The Plain Facts: 10 Things You Should Know About Ovarian Cancer Recurrence

Can Ovarian Cancer Return After Treatment?

Ovarian cancer is usually detected in the late stages. It is often widespread (metastasized) when diagnosed.

Your doctor will remove as much of the tumor as possible by surgery. You will then need chemotherapy. When your body has no tumor left, you are in remission.

Ovarian cancer relapses often. 23% of people have a relapse within 6 months of stopping chemotherapy, and another 60% after 6 months.

1. The Type and Stage of Ovarian Cancer Are Important

Your physician will send the tumor removed during surgery to the laboratory. Recurrence risk depends on the type of ovarian cancer.

High-grade serous adenocarcinomas and endometroid carcinomas are the most likely to recur. Other types like clear cell adenocarcinoma, mucinous adenocarcinoma, low-grade endometrioid adenocarcinoma, and others have a lower risk. 

Women with Stage 1 ovarian cancer have a 5-year survival of 92%. Stage 3 and 4 ovarian cancers relapse early and often. 

2. Ovarian Cancer Can Return Near or Far

Like other cancers, ovarian cancer can come back in three different locations.

Local Recurrence. The cancer returns at the ovary's location, even if the ovary was removed.

Regional Recurrence. The cancer reappears in the lymph nodes near the ovaries.

Distant Recurrence. The cancer appears in distant organs like the bones, liver, lungs, or brain.

More than 80% of women have recurrences in multiple places.

3. Ovarian Cancer Can Return After Hysterectomy

Ovarian cancer is treated by extensive surgery. The uterus, both ovaries and fallopian tubes, lymph nodes, and other tumor-affected parts are removed. Your physician will then prescribe chemotherapy.

But the cancer usually survives because it has already spread when diagnosed. Even with such massive surgery, ovarian cancer does recur.

4. You Should Have Regular Checks

Frequent checkups are vital for catching recurrence early. In the first two years, your doctor will see you every 3 months. Later, the visits can be every 4 to 6 months.

Your doctor will decide, depending on your earlier disease and physical examination, if testing is needed. This testing could include vaginal cytology, measurement of tumor markers, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans.

5. Don't Wait for Symptoms

You shouldn't depend on looking for symptoms. Your physician won't do that, either.

Ovarian cancer has a very high risk of recurrence. Your physician will screen you for recurrence at regular intervals. Almost all women with relapse are without symptoms when detected. 

Common symptoms of ovarian cancer recurrence are abdominal bloating or pain, nausea, poor appetite, and weight loss.

6. Blood Tests Can Help Detect Recurrence

A rise in certain chemicals in your blood tells your doctor about ovarian cancer recurrence. These chemicals are called tumor markers. Different types of ovarian cancer have different markers.

Cancer antigen-125 (CA-125) is a tumor marker used to test for epithelial ovarian cancer. Other useful markers are CA 19-9, HE-4, and CEA.

Alfa fetoprotein (AFP), human chorionic gonadotropin (HCG), and hormones like estrogen, inhibin, and testosterone are markers for other types.

7. CA-125 Is not a Magic Marker

A raised CA-125 doesn't always mean your cancer is back. You can have high CA-125 without cancer recurrence. Ovarian cancer can return without high CA-125 levels.

Raised CA-125 tells your doctor to look for recurrence. Starting chemotherapy with only raised CA-125 levels doesn't provide any benefit. It also reduces quality of life. 

This tumor marker helps assess the response to treatment, if it was raised before treatment.

8. Recurrence Treatment Is Chemotherapy

Your doctor will probably offer you chemotherapy and targeted drugs. Depending on the time since your last treatment, the drugs may be the same ones as before, or different ones.

Surgery for recurrence is rare. Radiotherapy helps shrink the tumor.

9. Maintenance Chemotherapy Doesn't Prevent Recurrence

Once you have achieved remission, your physician will stop chemotherapy and screen you for recurrence at intervals. 

Maintenance chemotherapy is taking the drugs after you have achieved remission.  But this is not helpful. The overall survival and length of remission are not better.

10. Healthy Life Habits Help

Giving up smoking and alcohol, being more physically active, and staying at a healthy weight will improve your overall health. It's not known if these measures prevent ovarian cancer recurrence.

There are no dietary supplements that are proven to prevent cancer recurrence.