When cancer returns after a period of remission/no evidence of disease, it is considered a recurrence. Around 70 percent of patients diagnosed with ovarian cancer will have a recurrence.
Is recurrent ovarian cancer terminal?
A recurrence can be scary, and it’s natural to jump to worst-case scenarios when you hear the words, “Your cancer is back.” If you or a loved one are experiencing a recurrence, it’s important to keep in mind that every person is different. For all their importance, statistics are just that—representations of a wide range of individuals and outcomes.
Data has shown that statistically speaking, recurrent ovarian cancer is treatable, but is rarely completely curable. Researchers have made significant advances in therapies, which means that more people are managing ovarian cancer as a chronic illness for longer periods of time after recurrence. There are some women who have had a recurrence, who then go on to be NED (no evidence of disease). Cancer type, where disease has progressed, and treatment options including clinical trials if applicable, are all physical things to consider. Your approach to a recurrence will depend on a number of factors, all of which should be discussed with your gynecologic oncologist. Treatment side effects and toxicity, quality of life, and your life’s goals should also be considered when planning your strategy for managing an ovarian cancer recurrence.
How likely is it for ovarian cancer to come back?
One of the most significant factors in determining a patient’s risk of recurrence is the stage of the cancer at diagnosis:
- Patients diagnosed in Stage 1 have a 10 percent chance of recurrence.
- Patients diagnosed in Stage 2 have a 30 percent chance of recurrence.
- Patients diagnosed in Stage 3 have a 70 to 90 percent chance of recurrence.
- Patients diagnosed in Stage 4 have a 90 to 95 percent chance of recurrence.
You can find more information on managing ovarian cancer recurrence in videos from our National Conference.
Where does ovarian cancer usually recur?
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.
Treatment for Ovarian Cancer Recurrence
The effectiveness and type of treatment for recurrent ovarian cancer depends on what kind of therapies the patient received in the past, the side effects associated with previous treatments, the extent of the recurrent cancer, how many recurrences the disease has already progressed through, and the length of time since the last treatment was finished. The amount of time between response to a prior treatment and the time of the recurrence is called “time to recurrence,” or “progression-free interval.”
- Most second line therapy for initial recurrence is platinum-based chemotherapy. In these cases, if the time to recurrence is less than six months, the ovarian cancer is typically classified as platinum-resistant, and the patient will be treated with usually one other type of chemotherapy drug. Patients are encouraged to consider participating in a clinical trial that might offer an opportunity to take a new investigational drug that could be helpful.
- If the time to recurrence after platinum-based chemotherapy is more than six months, the ovarian cancer is classified as platinum-sensitive and the patient will be treated with a platinum-based drug again and another chemotherapy agent.
During treatment for recurrence, it is very important to have a continual dialogue with your doctor about the benefits of treatment, with respect to remission and survival, versus the risks of the side effects that hurt the quality of your life. There are several options based on your previous treatments, and setting goals of care with your team will help determine which treatment choices are right for you at each treatment juncture.
There are many new advances in therapy options which can be used to stop the progression of cancer and prolong survival. Chemotherapy and clinical trials that include immunotherapy, antibody drug conjugates, and PARP inhibitors for example, may be utilized as second, third and fourth lines of therapy.
Sometimes, surgery is used to relieve symptoms, such as a blocked bowel caused by the recurrence. In select patients, surgery for debulking of cancer is also an option. HIPEC (hyperthermic intraperitoneal chemotherapy) and new advances such as Cytalux mapping may also be options your physician discusses. It is important to stress again that you, in consultation with your doctor, should set realistic goals for what to expect from treatment. This may mean weighing the possible positive outcomes of a new treatment against the possible negative ones. At some point, a patient may decide that continuing treatment is unlikely to improve health or survival, and is causing more suffering than hope. These decisions can be difficult to make but understanding what the risks and benefits of each therapy offered, how your body is responding to the treatments, and how the cancer is responding, may help provide clarity toward next steps and be comfortable in your decision, whatever it may be.
Seeking a second opinion
Part of getting the best care includes advocating for yourself, and ensuring you are comfortable with the accuracy and the direction of your treatment plan. If you have concerns, feel as if you need to explore more options, or simply would feel better having a second set of experts review your information, you have the right to seek a second opinion. In some cases, it will not be possible to get a second opinion because a treatment decision will need to be made right away, but outside of these situations you should feel free to exercise this option.
Before reaching out, you should check with your insurance provider to review any conditions or requirements. If you are nervous about telling your doctor, don’t worry — doctors are used to patients getting a second opinion and should even be able to help you find another trusted expert to visit. The American Cancer Society has more tips and information on getting as second opinion.
Navigating advances and new treatment options
Advances in research are exciting and promising, and can also be overwhelming. Figuring out which advances may apply to your individual situation is not easy. Don’t be shy about asking your medical team for their thoughts on whether there are new treatments or care options that may be right for you. If you feel your doctor is not on top of the most recent advances, you can research what’s new, and potentially even find clinical trial matches by searching with OCRA’s Clinical Trial Finder, which allows you to use an online search tool or to speak with a person on the phone to help you through the process of finding clinical trial options based on your diagnosis, previous treatments, and current health status..
You can also learn the latest updates in ovarian cancer research, treatment and care at OCRA’s Ovarian Cancer National Conference, which takes place every year. Our conference is virtual, so you can join from anywhere in the world, and watch expert presentations with important information as it fits your own schedule. Learn more about our National Conference.
Strategies for Coping with a Cancer Recurrence
A cancer recurrence can bring about all kinds of emotions, and though you may feel alone, there are people who can relate. There are many ways to reach out and get in touch with others who have faced a gynecologic cancer recurrence, and help you find ways to cope.
- OCRA’s Staying Connected virtual support series offers weekly support to those going through a recurrence. Registration is free, and must be made in advance.
- Find a trained survivor mentor to offer one-on-one emotional support and guidance through OCRA’s Woman to Woman program, offered as a virtual program as well as on-site at select hospitals.
- Connect with thousands of gynecologic cancer patients and survivors through Inspire, our online community forum.