Women who have been treated for ovarian cancer who have a recurrence are considered to have cancer that falls into one of three categories: persistent, refractory or recurrent.
Persistent cancer persists after surgery and first-line chemotherapy. In refractory cancer, the cancer continues to progress despite receiving treatment. In recurrent cancer, the cancer went into remission for months or even years but then recurred.
Many women do not become diagnosed with ovarian cancer in the early stages because the symptoms are not clear cut.
Recovery rates are lower when the ovarian cancer is diagnosed in the later stages.
“Despite recent improvements, initial or first-line chemotherapy fails to produce a remission in more than 70% of patients with ovarian cancer. Furthermore, approximately 40-50% of the women who do achieve a remission after first-line chemotherapy will experience a recurrence of cancer within 3 years,” according to Texas Oncology.
How is recurrence diagnosed?
Some women have a return of symptoms that are similar to the ones they originally had, such as abdominal bloating or back pain. Others do not develop symptoms. Recurrence of ovarian cancer is detected by using a number of tests.
CA-125 is a blood test for a biomarker that shows elevated levels of a glycoprotein associated with tumor growth. These levels will be checked.
Elevation may be due to other causes, so the CA-125 blood test is not alone diagnostic for ovarian cancer.
Abnormal X-rays, PET or CT scans, as well as a biopsy from a second-look laparotomy may be performed.
Treatment options
Treatment is individually planned, depending on which of the type of ovarian cancer the woman has. There are other determinants as well.
What stage was the cancer in? Was there a remission and for how many months? What type of chemotherapy or surgery has already been performed? In what location have the ovarian cancer cells reappeared?
In addition, it is often suggested that woman consider joining a clinical trial that is testing newer therapies to treat cancer.
Persistent ovarian cancer
If the ovarian cancer is considered persistent, further surgery to debulk more of the cancer may be attempted first. A decision will be made to either continue with the current chemotherapy the woman is taking, or a second-line chemotherapy will be used instead.(1)
Recurrent ovarian cancer
If the ovarian cancer is recurrent, then the length of time there was a remission is considered as well as what chemotherapy drug the woman originally had for first-line treatment.
Through the use of second-line chemotherapy, also called salvage chemotherapy, and/or use of drugs from a clinical trial may help prolong her life.
If the ovarian cancer returns in less than six months, the woman’s prognosis may be poor if she has already had the two of the most common treatments — taxane and platinum chemotherapy — and did not respond to them.(1)
If the ovarian cancer returns after six months of remission, the woman can have more surgery to debulk the tumor, receive radiation therapy and have platinum and taxane chemotherapy if she did not have them before. Texas Oncology states that they have a good chance of improving with the use of these drugs.
Otherwise there are a number of other second-line chemotherapy drugs that can be tried and found in studies to bring on a remission such as: Doxil®, Gemzar®, Hycamtin® or etoposide.(1)
In addition to the data gained from clinical trials, there has been progress using monoclonal antibodies, which bind to cancer cells and stimulate the immune system to attack and kill the cells.
High-dose chemotherapy, along with the use of stem cells that boost the body’s amount of red blood cells, can also be tried.
Proleukin® therapy, given in the abdominal cavity, or Nolvadex®, a hormonal blocking pill, have also been tried to treat ovarian cancer as well as other combination therapies.
Read through this oncology ovarian cancer page to learn more about these various treatments.
Support
The average duration of survival after a recurrence of ovarian cancer is about 12 to 18 months, according to Texas Oncology.
This means that building a strong support system to maintain the highest quality of life possible, along with attempting to prolong one’s life, become the main goals.
Below are some links to ovarian cancer support resources.
Ovarian Cancer National Alliance
National Ovarian Cancer Coalition
Johns Hopkins Ovarian Cancer Community
Michele is an R.N. freelance writer with a special interest in women’s health care and quality of care issues.
Edited by Jody Smith