Rethinking Epithelial Ovarian Cancer Surveillance Protocols

Background: This study aims to identify the main method of recurrence detection, site of recurrence, and three- and five-year disease-free survival (DFS) rates of ovarian cancer while considering the financial burden on the patient and family. Methods: Two hundred and ten consecutive epithelial ovarian cancer cases from the hospital-based cancer registry between January 2015 and June 2023, in which patients had documented remission after completing primary treatment and were diagnosed with first recurrence, were included in the study. These four modes of detection of recurrence were considered: symptoms (abdominal pain, bloating, abdominal distention, etc.), physical findings, raised tumor marker (CA-125), and imaging. Results: This study found that raised CA-125 is the primary detection method in 59% of cases, followed by symptoms (21.4%). Imaging identifies recurrence first in 15.2% of cases and physical examination in 4.3%. Observed patterns suggest an association between the site of recurrence - particularly the pelvis and abdominopelvic peritoneum - and the method by which recurrence was first detected. Physical exams are most effective for pelvic recurrences (72.8%), while symptoms and CA-125 levels are higher for abdominopelvic peritoneal recurrences (72.7% and 68.8%, respectively). Patients have a median of six hospital visits, travel a median distance of 70 km for each visit, incur direct costs of ₹9000, and have a median DFS of 18 months. Conclusion: The study highlights elevated CA-125 and symptoms as primary recurrence indicators, questioning physical exam efficacy, and stresses the financial and emotional burden of frequent hospital visits.