Follow-up of women after gynecological cancer treatment

Silva Filho, Agnaldo Lopes da; Praça, Mariana Seabra Leite; Pinhati, Matheus Eduardo Soares; Castro, Laura Guimarães; Moretti-Marques, Renato; Nogueira-Rodrigues, Angélica; Cândido, Eduardo Batista

doi:10.61622/rbgo/2025FPS3

person Agnaldo Lopes da Silva Filho

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0003-2527-3729

person Mariana Seabra Leite Praça

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0002-9249-0312

person Matheus Eduardo Soares Pinhati

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0003-1014-1555

person Laura Guimarães Castro

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0002-8695-0669

person Renato Moretti-Marques

school Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

0000-0003-3049-7727

person Angélica Nogueira-Rodrigues

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0002-3901-3832

person Eduardo Batista Cândido

school Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0002-5261-5563

Conflicts of interest:

none to declare.

National Specialized Commission on Gynecological Oncology of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO)

President:

Eduardo Batista Candido

Vice-president:

Renato Moretti Marques

Secretary: Sophie Françoise Mauricette Derchain

Members:

José Carlos de Jesus Conceição

Walquiria Quida Salles Pereira Primo

Suzana Arenhart Pessini

Jesus Paula Carvalho

Caetano da Silva Cardial

Delzio Salgado Bicalho

Etelvino de Souza Trindade

Geórgia Fontes Cintra

Marcia Luiza Appel Binda

Ricardo dos Reis

Filomena Marino Carvalho

Leandro Santos de Araújo Resende

Mariana Seabra Leite Praça

Guideline	NCCN	ESMO
Examination and review of symptoms	Every 3-6 months for 2 or 3 years, then every 6 months until the 5^th year. Annually thereafter.	Low risk: every 6 months (consider telephone contact) for 2 years. Annually thereafter. High risk: every 3 months for 3 years, then every 6 months until the 5^th year. Annually thereafter.
CT scan of abdomen and pelvis	Only in cases of advanced disease at diagnosis, every 6 months for the first 3 years, every 6-12 months for an additional 2 years.	Only in the high-risk group every 6 months for the first 3 years, then individually thereafter.
Other imaging tests*	Only if there is clinical suspicion of recurrence.	Only if there is clinical suspicion of recurrence.
CA-125	Not recommended for routine use.	Not recommended for routine use.
Oncotic cytology	Not recommended for routine use.	Not recommended for routine use.

Time since completion of primary therapy	Up to 2^nd year	3^rd year	4^th and 5^th year	After 5^th year
Examination and review of symptoms	Every 3-4 months	Every 4-6 months	Every 6 months	Annually
CA-125^a	Every 3-4 months	Every 4-6 months	Every 6 months	Annually
Imaging tests^b	Not recommended for routine use
Suspected recurrence or metastasis	Abdominal/pelvic MRI or PET-CT ± CA-125

Time since completion of primary therapy	Up to 5^th year	After 5^th year
Examination and review of symptoms	3-12 months	Annually
Ultrasound	Patients who have preserved fertility	Only if clinically suspected
Imaging tests*	Only if clinically suspected	Only if clinically suspected
CA-125 or other markers	Recommended if elevated before treatment	Recommended if elevated before treatment
Cytology	Not recommended	Not recommended

Time since completion of primary therapy	1^st year	2^nd year	3^rd year	4^th and 5^th years	After 5^th year
Dysgerminomas
Physical examination and analysis of tumor markers	Every 2-3 months	Every 3-4 months	Every 6 months	Every 6 months	Annually
Imaging tests*	Every 3-4 months	Every 6 months	Annually	Annually	Only if clinically suspected
Non-dysgerminomas
Physical examination and analysis of tumor markers	Every 2 months	Every 2 months	Every 4-6 months	Every 6 months	Annually
Imaging tests^**	Every 3-4 months	Every 4-6 months	Every 6-12 months	Every 6-12 months	Only if clinically suspected

Time since completion of primary therapy	Up to 2^nd year	After 2 years
Physical examination	Only if clinically suspected, with frequency based on disease staging: Early stage/low-risk disease: every 6-12 months High-risk disease: every 4-6 months	Only if clinically suspected, with frequency based on disease staging: Early stage/low-risk disease: every 6-12 months High-risk disease: every 4-6 months
Analysis of tumor markers inhibin B and AMH	Only if clinically suspected and if applicable, with frequency based on disease staging: Early stage/low-risk disease: every 6-12 months High-risk disease: every 4-6 months	Only if clinically suspected and if applicable, with frequency based on disease staging: Early stage/low-risk disease: every 6-12 months High-risk disease: every 4-6 months
Imaging tests*	Reserved for patients with symptoms, elevated biomarkers, or suspicious findings on physical examination	Reserved for patients with symptoms, elevated biomarkers, or suspicious findings on physical examination

Time since completion of primary therapy	Up to 2^nd year	From 3º ao 5º year	After 5^th year
Examination and review of symptoms
Low risk	Every 6-12 months	Annually^*	Annually^*
High risk^**	Every 3 months	Every 6 months	Annually^*
Cytological examination	Annually^***
Imaging tests^****
Stage I
Without fertility preservation	Only if there is clinical suspicion of recurrence.^*** For patients with FIGO stage IB3 or who required postoperative adjuvant radiotherapy or chemoradiotherapy due to high-risk factors,^** PET-CT of the neck/chest/abdomen/pelvis/inguinal region may be performed 3-6 months after completion of treatment.^******
With fertility preservation	Contrast-enhanced MRI of the pelvis 6 months after surgery and then annually for 2-3 years. Other imaging tests only if there is clinical suspicion of recurrence.^*****
Stage II-IV	PET-CT of the neck/chest/abdomen/pelvis/inguinal region (preferred) or contrast-enhanced CT of the chest/abdomen/pelvis within 3-6 months after completion of treatment. ^****** Contrast-enhanced MRI of the pelvis within 3-6 months after completion of therapy. Other imaging tests only if there is clinical suspicion of recurrence.^*****
Stage IVB or recurrence	CT, MRI, or PET-CT to assess response or determine additional treatment.
Suspected recurrence or metastasis	PET-CT of the neck/chest/abdomen/pelvis/inguinal. Consider MRI of the pelvis.

Time after primary treatment	1^st year	2^nd year	From 3^rd to 5^th year	After 5^th year
Low risk	Every 6 months	Every 6-12 months	Annually^*	Annually^*
High risk^**	Every 3 months	Every 3 months	Every 6 months	Annually^*
Pap smear/cytology test	Annually^***
Imaging tests^****	Insufficient evidence for routine use
Suspected recurrence	CT or PET-CT

	Endometrial cancer	High-grade and low-grade serous ovarian tumors and borderline tumors	Germ cell ovarian tumors	Stromal ovarian tumors
Examination and review of symptoms
Imaging tests			CT
Tumor markers^a	CA-125	CA-125	AFP Estrogen hCG LDH	AMH Estrogen Testosterone
Patient cytology

[TFN1] *Imaging tests (chest X-ray, chest CT, abdominal/pelvic MRI, and PET-CT) should be considered in selected patients, as clinically indicated. NCCN: National Comprehensive Cancer Network; ESMO: European Society for Medical Oncology; CT: computed tomography; MRI: magnetic resonance imaging; PET-CT: positron emission tomography-computed tomography Source: Adapted from Salani et al. (2017)⁽⁵⁾ and National Comprehensive Cancer Network.⁽¹⁰⁾