News Author: Nick Mulcahy
CME Author: Laurie Barclay, MD
Authors and Disclosures
CME Released: 06/07/2011; Valid for credit through 06/07/2012
June 7, 2011 — For the first time, the Society of Gynecologic Oncology (SGO) has issued expert recommendations for gynecologic cancer surveillance. The document was published in the June issue of the American Journal of Obstetrics & Gynecology.
The guidelines were created with primary care providers — internists, family practitioners, and gynecologists — especially in mind, said the lead study author, Ritu Salani, MD, MBA, assistant professor, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus.
“This is for patients who completed treatment and are returning to their primary care provider,” she told Medscape Medical News.
The guidelines, which review the most recent data on surveillance for gynecologic cancer recurrence in women who have had a complete response to therapy, hold some potentially practice-changing surprises, said Dr Salani.
“Before reviewing the literature, I was not aware of the low efficacy of Pap tests for gynecologic cancer surveillance,” she said, offering an example of a potentially practice-changing insight in the new guidelines.
Papanicolaou (PAP) tests have “very low rates” of detection of recurrent disease for endometrial and cervical cancer but are “commonly” performed in these patients, said Dr Salani. The tests are also “unnecessarily” performed in ovarian cancer.
In the new guidelines, Pap tests are not indicated for surveillance in endometrial, cervical, or ovarian cancer patients. “I think that’s going to be a practice change for a lot of physicians,” she said.
What are recommended as surveillance techniques and monitoring intervals for endometrial, ovarian, nonepithelial ovarian, cervical, vulvar, and vaginal cancers?
For the most part, the recommended surveillance for all of the gynecologic cancers consists of a detailed review of symptoms and physical examination at office visits, the intervals of which vary depending on the cancer and years of survival. This method “results in the detection of most recurrences,” write Dr Salani and her colleagues.