A lady with CA ovary in follow up with raised CA 125 level, Next step :

Ans. is b i.e. PET In a case of treated ovarian cancer - Treatment assessment is done by : Tumor marker CA 125 - It is a reliable indicator of disease response or progression. - If CA 125 levels decreases after treatment - It indicates response to treatment. - If CA 125 levels increase after treatement - It indicates relapse after treatment. - A review of the literature suggests that an elevated Ca 125 level predicts persistent disease at second look surgery in 97% of the cases but CA 125 is not sensitive enough to exclude subclinical disease in many patients. - Follow up in a patients of ovarian cancer is done by physical and pelvic examination along with estimation of CA 125 levels. Patient is advised to visit every 3-4 months for the first 2 years and then 6 monthly for 5 years. Clinical examination and CA 125 together can detect 90% of recurrences. Radiological procedures are not required in all cases. But since here CA 125 is elevated and we have to choose one option - the best is PET as : - CT scan cannot distinguish between a relapsed tumour and fibrosis where as PET scan will exactly demonstrate whether it is a relapsed tumour or a fibrosis. - In a patient treated with chemotherapy or radiotherapy fibrosis is common. It can present as a mass.