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The prolonged study of Ca 125 after chemotherapy may allow to detect relapse of ovarian cancers 6 months to one year before the appearance of clinical symptoms.

Classical clinical history of a patient with ovarian carcinoma. After the initial surgery and the first chemotherapy 6 courses, an apparent complete clinical remission has been induced. The regular watch of Ca-125 shows unexplained small variations up to the time of a regular constant increase which signifies relapse. The patients is treated anew at the time of the appearance of symptoms, but chemotherapy generally induces short remissions and the patient dies from her disease. During the unexplained variations of Ca125, the patient suffers from a great psychological discomfort.

The psychological difficulties which are generated by insignificant Ca125 variations may induce a systematic refusal of biological watch after chemotherapy.

Same clinical history. The patient is treated only at the time of clinical symptoms of relapse. Chemotherapy induces the same short time remission. The patient does not suffer from the psychological discomfort before relapsing but may be shocked not to have 'benefited' of a better biological watch.

When looking to the first curve, it is clear that treating the patient as soon as a small increases of Ca125 appear would bring a return of the marker to the normal values without any clinical significance.

On the other hand, up to now (2005), it is clear that we have no curative treatment after relapse for ovarian carcinoma and that the duration of the total life of the patient (from first surgery) induced by the second chemotherapy is probably not clearly changed if we treat here when the markers increase (we just add toxicity when there is no clinical symptoms of relapse) or when there are clinical symptoms.

In order to know if the Ca125 has a practical value when watching for the relapse, a European study has been set up. The blood samples are taken every three month, but neither the patient nor the physician are informed of the results. From 'Data Centre' in Brussels, in a randomised way, every two patients with increasing markers will be treated ; in the other case, the treatment will be done when clinical symptoms are detected.

The inclusion of a great number of patients in this study, which demands long and open explanations to the patients and families in order to obtain a really well informed consent, should hopefully help us know if the expanses and psychological problems induced by the use of Ca125 watching are useful for our patients.

This kind of reasoning would probably not be good if a curative treatment would be available.