Ovarian Cancer Follow-Up Care: What Happens Next?

Ovarian cancer follow-up care can bring relief, hope, and many new questions. You may wonder how often you will see your doctor, which tests you will need, or how your care team will know if the cancer returns.

In this episode of Teal Talk, we speak with Dr. Gizelka David-West of Northwell Health about what happens after treatment. She explains how doctors use physical exams, symptoms, blood tests, and imaging to monitor each person’s health.

In addition, she discusses CA-125, circulating tumor DNA, and the anxiety that can come with waiting for test results. Most importantly, she reminds survivors that follow-up care should be personal. Your plan should reflect your cancer, your treatment history, and your needs.

This article is for education only. It should not replace medical advice from your care team.

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What does ovarian cancer follow-up care include?

After ovarian cancer treatment, you will continue to see members of your healthcare team. This next phase may be called follow-up care, surveillance, or survivorship care.

However, follow-up care is not the same for everyone.

Your plan may depend on:

• The type and stage of ovarian cancer
• The treatments for ovarian cancer you received
• Whether you are receiving maintenance treatment
• Which tumor markers apply to your cancer
• Your symptoms and overall health
• How much time has passed since treatment

Dr. David-West explained:

“So it again is very personalized and tailored to the patient sitting in front of us.”

Your appointments may include a physical exam, blood tests, imaging, and a review of your symptoms. Your doctor may also check for treatment side effects.

According to the National Cancer Institute’s guide to follow-up medical care, follow-up visits can identify changes in your health and address physical or emotional concerns after treatment.

For example, an exam may include checking your abdomen and pelvis for changes. Bloodwork may include CA-125 or another tumor marker. Your doctor may also recommend a CT scan, MRI, or another imaging test when needed.

In addition, your follow-up plan may also depend on the ovarian cancer treatments you received.

However, follow-up care should look beyond cancer tests.

Ovarian cancer and its treatment can affect many parts of your life. These may include your energy, digestion, sexual health, heart health, and emotional well-being.

For example, your gynecologic oncologist may work with your primary care doctor and other specialists. This team approach can support your overall health and quality of life.

How is CA-125 used after ovarian cancer treatment?

CA-125 is one of the most common blood tests used during ovarian cancer follow-up care.

CA-125 is a protein that can be measured in the blood. Some ovarian cancers cause this number to rise. However, not every ovarian cancer produces a high CA-125 level.

The test may be most useful when your CA-125 was high before treatment and decreased as treatment worked.

The National Cancer Institute’s tumor marker guide explains how CA-125 may be used to monitor treatment and watch for recurrence.

Dr. David-West explained:

“And really just having one data point in time is not enough, right? Having that trend, seeing what’s happening over time really gives you more information. It gives you the bigger picture”

A small change in CA-125 does not always mean that ovarian cancer has returned.

CA-125 levels can move up and down. Infections, inflammation, and other noncancerous conditions may also affect the result. In addition, some ovarian cancers do not cause elevated CA-125 levels.

As a result, your doctor will usually consider more than one number. Your care team may look at:

• Your previous CA-125 results
• How quickly the result is changing
• Whether the change continues
• Your current symptoms
• Findings from your physical exam
• Imaging results

For some people, CA-125 is not a helpful marker. Their doctors may use other blood tests or rely more on symptoms, examinations, and imaging.

It is also important to ask how a rising CA-125 would change your care.

Research has found that starting treatment based only on a rising CA-125, before symptoms appear, does not necessarily help people live longer. It may also lead to earlier treatment and more side effects.

The National Cancer Institute’s review of CA-125 surveillance provides more information about the study behind this finding.

If your care team finds signs of recurrence, visit NOCC’s Ovarian Cancer Recurrence Resource Center.

Which symptoms should you report between appointments?

After ovarian cancer treatment, your body may feel different than it did before your diagnosis.

Surgery, chemotherapy, and other treatments can affect digestion, energy, appetite, urination, and bowel habits.

Therefore, it can help to understand your new baseline. Your baseline is what feels normal for you now.

Dr. David-West suggested:

“Maybe keep a diary, keep a log of what your baseline is, because after treatment, after surgery, you’re going to potentially have a new baseline.”

A symptom diary can help you notice patterns. It can also make it easier to explain a change to your care team.

You may want to record:

• When the symptom started
• How often it happens
• How long it lasts
• Whether it is getting worse
• What makes it better or worse
• How it affects your daily life

Symptoms that may need to be reported include:

• Bloating
• Pelvic or abdominal pain
• Trouble eating
• Feeling full quickly
• Changes in urination
• Changes in bowel habits
• Nausea or vomiting
• Unexplained weight changes
• Unusual bleeding

These symptoms can have many causes. Therefore, they do not always mean that ovarian cancer has returned.

However, you should tell your care team about symptoms that are new, persistent, or getting worse. You do not need to wait until your next scheduled appointment.

What could ctDNA mean for ovarian cancer monitoring?

Another topic discussed in the episode is ctDNA, or circulating tumor DNA.

CtDNA refers to small pieces of DNA released by cancer cells into the blood. A blood test can look for this genetic material.

The National Cancer Institute defines ctDNA as small pieces of DNA released from tumor cells into the bloodstream.

Dr. David-West explained:

“The newest test that we’re encouraging or advocating for is the ctDNA. It’s the circulating tumor DNA. It’s a blood test that will look to see if they can actually see the cancer DNA floating around in your bloodstream.”

In simple terms, ctDNA testing looks for genetic material connected to a person’s cancer.

You may also hear this type of testing called a liquid biopsy. A liquid biopsy uses blood or another body fluid instead of removing a tissue sample from a tumor.

Researchers are studying whether ctDNA may help doctors:

• Monitor how cancer responds to treatment
• Find signs that cancer may remain after treatment
• Estimate the chance of recurrence
• Identify changes before they appear on a scan
• Understand how a cancer changes over time

Early research is promising.

A 2022 study published in Gynecologic Oncology found that ctDNA detected after ovarian cancer surgery, with or without chemotherapy, was strongly linked with a higher risk of recurrence. In that study, ctDNA was a stronger predictor of relapse than CA-125 positivity.

In addition, a 2024 review found that detectable or higher ctDNA was linked with less time before the cancer worsened and shorter overall survival.

However, the studies used different testing methods, timing, and thresholds used to define a positive result. Therefore, researchers still need to learn how ctDNA results should guide treatment decisions.

Researchers are also studying whether ctDNA may identify signs of recurrence before changes appear on a scan or in CA-125 results.

That may sound helpful. However, an early result can also create difficult questions.

Should the test be repeated? Should imaging happen sooner? Would closer monitoring help? Should treatment begin before other signs of recurrence appear?

There is not always one clear answer.

Dr. David-West described the importance of working together:

“It’s shared decision-making, and we collaborate, and we monitor for symptoms, and do closer interval scans. Again, very personalized to who’s sitting in front of us to help guide their journey through a potential recurrence.”

Before having ctDNA testing, ask what the result can and cannot tell you. You should also ask whether the result would change your care now.

How can you manage anxiety before a scan or follow-up visit?

Follow-up visits can bring relief, hope, and worry. Anxiety may begin days before a scan or blood test. It may also grow while you wait for results.
This is sometimes called scan anxiety or scanxiety.

Dr. David-West shared:

“My patients tell me they have the date marked on their calendar, and the days leading up they have the butterflies and the palpitations and just that anxiety, right?”

These feelings are common. A scan, new symptom, or follow-up appointment can bring back fears about recurrence. Feeling worried does not mean that you are not staying positive.

A few simple steps may help:

• Write down your questions before the appointment.
• Ask when and how you will receive your results.
• Bring a trusted person with you.
• Plan a calming activity while you wait.
• Limit online searches that increase fear.
• Try slow breathing, meditation, or gentle movement.
• Talk with a counselor or support group.

It can also help to tell your care team that you feel anxious. They may explain what to expect, answer questions, or connect you with an oncology social worker or counselor.

Ask for more support if anxiety affects your sleep, appetite, work, relationships, or ability to attend appointments.

Dr. David-West offered this reminder:

“And I think that’s the most important message I can drive home, is that there is always something we can do, something we can offer, a way that we can help you.”

Conclusion

Ovarian cancer follow-up care is not one-size-fits-all. Your plan may include physical exams, symptom reviews, blood tests, and imaging based on your health needs. In addition, emerging tools such as ctDNA may provide more information. However, researchers are still learning how these results should guide care.

Most importantly, you do not have to navigate this phase alone. Ask questions, report new or persistent symptoms, and tell your care team when anxiety becomes difficult to manage.

Frequently asked questions about ovarian cancer follow-up care

Ovarian cancer follow-up care can bring new questions about appointments, test results, symptoms, and recurrence. Therefore, these answers can help you prepare for more informed conversations with your healthcare team.