well known, however both the breast cancer and cardiovascular risk for women at high risk of ovarian cancer taking the OCP is uncertain. The possible risks need to be balanced against the likely benefits of prescribing the OCP to women to reduce their risk of ovarian cancer.

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