The most effective method for the detection of most gynecologic cancer recurrences is three-pronged: Take a thorough history, perform a thorough examination, and educate the patient about concerning symptoms. This advice is included in the expert recommendations for cancer surveillance recently released by the Society of Gynecologic Oncology in the American Journal of Obstetrics & Gynecology (2011;204:466-478; http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811003176.pdf).
“There is very little evidence that routine cytologic procedures or imaging improves the ability to detect gynecologic cancer recurrence at a stage that will impact cure or response rates to salvage therapy,” wrote the guideline authors.
Although gynecologic cancers account for only 10% of all new cancer cases in women, they also account for 20% of all female cancer survivors. Most recurrences occur within 3 years after primary treatment. After the first 2 to 3 years posttreatment, patients are transitioned back to their primary care providers, who may be unclear on guidelines or surveillance for each specific cancer type.
The new clinical document reviews the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy, and offers recommendations for surveillance of endometrial, ovarian, cervical, vulvar, and vaginal cancers—specifying when various examinations, tests, and imaging should be ordered in the months and years following treatment. The document also includes a checklist for surveillance of gynecologic malignancies.
“The goal of follow-up evaluation for the detection of recurrent disease requires both clinical and cost-effectiveness,” observed the writers of the new set of standards. “Failure to adhere to recommended guidelines results in unnecessary tests, and efforts should be made to provide effective surveillance, which will result in cost-savings.”