Patients who have been diagnosed with ovarian cancer may have persistent, refractory or recurrent cancer following treatment with surgery and first-line chemotherapy. Persistent cancer refers to residual cancer growths or cells that persist during and following initial treatment. Patients who have achieved complete remission following initial therapy and who subsequently experience a return of cancer cells after treatment are said to have relapsed or recurrent cancer. Patients with ovarian cancer who experience progression or continued growth of the cancer during treatment are said to have refractory cancer. Patients with persistent, recurrent or refractory ovarian cancer can benefit from additional treatment with second-line therapy, which is often referred to as salvage therapy. A patient’s treatment options will differ depending on whether the cancer is persistent, recurrent or refractory.
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The following is a general overview of the diagnosis and treatment of recurrent ovarian cancer. Each person with ovarian cancer is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.
How is Recurrent Ovarian Cancer Detected?
Recurrent or persistent ovarian cancer may be detected by several methods. Some patients will experience abdominal swelling, pain or symptoms related to the spread of cancer cells (metastases) to the bone, liver, or brain. Other patients may simply have an increase or persistent elevation in the CA-125 level, a blood test commonly used to monitor ovarian cancer activity. When an increase in the CA-125 occurs, most patients will undergo ultrasound or CT scanning of the abdomen and pelvis or other diagnostic procedures in order to determine the location of recurrent cancer. The availability and effectiveness of additional treatment depends on the kind of chemotherapy previously administered, the duration since last treatment and the extent of recurrent cancer.
Despite recent improvements, initial or first-line chemotherapy fails to produce a remission in more than 70% of patients with ovarian cancer. Furthermore, approximately 40-50% of the women who do achieve a remission after first-line chemotherapy will experience a recurrence of cancer within 3 years. Patients who have failed initial surgery and first-line chemotherapy for ovarian cancer are broadly divided into three groups: those with persistent ovarian cancer, recurrent ovarian cancer or refractory ovarian cancer. Currently available salvage chemotherapy can often prolong survival, but is rarely curative. The treatment option that may offer the greatest benefit to patients who wish to pursue aggressive or potentially curative treatments may be participation in clinical studies that are evaluating new and innovative treatment strategies.
What is the Role of Surgery in Recurrent Ovarian Cancer?
Typically, women who have ovarian cancer are initially treated with surgery, followed by chemotherapy or radiation therapy. If the cancer recurs (returns) after treatment, a combination of chemotherapy drugs is often used to increase survival time and relieve the symptoms of the cancer. More recently, researchers in California have reported that the use of a second surgery plus chemotherapy (and radiation therapy in some) to treat recurrent ovarian cancer may prolong survival times.
In this clinical study, 106 women who experienced a recurrence of ovarian cancer 6 months or more after their initial treatment received additional therapy. The treatment for recurrent cancer consisted of a second surgery to remove all visible cancer. In addition, 40% of the patients received chemotherapy before the surgery, and the other 60% received chemotherapy after the surgery. Some patients also received radiation therapy after the surgery. The results of this study showed that surgeons were able to remove all visible cancer in 82% of patients. After the surgery, 3% of patients had small amounts of residual cancer remaining and 15% had large amounts of residual cancer remaining. The average survival time with this treatment regimen was 36 months, with a 5-year survival rate of 28%. Women who had a long interval between initial treatment and the cancer recurrence had better outcomes, as did those who had only small amounts of visible cancer at the time of the second treatment. Side effects of treatment included 2 deaths from treatment-related complications.
The researchers concluded that women who have a second surgery to treat recurrent ovarian cancer appear to have a longer survival time than those who receive only chemotherapy and/or radiation therapy without additional surgery.