Recurrence

What is a recurrence?

Unfortunately, the removal of the original site of your cancer along with post-surgical chemotherapy does not guarantee the complete destruction of all microscopic disease. If your cancer returns after first-line treatment, it is then termed a recurrence or relapse. As few as 5% and as many as 70% of ovarian cancer patients have a recurrence, depending on their stage of disease at diagnosis.

How do I know if the cancer has returned?

A tool used in monitoring ovarian cancer recurrence is your CA125 blood test. A doubling from your normal level could be an indicator that the cancer has returned or is in the process of likely returning. The CA125 rise can be accompanied with or without physical symptoms. An elevated CA125 without any evidence of cancer is called a serological relapse. There is no real standard in treating this however some women may benefit from antiestrogen medications to slow the rise but as previously stated, the CA125 test is a tool not a diagnosis.

Usually a patient with relapsed ovarian cancer becomes symptomatic such as - has abnormal, constant or worsening pain, has prolonged constipation along with vomiting, experiences unexplainable weight loss or gain, has vaginal bleeding or discharge, has heartburn or bloating. Pay special attention to symptoms like those which resulted in your initial diagnosis. Relapsed ovarian cancer is confirmed by a CT scan and/or MRI, a CA125 blood test and possibly a biopsy.

How is recurrent cancer treated?

Surprisingly, there is no standard method of treating recurrent ovarian cancer; each patient needs to have a "tailor-made" treatment approach. There are several reasons for this:

1. Your oncologist needs to assess the probability of response based on your treatment-free interval (TFI). This is simply the number of months from the date of your last chemotherapy to the date of recurrence.
2. Your doctor needs to help you understand and weigh the quality of life issues you could experience in re-treatment - in light of the fact that a permanent remission is now highly unlikely.
3. You may have residual issues from the previous chemo such as peripheral neuropathy, kidney dysfunction or other toxicity issues which have to be considered on a cumulative basis on top of the possible toxicity of the treatment being offered.
4. You may have had other medical problems - related or unrelated to ovarian cancer - develop during the treatment-free interval.

Most ovarian cancer patients received a combination of Taxol and carboplatin chemotherapy drugs as their first-line treatment. If your TFI is more than a year, you are deemed to be platinum sensitive and will most likely be offered the same/similar chemo drugs as you originally had.

If your treatment-free interval is less than six months, it's considered unlikely that you will be responsive to another round of the same first-line drugs. This is referred to as platinum resistance and you will likely be offered a second-line or different chemotherapy drug.

Sometimes, however rarely, surgical removal of a recurrent tumour - usually a single site either in the pelvic region, abdomen or lungs - is an option followed by chemotherapy or possibly radiation. Surgery may also be performed if your cancer is causing a small- or large-bowel obstruction. In this instance, the goal of the surgery is to provide relief from the symptoms.

What are my chances?

It is devastating to learn that your cancer has returned. Here's what my own Medical Oncologist said to me at that moment - "My job is to keep you alive until technology catches up." What wonderful optimism!

There are plenty of people alive today whose doctors predicted short life spans and although not considered curable, recurrent ovarian cancer is indeed treatable. More and more it is looked upon as a chronic disease. The survival rate continues to improve as do the treatment options. Please see "Clinical Trials" under this tab. Realistically focusing on "healing" - a mind-body-spirit approach - instead of focusing on "cure" will help you enormously.

Additional Information:

The following paper from TheOncologist provides more information on the usefulness and limitations of CA125:

• CA125 Response: Can it Replace the Traditional Response Criteria in Ovarian Cancer?

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