Ovarian Cancer Recurrence
||How Are Recurrences Treated?
Most women with advanced stages of the disease will experience a recurrence after their ovarian cancer treatment is completed. Ovarian cancer can recur because some cancer cells were left behind after surgery and eventually grow large enough to become obvious. The cancer can come back to the same place as the original tumor (local recurrence) or to another part of the body (regional recurrence). Nearly 70 percent of women who receive an ovarian cancer diagnosis will have a recurrence.
Very often these recurrences can be treated with chemotherapy to stop the progression of the disease and improve the woman's survival rate. Although recurrent ovarian cancer is treatable it is rarely curable. Women with recurrences may have to undergo periods of chemo for many years. The toxicities resulting from this will play a major role in any treatment decision.
If the recurrence occurs within 6 months of the original treatment, the tumor is deemed to be platinum resistant – if the original treatment involved the use of chemo drugs with the platinum compounds carboplatin or cisplatin. In such instances further surgery is not recommended but a different combination of chemo drugs will be tried such as Doxil, Topotecan and Gemzar. If the tumor returns after 6 months then it is deemed platinum sensitive. That means it did respond to the original chemo drugs, so they will probably be used again. Surgery to remove as much of the tumor as possible may also be considered.
The chances of a positive outcome to therapy are good, and the prognosis generally improves the longer the length of time between the recurrence and initial treatment. New chemo drugs such as ifosfamide and Taxol offer better chances of controlling recurrent symptoms of ovarian cancer. Alternative drugs such as altretamine and etoposide may also be considered. Doctors may also prescribe hormonal therapy (HT) with tamoxifen, leuprolide or megestrol acetate showing good remission results. As female hormones play such an important role in causing many female cancers it makes sense to shift the body's hormone balance in order to discourage a recurrence of cancer. HT is not the same as HRT or estrogen replacement therapy (ERT) which is used for treating menopause symptoms such as night sweats and hot flashes. Where HRT increases estrogen levels, HT does the opposite. See Breast cancer hormone therapy for a more detailed explanation.
If a woman experiences a recurrence, she should fully discuss any further treatment with her doctor and weigh the pros and cons. With some women, if the disease is very advanced, continuing treatment may not improve her chances of cure or remission. It may in fact only reduce her quality of life. Whatever decision she comes to, she must be certain she is comfortable with it. If she decides to not pursue treatment it does not mean she will be abandoned by her doctors. In fact she may need even more care in order to palliate some of the effects of the cancer. At this point she will be advised to make contact with a Hospice organization which will help her to be cared for at home. The decision not to pursue further cancer treatment does not mean the woman is choosing death - but rather that she is choosing life - for however long that may be, free of the burden of surgery and chemotherapy.
One of the main factors in determining the risk of recurrence will depend on the stage of the original cancer diagnosis. Different stages will indicate different chances of recurrence and ultimately survival rates (see stages of ovarian cancer).
The signs of recurrent cancer will depend on how advanced it is. The majority of women with advanced stages will have a recurrence at some stage, and those signs may include:
• Bloated stomach
According to a study published by the National Cancer Institute (NCI) Bulletin, women who are in ovarian cancer remission do not benefit by starting preventative chemotherapy early. The study found that women who start chemotherapy to prevent a recurrence based on elevated levels of CA-125 in their blood do not live longer than women who only use chemo after symptoms of a recurrence have occurred. 500 women participated in the randomized clinical trial and the results were presented to the American Society of Clinical Oncology (ASCO). Half of the women were assigned chemotherapy once their CA-125 levels reached twice the normal level, while the other half were not informed about their CA-125 levels and only started treatment when clinical symptoms occurred indicating a relapse. Elevated CA-125 levels (taken by a simple blood test) can indicate a return of a tumor. The results of the study should influence how clinicians monitor and treat recurrence patients. Currently most women who are treated for ovarian cancer are regularly checked for CA-125 levels. In fact some women become almost addicted to the screening and it can cause great anxiety. Although CA-125 monitoring is deeply ingrained in most clinical practices, this study begs the question - if early intervention with chemotherapy does not improve ovarian cancer survival rates or quality of life, then why is it being done? Researchers insist the test is not obsolete but recommend that doctors carry it out less frequently in patients who are not showing symptoms (particularly as the test may cause a accumulation of toxins over time which may even hinder chemo when it is really needed). They also insist that doctors should consider delaying palliative chemotherapy until a recurrence has been clinically proven.
Ovarian cancer treatment is changing and advancing all the time. The NCI encourages all women with the disease to participate in cancer clinical trials to help continue advancements. A new area of study is biologic therapy which may soon be recommended as a form of treatment for the disease. Generally ovarian cancer seems sensitive to the effects of the immune system and scientists are investigating ways to manipulate this weakness. Studies are being carried out which use Interferon on its own and in combination with chemotherapy to treat women with small amounts of cancer left after surgery. Biological therapy has been used effectively for creating vaccines to many diseases. The concept is to teach the body's own immune system how to attack something that should not be there. For example highly purified proteins can be used to give the body's defense system a wake up call. Interferon and interleukin are two such proteins which can be grown in large numbers in labs. Other therapies might boost the amount of defense cells in circulation. Scientists are also investigating the use of monoclonal antibodies which resemble the body's normal antibodies that attack cancer cells. However these lab produced antibodies are extra potent and are loaded up with radioactive or chemotherapy compounds, a sort of man-made smart bomb. One of the main problems with this therapy is that the antibodies can end up attacking the wrong cells. However one particular monoclonal antibody called Oregovomab has been shown to stimulate an immune response to ovarian tumors, resulting in longer periods of time between initial treatment and recurrences. Also, a study published in the European Journal of Cancer (2011) concluded that Bevacizumab (Avastin), an angiogenesis inhibitor and monoclonal antibody, remains effective for the treatment of recurrent patients, regardless of their platinum-sensitivity status. Combined with chemotherapy drugs gemcitabine (Gemzar) and carboplatin, patients reduced their risk of progression of the disease by 64 percent when compared to just chemotherapy alone.
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