Ovarian Cancer Recurrence and Remission

What is ovarian cancer?

Ovarian cancer starts in the ovaries, which are the glands in women that produce eggs and hormones like oestrogen and progesterone. Early-stage ovarian cancer often lacks clear symptoms, leading to diagnosis predominantly in advanced stages.

Following initial treatments, typically involving surgery and chemotherapy in women, many patients enter remission - a phase where no detectable signs of cancer are present. However, ovarian cancer is associated with a high recurrence rate, and understanding the dynamics of remission and recurrence is crucial for long-term management.

What is ovarian cancer remission?

After treatment, the level of cancer cells are decreased. Ovarian cancer remission refers to the period of time after treatment where cancerous cells at extremely low levels due to treatment. The low concentration of cancer cells often lead to an absence of detectable signs and symptoms of the disease after treatment. 

Understanding remission is important for managing cancer effectively. There are two main types of remission:

1. Complete remission

   • Complete remission occurs when no evidence of cancer is found after treatment. This is confirmed through physical exams, imaging tests (such as CT or PET scans), and blood tests, including CA-125 level monitoring.

2. Partial remission

   • In partial remission, the cancer has significantly reduced in size, but some signs of the disease may still remain.

   • Achieving complete remission is the primary goal of initial treatment. However, the risk of recurrence remains high, particularly in advanced ovarian cancer cases.

How is ovarian cancer remission achieved?

Reaching remission typically involves a combination of treatments designed to reduce the number of cancer cells and prevent recurrence:

1. Surgery

   • Debulking surgery aims to remove as much of the tumour as possible, setting the stage for effective follow-up treatments.

2. Chemotherapy

   • Chemotherapy is administered after surgery to target and destroy any remaining cancer cells in the body. Platinum-based chemotherapy is often a cornerstone of initial treatment, especially for advanced cases, and is linked to longer progression-free survival.

3. Targeted therapy

   • Advanced treatments like PARP inhibitors (e.g., olaparib) are used for patients with BRCA gene mutations, somatic mutations or other specific genetic profiles to attack cancer cells effectively.

   • PARP is an enzyme that’s naturally present in the human body. It helps to repair single-strand DNA breaks in cells.

   • PARP inhibitors block the action of PARP enzymes, preventing the repair of single-strand DNA breaks, leading to the accumulation of DNA damage, ultimately causing cancer cell death.

   • Normal, healthy cells are not as affected by PARP inhibitors as they have other, normal functioning repair pathways.

4. Maintenance therapy

   • Maintenance therapies, such as chemotherapy, targeted therapy, or immunotherapy, are often used after initial treatment to extend remission periods and delay recurrence.

How long does ovarian cancer remission last?

The duration of remission varies depending on several factors:

1. Stage of cancer at diagnosis

   • Patients diagnosed in earlier stages generally experience longer remission periods compared to those with advanced cancer.

   • Patients diagnosed in earlier stages have lower cancer cell burden (fewer cancer cells) and absence of metastasis. Making it easier to treat, lower the number of cancer cells and achieve a longer remission period.

2. Type of ovarian cancer

   • Certain subtypes, such as low-grade serous carcinoma, may follow different recurrence patterns and affect remission duration.

3. Response to treatment

   • Patients who achieve complete remission are more likely to remain disease-free for extended periods. Progression-free survival is often used as a key measure to evaluate how effectively treatment delays the return of cancer, improves quality of life, and extends disease-free intervals for patients.

   • While remission can last months or years, this type of cancer has a high likelihood of recurrence, making ongoing monitoring essential.

Monitoring ovarian cancer during remission

Close monitoring during remission is vital to detect any signs of recurrence early. Common follow-up procedures include:

1. CA-125 blood tests

   • Elevated levels of the CA-125 protein can signal recurrence, particularly in women whose levels were elevated at diagnosis.

2. Imaging tests

   • Regular CT or PET scans help identify any signs of cancer returning.

3. Physical exams

   • Routine check-ups with an oncologist ensure symptoms or changes are addressed promptly.

Learn more about what different CA125 levels mean and which levels may indicate cancer recurrence here.

What is ovarian cancer recurrence?

Recurrent cancer happens when the cancer comes back after a period of remission. It can occur in different locations:

• Local recurrence: Cancer returns near the original site.

• Regional recurrence: Cancer spreads to nearby lymph nodes or tissues.

• Distant recurrence: Cancer metastasises to other organs like the liver, lungs, or brain.

Recurrence is further categorised based on the cancer’s response to treatment:

1. Platinum-sensitive recurrence: 

   • The cancer returns more than 6 months after completing platinum-based chemotherapy, indicating it may respond to the same treatment again.

2. Platinum-resistant recurrence: 

   • The cancer returns within 6 months and usually requires alternative treatments.

3. Platinum-refractory recurrence: 

   • The cancer does not respond to platinum-based chemotherapy at all.

Symptoms of ovarian cancer recurrence

Symptoms of recurrence are often similar to those experienced during the initial diagnosis. They may include:

• Abdominal pain or bloating

• Changes in bowel or bladder habits

• Unexplained weight loss

• Persistent fatigue

• Shortness of breath, especially if the cancer has spread to the lungs

• Rising CA-125 levels may also serve as an early indicator of recurrence before symptoms develop.

It is crucial for patients to report any new or worsening symptoms to their oncologist promptly for evaluation. Request an appointment with our experienced oncologists to receive personalised care and timely support for your health needs. 

How is ovarian cancer recurrence diagnosed?

Recurrence is typically diagnosed using the following methods:

• CA-125 levels: Rising CA-125 levels may indicate recurrence before symptoms appear.

• Imaging studies: Tests like CT scans, MRIs, or PET scans are used to detect areas where the cancer may have returned.

• Biopsy: In some cases, a biopsy may be performed to confirm recurrence.

Treatment options for recurrent ovarian cancer

Treatment plan for recurrent ovarian cancer depends on factors such as how long the patient was in remission, the extent of the recurrence, response rates and overall health. Options include:

1. Chemotherapy: 

   • Different drugs or combinations may be used, especially if the cancer is resistant to previous treatments.

2. Targeted therapy: 

   • This option encompasses a variety of drugs designed to combat cancer cells through different mechanisms. These therapies can disrupt the blood vessels that cancer cells depend on, deliver anticancer agents directly to the cancer cells, or activate the immune system to identify and attack the cancerous cells.

   • PARP inhibitors, such as olaparib, are often used, particularly in patients with BRCA mutations or HRD (homologous recombination deficiency).

3. Immunotherapy: 

   • Although not yet standard for this type of cancer, immunotherapies like pembrolizumab are being studied in clinical trials.

4. Surgery: 

   • In cases of localised recurrence, surgery may be performed to remove recurrent tumour.

5. Clinical trials: 

   • Patients with recurrent ovarian cancer may qualify for trials testing innovative therapies or drug combinations.

Prognosis for recurrent ovarian cancer

The prognostic factors for recurrent cancer varies based on the type and timing of recurrence:

1. Platinum-sensitive recurrence: 

   • Platinum-sensitive recurrent ovarian cancer often has better outcomes and may respond well to re-treatment with chemotherapy treatment.

2. Platinum-resistant or refractory recurrence: 

   • Platinum-resistant ovarian cancer typically has poorer prognostic factors and requires more aggressive or experimental treatments.

While recurrent cancer is often not curable, it can often be considered as a chronic disease, with periods of remission and ongoing treatment. Early detection, palliative care and a personalised treatment approach can help improve quality of life and outcomes.

Understanding the dynamics of remission and recurrence in ovarian cancer is key to managing the disease long-term. With advancements in treatment options and ongoing research, the outlook for ovarian cancer patients continues to improve. Always consult with your healthcare team to create a personalised treatment plan for monitoring and managing your conditions. Request an appointment with us today to receive expert care tailored to your needs.

FAQ

What is the chance of recurrence in ovarian cancer?

The chance of recurrence depends on the stage and type of ovarian cancer. Unfortunately, most patients with advanced-stage ovarian cancer experience recurrence. Studies estimate that 70-90% of women with advanced ovarian cancer will face recurrence, even after achieving remission.

How long can ovarian cancer stay in remission?

The duration of remission varies from person to person. Some patients may remain in remission for years, while others may experience recurrence within months. Platinum-sensitive patients often have longer remission periods, whereas platinum-resistant patients may have shorter durations.

What can be done to prevent ovarian cancer recurrence?

While there is no guaranteed way to prevent recurrence, the following measures may help:

• Maintenance therapies, such as PARP inhibitors for patients with BRCA mutations

• Regular monitoring and timely reporting of symptoms

• Maintaining a healthy lifestyle with a balanced diet and exercise

Can ovarian cancer be cured after recurrence?

While recurrent ovarian cancer is often not curable, it can be treated and managed. Many patients achieve multiple remissions and extended survival through various treatments. Advances in maintenance therapies and innovative treatments continue to improve long-term outcomes.

What are the treatment options for platinum-resistant ovarian cancer?

For platinum-resistant ovarian cancer, alternative treatments include:

• Non-platinum chemotherapy (e.g., liposomal doxorubicin, topotecan)

• Targeted therapies like PARP inhibitors

• Participation in clinical trials for innovative therapies 

• Surgery is generally less effective in platinum-resistant cases.

How often should I be monitored during remission?

Regular follow-up appointments  with your healthcare team are essential during remission. Most oncologists recommend check-ups every 3 to 6 months, which may include CA-125 blood tests and imaging studies. The frequency of monitoring may decrease for patients who remain in remission for extended periods.

Is there a genetic link in ovarian cancer recurrence?

Yes, genetic mutations, such as BRCA1 and BRCA2, significantly increase the risk of cancer and influence recurrence likelihood. Genetic testing is often recommended to guide treatment, particularly for targeted therapies like PARP inhibitors.

How do I cope with the emotional toll of ovarian cancer recurrence?

Dealing with recurrent ovarian cancer can be emotionally challenging. Support options include:

• Guidance from healthcare providers

• Counselling or therapy

• Joining support groups for shared experiences

• Accessing mental health resources to manage stress and anxiety

Are there new treatments available for recurrent ovarian cancer?

Yes, recent advancements include:

• PARP inhibitors

• Anti-angiogenic drugs (e.g., bevacizumab)

• Immunotherapies 

• Clinical trials also provide access to cutting-edge treatments and innovative drug combinations, offering new hope for patients.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request for an appointment with Thomson Medical today.