Once a person has been treated for ovarian cancer, and all traces of the disease have been removed, there is rightful cause for celebration and relief. Still, the possibility of a recurrence is often in the back (or the front) of a patient’s mind.
Dr. Stephanie Wethington, gynecologic oncologist at Johns Hopkins Medicine, joined us in Fall 2020 for our virtual National Conference to talk about ovarian cancer recurrence and answer some frequently-asked questions. In addition to the information below, you can watch both presentations on ovarian cancer recurrence, in full, in our conference video collection.
As always, the information below should not be used as personal medical advice. If you are experiencing or suspect a recurrence, be sure to talk with your medical team.
This is one of the most common questions about ovarian cancer recurrence, and understandably so. In many cases, a patient has had the ovaries, fallopian tubes, and uterus removed—so how could the cancer, which was confined to those parts, possibly return? Unfortunately, this is what makes any cancer so insidious—its ability to metastasize, or spread, even if all the correct protocols are followed. Even if a surgeon removes all the visible tumors and if a patient completes chemotherapy, there may still be cancer cells in the body that will cause the cancer to come back.
If ovarian cancer does recur after surgery, it can present in different ways, either localized to another part of the body, or as a widespread recurrence.
There is no clear-cut way to prevent an ovarian cancer recurrence. No specific diet, vitamin or regimen can be prescribed as a proven method of prevention. However, maintaining good health by eating well and staying as active as possible is always good practice. Do your best to eat a wide variety of foods—lots of fruits and vegetables and lean meats, and limited dairy and red meats. Eating a balanced diet that incorporates a lot of nutrients is important, even more than taking additional vitamins. Exercise, in whatever form works for you, can also promote overall good health, along with having a positive impact on mental health and stress levels.
Every situation is different, but once ovarian cancer recurs, it may be necessary to reframe the cancer as a chronic disease rather than a disease to be cured completely. Together with your medical team, you may work out a plan for ongoing treatment at different intervals, either on a continuous regimen, or with intermittent treatment breaks.
It’s important to remember that treating recurrent ovarian cancer is not a linear path. Often, your gynecologic oncologist may not have a definitive answer to what can feel like basic questions, like, “How many treatment cycles should I plan to have?” That’s because the path forward will depend on how your body responds to treatment, side effects, and more.
Your gynecologic oncologist will consider your cancer type, previous treatment response, medical history, and other factors, and recommend the most effective course of treatment.
Depending on your individual situation, you may pursue standard of care treatment, or you may be a candidate for investigational treatment, through a clinical trial. In addition, surgery, radiation, and systemic therapies (cytotoxic chemotherapy, targeted agents, immunotherapy, hormonal therapy) may all be discussed as treatment options.
Palliative medicine–a subspecialty that focuses on improving quality of life for those managing serious illness–can be invaluable when managing a recurrence. Patients who receive palliative medicine demonstrate less anxiety, fewer symptoms, and can even live longer. The American Society of Clinical Oncology recommends that patients consult with a palliative medicine specialist or have a palliative medicine assessment within the first 8 weeks of recurrence. Be sure to ask your doctor how palliative medicine can help you.
It may feel counterintuitive, but acknowledging that recurrence can be a roller coaster physically and emotionally at the outset can be helpful in preparing yourself for whatever comes your way. There is no perfect predicted model to follow for a recurrence, but there is reason for hope. More people than ever are managing ovarian cancer as a chronic disease, and researchers are making progress toward new and better treatments every day.
Remember that you are not alone, and that there is a community available to help you through the ups and downs. OCRA’s peer support program, Woman to Woman, connects gynecologic cancer patients with trained volunteer mentors, and is available virtually. And, our Staying Connected online support group meets weekly to share experiences and connect with others who can relate.
Watch the video “Managing Ovarian Cancer Recurrence (Q&A Session) for answers to more questions, including:
I’ve been disease-free for a long time–over five years. Is there ever a safe time to stop surveillance for recurrent ovarian cancer?
This is something to be worked out with your medical team. The choice is ultimately up to you, but most doctors would recommend continuing follow-up.
If ovarian cancer becomes platinum-resistant, is it considered platinum-resistant for future recurrence?
Yes. Once a tumor has reached the point of resistance to platinum-based chemotherapy, it will always be platinum-resistant.
Are PARP inhibitors effective when used repeatedly?
This is a million-dollar question for the many patients who have received PARP inhibitors for maintenance therapy, followed by platinum-based chemotherapy for a recurrence. Several studies are underway, investigating whether PARP inhibitors can be effective when used again. Some clinicians have begun to use PARP after PARP, while acknowledging the limitations of our understanding.
Watch now: “Managing Ovarian Cancer Recurrence,” and an additional Q&A session, plus more informational videos originally presented at our 2020 virtual National Conference, are now available in their entirety on our website. View all ovarian cancer videos.