After you’ve gone through ovarian cancer treatment, your doctor will work with you to make sure you stay well. But sometimes the cancer returns. Doctors call this “recurrence.”
To check for any recurrence, you’ll have follow-up visits with your cancer doctor (oncologist) every few months initially and then the timing will increase between visits. It’s also important for you to tell your doctor about any unusual changes you notice about your body -- don’t wait for your next appointment.
Though ovarian cancer could come back anywhere in your body and cause a wide variety of noticeable problems, it most commonly recurs close to the original cancer in your abdomen, where typical symptoms include:
You may also get imaging done with X-rays, a CT scan, or a PET scan if something seems amiss. Your medical team will probably also test your blood for levels of certain substances that could suggest a tumor, like:
- CA-125: A protein in the blood that can help check for signs recurrence of epithelial tumors (cells from the outer surface of ovaries). Most ovarian cancers are epithelial cell tumors.
- Alpha-fetoprotein (AFP) or human chorionic gonadotropin (HCG): Your doctor would check for this if your ovarian cancer involved germ cell tumors. Germ cells make your eggs.
- Hormone levels of estrogen, testosterone, and inhibin: You may get these levels checked if your ovarian cancer involved stromal tumors (connective tissue cells).
Risk of Recurrence
Your risk of recurrence after your first treatment for ovarian cancer depends on many factors. You might have stretches of time when you’re cancer-free (remission) that alternate with periods of new cancer growth (recurrence). More women are living with this cancer for a longer period of time than ever before. This is partly due to new and better treatments that extend life for those with ovarian cancer. The risk of recurrence varies widely, depending in large part on the “stage” of your cancer before treatment.
Stages for ovarian cancer run from I to IV (1 to 4), with IV being the most serious and most likely to recur. To determine the stage of your cancer, doctors use a number of factors, including the size and location of the cancer and how far it has traveled from where it started. The stage affects the possibility your cancer will return.
- Stage I: 10% chance of recurrence
- Stage II: 30% chance of recurrence
- Stage III: 70% to 90% chance of recurrence
- Stage IV: 90% to 95% chance of recurrence
Treatment
The start of chemotherapy for ovarian cancer usually means a combination of a “platinum” drug and another type of chemo called a “taxane.” You get it through a needle in a vein every 3 or 4 weeks.
Your medical team will use information about your response to this therapy to help plan an approach to your new recurrent ovarian cancer. They base this on a number of things:
- Extent and location of new (recurrent) cancer
- Time since last chemotherapy treatment finished
- Effectiveness and type of past chemotherapy
- Side effects of past treatment
The “time to recurrence” is the time between the end of your platinum-based chemotherapy and when your cancer returns.
If your time to recurrence is more than 6 months, doctors call your cancer “platinum-sensitive.” In this case, your doctor will use platinum-based drugs again and might also add another chemotherapy agent.
If your time to recurrence is less than 6 months, doctors call your cancer “platinum-resistant” and use different chemotherapy drugs. They also might suggest you consider joining a clinical trial to explore new medicines that could help. Your doctor should be able to help you look for clinical trials and tell you what’s involved and what to expect.
Prevention
The most important thing you can do to prevent any recurrence from getting out of hand is go to your regular scheduled follow-up visits. Early detection is key. Your team will check you for signs of new growth and monitor the effects of any ongoing treatment.
Cancer can affect anyone and often without any rhyme or reason. Healthy diet and regular exercise can help boost your immune system and prevent new health problems, but, there’s not much you can do to prevent the recurrence of your disease. However, careful monitoring with your cancer health care team will help catch new growth quickly so you can treat it as early as possible.
Talk to your medical team right away if you notice possible symptoms of recurrence like belly pain, bloating, nausea, vomiting, pain during sex, or problems going to the bathroom. Just keep in mind that in many cases, you might not notice any new symptoms of a recurrence of ovarian cancer.
Outlook
Your medical team can use chemotherapy and other treatments to slow cancer growth and control symptoms, but recurrent ovarian cancer is rarely curable.
In addition, the treatment itself can be quite toxic, hampering your quality of life. Your team may be able to adjust your meds or add other drugs to counteract side effects. Or you may wish to stop certain treatments. That’s why you should talk with your medical team throughout your treatment about how to weigh the side effects of treatment against the current and long-term benefits.
Keep in mind that palliative care is a medical specialty that’s appropriate for any serious condition, including cancer. It involves your well-being as well as your cancer care, addressing things including pain management, stress, and mental, emotional, or spiritual issues that are on your mind. You can get this care as part of your routine cancer care, in a hospital or at home.
