Follow-up is generally performed every three months for the first two years after treatment.
• The neck, lungs, abdomen and pelvis are carefully examined at each visit.
• The serum CA-125 level is followed closely and is sometimes the first indication of recurrent cancer.
• Abdominal and pelvic CT or MRI scans may be done, but their routine use has not been shown to be effective
in the absence of symptoms.
Second-Look Surgery If after six cycles of chemotherapy there is no evidence of progressive disease—as determined by physical examination, the serum CA-125 level and pelvic and abdominal CT scans—then second-look exploratory abdominal surgery may be performed. Although it is sometimes considered the standard of care, there has been no proven survival benefit of this procedure. It is, however, the most reliable way of determining whether any cancer is left after treatment. Any residual cancer can also be removed.
If no cancer is found during the second-look operation, a thorough procedure requires taking peritoneal washings and biopsies from any adhesions or 20 to 30 random biopsies. These include the surfaces of the bladder, pelvis, pelvic sidewalls, diaphragm and the pelvic and aortic lymph nodes if not sampled previously. If any of the omentum is still present, it is also removed. An appendectomy is usually done as well. Traditionally, if the second-look operation and microscopic examination of all the biopsies reveal no cancer, no further treatment is required.
