B-QuiCK: Gynaecological cancers - follow-up and surveillance

B-QuiCK: Gynaecological cancers – follow-up and surveillance

• Follow-up and surveillance of patients who have undergone curative-intent treatment for gynaecological cancer is an opportunity to identify recurrence as early as possible, and therefore optimise outcomes
• The frequency and duration of follow-up is usually individualised based on the type of gynaecological cancer, treatment given, risk of recurrence and the patient’s co-morbidities
  • Patients are usually followed up for two to five years, with more frequent appointments during the first two to three years as this is when the majority of recurrences occur. Some vulval cancers, e.g. HPV-independent vulval squamous cell carcinomas, typically recur later, and patient’s may require long-term, i.e. life-long, surveillance.
• As most recurrences are detected in patients with symptoms outside of scheduled follow-up appointments, educate patients on the symptoms and signs of gynaecological cancer recurrence and advise them to return for examination if any symptoms of recurrence arise in between follow-ups. Emphasise that they should not wait until their next planned appointment.

Follow-up and surveillance recommendations

It is not intended that all aspects of follow-up after treatment for gynaecological cancer are covered in the same appointment. These checks may take place in dedicated follow-up appointments, opportunistically during appointments for other reasons and over time.

• Take a focused patient history to identify any relevant symptoms of recurrence (Table 1)
• Perform a physical examination. This should include:
  • Palpation of relevant lymph nodes
  • Abdominal and pelvic examination, including a speculum examination (looking for any local signs of a lesion, nodule, mass, ulceration or bleeding), bimanual and rectovaginal examination (feeling for any fullness or palpable mass)

• Participation in the National Cervical Screening Programme is no longer required for patients after a hysterectomy for gynaecological cancer unless they had a recent history of abnormal results. Cervical cytology is also not useful after treatment with primary radiotherapy for gynaecological cancer. The oncologist will usually provide guidance on whether cervical cytology (or vaginal vault cytology) is required for a patient, including appropriate testing intervals.
• Imaging and laboratory tests are not usually required unless there is clinical suspicion of recurrence. Routine testing of CA 125 is not required for surveillance as it has not been shown to increase survival.
• Monitor and manage any treatment-related adverse effects. These may include:
  • Fatigue
  • Gastrointestinal-related effects
  • Urinary-related effects
  • Menopausal symptoms
  • Sexual function
  • Lymphoedema
  • Pelvic insufficiency fractures
  • Peripheral neuropathy
  • Changes in cognitive function
• Assess the patient’s mental health and emotional wellbeing
• Reinforce the importance of a healthy lifestyle, e.g. regular physical activity, balanced diet, weight management, smoking cessation and ensure patients have access to support services