Management of asymptomatic patients on follow-up for ovarian cancer with rising CA-125 concentrations

Abstract

In most women who have been treated for ovarian cancer, serum concentrations of the tumour marker cancer antigen (CA)-125 will serially rise on average 4 months before they develop symptoms or signs of relapse. Whether or not early reintroduction of treatment produces a survival advantage is unclear. Although a high chance exists that tumour response can be achieved with chemotherapy, complete cure of these patients is rarely possible. Potential advantages of early treatment of relapse include delaying cancer-related symptoms; psychological reassurance; and, possibly, improved survival. Potential disadvantages include loss of time without treatment and the associated toxic effects. Patients should be counselled on these advantages and disadvantages before deciding whether to have their CA-125 concentrations routinely measured during follow-up. In this review, we make suggestions, on the basis of the extent and duration of response to previous treatment, as to how to manage patients once their CA-125 concentrations start rising. Our suggestions range from close observation if scans are clear to various chemotherapy regimens, hormonal treatment, and surgery. Asymptomatic patients with rising CA-125 concentrations provide an ideal group in which to test new investigational agents that might have potential as maintenance treatment.