Playing the waiting game ... the asymptomatic patient with recurrent ovarian cancer detected only by rising Ca125 levels.

The recurrence of ovarian cancer is usually heralded by an increase in the blood level of the tumour marker Ca125 but most oncologists are reluctant to initiate second-line chemotherapy before there is clinical or radiological evidence in addition to the increasing tumour marker. Thus patients have to spend an indefinite period of time, which can be as long as a year or more, knowing that their cancer has returned, but that treatment will be delayed until they have symptoms. For patients, this situation requires a change of outlook and an abandonment of the idea that early treatment is the best option. A dilemma exists for both oncologists and patients over the best time to begin aggressive treatment in this situation. This article explores some of the arguments for and against early treatment, in the hope that it might provide some insight into patients' concerns, and help patients to enjoy their symptom-free and treatment-free period of recurrence with some measure of tranquillity.