About 80 per cent of women diagnosed with ovarian cancer will achieve remission. However, It is unknown if the cancer will come back or how long before it comes back. These unanswered questions linger in every woman‘s mind who has ever been diagnosed with cancer. Get the information and support you need for remission and recurrence.
The Canadian Cancer Society defines remission as: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.
About 80 per cent of women diagnosed with ovarian cancer will achieve remission. Optimal debulking surgery by a gynecologic oncologist results in an improved response to chemotherapy; this in turn, results in a longer remission.
It is an unknown if the cancer will come back or how long before it comes back. But survival has increased with the advances with chemotherapeutic drugs and surgery.
Initially it is hard to be finished treatment. You may experience anxiety, feel adrift and/or be concerned about aches and pains signalling recurrence. There may also be side effects left over from the treatment.
And many women who have been diagnosed with ovarian cancer, like others with cancer, feel they have been changed by the experience of dealing with a devastating diagnosis and serious disease.
However, there are so many cancer survivors who go on to lead full and productive lives after treatment.
Symptoms such as heart burn, bowel problems or vaginal bleeding can signal a recurrence. Although studies regarding the use of CA125 monitoring for relapse show little benefit in terms of survival, if your CA125 level was elevated at diagnosis, your doctor may still consider using this test to monitor a possible recurrence. While the CA125 level may be elevated, you might be feeling well and be without symptoms. Even with the physical exam or with imaging studies it may not be possible to identify the site of recurrence. Women with ovarian cancer have expressed how using CA125 may be helpful in alleviating their anxiety. Whether to use the CA125 or to monitor for possible recurrence on the basis of symptoms needs to be discussed with your gynecologic oncologist.
The landscape has changed in the last decade or so regarding options for treatment of recurrence:
- with the use of chemotherapy drugs (alone or in combination) and
- with secondary debulking (surgery when the cancer recurs)
Some considerations regarding treatment of recurrence include:
- The length of time from the finish of the first treatment series to recurrence (called progression free survival).
- If the cancer recurs in less than 6 months following the standard taxol and carboplatin regimen, it is likely that carboplatin has not been effective (this is referred to as platinum resistance) and that alternatives to platinum drugs will be needed to treat the recurrence.
- If it is 6 – 12 months from completion of treatment to recurrence, platinum drugs may be considered again.
- If it is more than 12 months, platinum drugs are likely to be used again.
- Platinum drugs are usually the first choice, and if there is a further recurrence (3rd or 4th) a number of regimens are possible.
- Consideration about side effects, such as neuropathy, also needs to be given to the choice of chemotherapy drugs.
- Clinical trials may be an option to be explored.
- Intraperitoneal chemotherapy (IP) is not usually given in recurrence because of the possibility of adhesions that limit its effectiveness.
- Surgery (secondary debulking) is an option if it has been a long time since completing chemotherapy (more than 12 months) and the new disease is only in one area. If there has been metastasis to the liver, surgery is rarely an option.
Ovarian Cancer Canada created If it recurs – A resource for women with ovarian cancer and their families, an online information guide about ovarian cancer recurrence, which is designed to help women make choices at a difficult time in their lives.
If it recurs – A resource for women with ovarian cancer and their families
I - After your cancer treatment
II - Treatment for recurrence
III - Talking with the doctor
IV - Support during recurrence
V - Side effects of treatment
VI - Taking care of yourself
VII - For family members
You will be dealing with a range of emotions as you face a recurrence of ovarian cancer and attempt to come to terms with your new reality. These emotional states may be repeated at various points during the cycle of illness.
Following the diagnosis, there is often a sense of shock or disbelief, an inability to face the reality of what is happening. This may be followed by anger, bargaining or guilt followed by depression.
Ultimately, there is acceptance, which will enable you to continue to fight and maintain a positive attitude. We all have a remarkable capacity to adapt to even the bleakest of situations and find the hope and courage to continue to deal with this disease.
Acceptance and coping mechanisms tend to develop with every stage, that’s why an illness is often referred to as a “journey”. New experiences, new ways of thought can open up opportunities for self-discovery and emotional growth.
Click here for strategies on developing an Action Plan.
Please visit Ovarian Cancer Canada's YouTube site to hear an excellent talk "If the Cancer Comes Back" by Dr. Christopher Giede, about ovarian cancer recurrence.
The National Comprehensive Cancer Network (US) provides clinical practice guidelines for ovarian cancer. Although this document is technical because it is targeted to health professionals, it provides a clear framework for treatment options.
Excellent information from American Cancer Society:
Canadian Cancer Society booklet:
Living with cancer: A guide for people with cancer and their caregivers - for those diagnosed with cancer and the people who care for them.
The Canadian Cancer Trials website was created by the Canadian Partnership Against Cancer and its partners. The website allows users to search for clinical trials in Canada by cancer type, province, drug, keyword or phrase. If you find a trial in which you would like to participate, you can share, save or print the trial details and review them with your doctor or care team. Only a doctor can refer you and enroll you in a clinical trial.
OTHER CONSIDERATIONS – HOSPICE PALLIATIVE CARE
There may come a point in the ovarian cancer experience when palliative care is the best option.
The Canadian Hospice Palliative Care Association (CHPCA) defines hospice palliative care as “care that aims to relieve suffering and improve the quality of life throughout the illness and bereavement experience.”
The hospice palliative care agency in your community may be able to provide you and your loved ones with some important services. Hospice palliative care can provide:
- Help with managing pain and other distressing symptoms
- Social, psychological, emotional, and spiritual support
- Support for the caregiver
- Help with deciding on the kind of care you want and with your plan of care
The team hospice palliative care team might include:
- Nurses who specialize in palliative care, the family physician, a physician who specializes in palliative care, a social worker, a spiritual counsellor, a pharmacist, and others
- Volunteers who can provide companionship, relief for the caregiver, and transportation.
- Nutritionists, physiotherapists, occupational therapists, home support workers, and others.
Hospice palliative care is offered at home, in hospitals, in long-term care facilities, and in hospices. To learn more about the choices available in your community, go to www.chpca.net.
Quality End-of-Life Care Coalition of Canada
All Canadians have the right to quality end-of-life care that allows them to die with dignity, free of pain, surrounded by their loved ones, in the setting of their choice. Ovarian Cancer Canada is a member of Quality End-of-Life Care Coalition of Canada, a network of 33 national organizations. The mandate of the QELCCC is to act as an advocate for quality end-of-life care for all Canadians.
For information about QELCCC, go to http://www.chpca.net/qelccc.htm.