Cancer that comes back is called a ‘recurrence’. A recurrence of ovarian cancer usually means the cancer has started to grow again near where the original cancer began or in another part of your body.
It can be difficult to learn your cancer has come back. However, there is still treatment available. While a cure may not be possible at this stage, many women can live for an extended time with a good quality of life. Every woman is different, so it is important you speak with your oncologist about your individual situation and outcomes.
The approach to treatment and the prognosis depends on how long it took for the cancer to come back after completing chemotherapy. The longer the interval before it comes back, the better. If the interval is greater than six months, this is called ‘platinum-sensitive ovarian cancer’. If the interval is shorter and less than six months, it is called ‘platinum-resistant ovarian cancer’.
The most common type of treatment for ovarian cancer that has come back is chemotherapy. This is called ‘second line’ chemotherapy. The aim of treatment is to shrink the cancer and control it for as long as possible. You and your healthcare team will work together to treat and manage the cancer.
You and your doctor may suspect your cancer has come back if you begin to experience symptoms similar to those when you were first diagnosed or if you notice other changes in your health. Always tell your doctor about any symptoms that are new or have returned.
Your doctor may also suspect that your cancer has come back based on changes found in your follow-up physical examination or if your CA125 level has been rising. Some women may have signs that the cancer has come back even though their CA125 isn’t rising.
If tests or symptoms suggest that your cancer has recurred, it may then be confirmed by an ultrasound or CT scan. It is important to remember that your follow-up plan is designed by you and your doctor to check on you and ensure you get the care you need.
Many women say that finding out their cancer has come back is more stressful than their initial diagnosis. Ask for all the support you need at this time. You may want a family member or close friend to come to appointments with you, and this may be a time when you need to talk to someone such as a counsellor or psychologist who can provide you with extra emotional support.
The best type of treatment for advanced or recurrent cancer will depend on several factors including:
- Where in the body the cancer is and how big it is
- Previous treatment (if any) and how well you responded
- Any side effects you had
- How long it has been since your last chemotherapy finished
- Your overall health and wellbeing
- Which treatment you prefer
Surgery is an important part of the initial treatment for ovarian cancer, but its role in treating recurrent ovarian cancer is not so clear. When ovarian cancer recurs, it is not usually a single tumour that can be easily removed. Your gynaecological oncologist may consider further surgery if it has been some time since your original surgery, and there is good evidence the new cancer, or a significant part of it, can be removed. Usually, surgery is not an option if it is less than 12 months since your first completed treatment.
All of these are important to consider because they can all influence how well the chemotherapy will work and how well you will cope with side effects. Several different chemotherapy drugs may help you. Your oncologist or specialist nurse can talk to you about their benefits and possible side effects.
Depending on your response to previous chemotherapy, your oncologist may also talk to you about using hormonal therapies such as arimadex, tamoxifen or provera. Hormonal therapies help block or lower the amount of hormones in the body to slow down or stop the growth of cancer. They are sometimes used for women with epithelial ovarian cancers, and more commonly used for women with stromal tumours.
Spirituality is about your personal sense of purpose and peace, and your beliefs about the meaning of life.
There are different ways to express your spirituality. For many people, it is through their connection with other people, with nature, and possibly with a higher power. For some people, organised religion provides a way to express spirituality.
It is normal for a diagnosis of cancer to both intensify and cause upheaval in your spiritual life. You may want to talk to a chaplain, minister, priest, rabbi, Inman or other religious leader. Or you may want to explore your own ways of connecting more deeply with others and the world. This may include spending more time in nature, appreciating art and music, reading more widely about spiritual ideas, meditating, or writing in a journal.
Talk to your oncologist about the most suitable schedule and delivery method for second-line chemo. Considerations may include whether IV access is a problem for you or whether nausea and vomiting may make oral chemotherapy less suitable.
Ask your medical oncologist if there is a current clinical trial that may be suitable for you. Most of the improvements we have in the treatment of ovarian cancer today are based on the results of previous clinical trials. These trials are used to assess new treatments and quality of life for both initial and recurrent ovarian cancer. See the Clinical trials section of our website.