Review
Oncology
Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations

https://doi.org/10.1016/j.ajog.2011.03.008Get rights and content

Although gynecologic cancers account for only 10% of all new cancer cases in women, these cancers account for 20% of all female cancer survivors. Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow. Therefore, determining the most cost-effective clinical surveillance for detection of recurrence is critical. Unfortunately, there has been a paucity of research in what are the most cost-effective strategies for surveillance once patients have achieved a complete response. Currently, most recommendations are based on retrospective studies and expert opinion. Taking a thorough history, performing a thorough examination, and educating cancer survivors about concerning symptoms is the most effective method for the detection of most gynecologic cancer recurrences. 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. This article will review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy.

Section snippets

Endometrial cancer

Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer in women. Yearly, there are approximately 44,000 new endometrial cancer diagnoses and 8000 deaths in the United States.1 Commonly, patients experience symptoms such as abnormal or postmenopausal bleeding, which warrant further investigation with ultrasound scanning and/or endometrial sampling. The combination of symptoms and diagnostic testing results in 83% of patients being diagnosed in the early stages

Ovarian cancer

Ovarian cancer affects almost 22,000 women each year in the United States and results in >13,000 deaths yearly.1 Although responsible for <30% of all gynecologic malignancies, ovarian cancer accounts for >50% of deaths. These results stem from a lack of accurate screening tools and symptoms that are vague and often not specific, which result in approximately 75% of patients being diagnosed with advanced disease.6 Since the 1970s, the median overall survival of patients with advanced ovarian

Cervical cancer

More than 12,000 women are diagnosed with cervical cancer each year in the United States.1 Patients are diagnosed with stage I disease in 50% of cases, and the 5-year survival rate for this group exceeds 90%.6 However, recurrence rates for this group of patients are high, ranging from 10–20%.68 The treatment of recurrent cervical cancer depends greatly on the primary therapy that is used and the location of recurrence. Patients with locally recurrent disease can be offered salvage treatments

Vulvar cancer

With 3900 new cases and 920 deaths annually in the United States, vulvar cancer is uncommon and represents approximately 4% of malignancies of the female genital tract and 0.6% of all cancers in women.1 Radical local excision of the vulva and inguinofemoral lymphadenectomy has been the standard surgical therapy for nearly 8 decades. More recent advances have included the introduction of preoperative chemoradiation for large primary tumors that involve the urethra, vagina, or anus and the

Vaginal cancer

Primary cancer of the vagina is an uncommon malignancy. With approximately 2300 cases diagnosed annually in the United States, vaginal cancer comprises approximately 3% of all malignant neoplasms of the female genital tract.1 Given the rarity of the disease, there is a paucity of information to guide posttreatment surveillance for patients with vaginal cancer. There are no data to support the routine use of follow-up vaginal cytologic evaluation or imaging in the asymptomatic patient.

Comment

Although gynecologic cancers account for only 10% of all new cancer cases in women, the number of survivors from these malignancies approaches 20%.1, 86 Improvements in cancer care have resulted in almost 10 million cancer survivors, and this number is expected to grow at an even faster rate than ever before.86 Thus, the determination of the most clinically and cost-effective surveillance for the detection of recurrence is critical.

As survivorship increases, transitioning patients from oncology

Acknowledgment

The Society of Gynecologic Oncologists' (SGO) Clinical Practice Committee has developed a series of Clinical Documents that are designed in part to improve the overall quality of women's cancer care, to reduce the use of unnecessary, ineffective, or harmful interventions, and to facilitate the treatment of patients with a goal to maximum the chance of benefit with a minimum risk of harm and at an acceptable cost.

SGO Clinical Documents remain strictly confidential and are not to be disclosed or

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