Introduction/Background Upto 80% of advanced ovarian cancer usually recur irrespective of the primary treatment.The main objective was to determine the most common method of detecting first recurrence.

Methodology It was a single institution retrospective study between 2015-June 2023 .210 consecutive epithelial ovarian cancer patients who have documented remission after completing adjuvant chemotherapy and diagnosed with first recurrence were included in the study.

Primary mode of detection was defined as the method which first led to further investigations or start treatment.

Results Most common method of detection was elevated Ca 125 ( 59%) followed by symptoms (21.4%). Imaging was the first mode of detection in 32( 15.2%) cases and physical examination finding in only 9(4.3%) cases.

Out of 210 cases, 14 cases had biochemical recurrence without any symptoms, physical findings and imaging findings. Hence a total 194 cases were analyzed for site of recurrence.

Most common site of recurrence was peritoneum followed by pelvis. When the site of recurrence with method of detection was compared, we found that all cases with pelvic or peritoneal recurrence had raised Ca 125 as the first method to detect recurrence which was statistically significant (p value =0.008 and 0.002 respectively ).

Bloating and pain in the abdomen was the most common symptom and was associated with peritoneal recurrence.

Nodular mass felt in the vault/pelvis was the most common physical finding which was associated with per vaginal bleeding and was found to have pelvic recurrence.

All the patients had an average of 7(1–23) visits to the hospital before being detected with first recurrence.

The mean distance traveled by the patients to reach the hospital was 146 km ( 237–1774).

Conclusion This study suggests that the initial recurrence is most commonly identified through elevated CA 125 levels and symptoms, raising concerns about the effectiveness of existing surveillance practices.

Disclosures Nil.