• Ovarian, fallopian tube, and peritoneal cancers often come back after being treated, which is called recurrence.
• Keeping an eye on symptoms like fatigue, pain, and sleeping problems can help you and your doctor know if ovarian cancer comes back.
• Treatments for recurrent ovarian cancer may include chemotherapy, surgery, targeted therapy, radiation, and palliative care.

Experts estimate that between 70 percent and 80 percent of people treated for ovarian cancer have a recurrence, or a relapse, after initial treatment. Ovarian cancer is a type of gynecologic cancer that includes cancers of the ovary, fallopian tube, or peritoneum. Ovarian cancer is hard to catch during exams and often doesn’t cause symptoms. Around 80 percent of ovarian cancers are not diagnosed until they are already at a later stage.

Ovarian Cancer Recurrence

If your ovarian cancer was initially diagnosed at an earlier stage, it is less likely to come back. Here are the recurrence rates based on cancer stage:

• 10 percent of people with stage 1 ovarian cancer will have a relapse.
• 30 percent of people with stage 2 ovarian cancer will have a relapse.
• 70 percent to 90 percent of people with stage 3 ovarian cancer will have a relapse.
• 90 percent to 95 percent of people with stage 4 ovarian cancer will have a relapse.

The amount of time it takes for cancer to come back after being treated is referred to as progression-free survival (PFS). The average PFS for ovarian cancer is 18 to 24 months. Recurrent ovarian cancer is most likely to come back within this window of time, although it may also come back earlier or later.

Ovarian Cancer Prognosis After Recurrence

If your ovarian cancer comes back, your doctor may estimate your prognosis, or outlook. Certain factors may indicate a better prognosis following a recurrence of ovarian cancer. Some of these factors include:

• Younger age
• Diagnosis at an earlier stage
• A longer window of time between remission and relapse
• Successful removal of more of the tumor during initial surgery

The term overall survival estimates how long people with cancer are likely to live. Overall survival rates depend on the type and stage of ovarian cancer. About 48 percent of people with epithelial ovarian cancer live for five years after their first diagnosis, but 88 percent of people with stromal cancer and 93 percent of people with germ cell tumors survive for this long. Advanced stage ovarian cancer (cancer that has spread) is also more likely to lead to a shorter overall survival.

Recurrent ovarian cancer has worse overall survival rates. The median time people live after having an ovarian cancer relapse is two years. However, these statistics don’t predict what your own outcome will be. Your doctor can help you get a better understanding of your personal outlook based on your individual characteristics.

Signs and Symptoms of Ovarian Cancer Recurrence

Recurrent ovarian cancer may cause the same symptoms as the original cancer, or these symptoms may be different. The most common symptoms that often cause the greatest amount of trouble for people living with ovarian cancer are:

• Tiredness
• Sleeping problems
• Pain

Other symptoms are frequently found as well. These can include nausea, constipation, bloating, and ascites (fluid buildup in the abdomen).

Once you’ve been treated for ovarian cancer, you will probably need regular follow-up appointments with your doctor to check for signs that the cancer has recurred. Your doctor will likely give you a physical exam and ask you about your symptoms. They may also have you undergo blood tests or imaging tests to identify possible cancer signs.

Treatment for Ovarian Cancer

The first set of treatments you receive after you are initially diagnosed with ovarian cancer is called first-line therapy. For ovarian cancer, this often includes chemotherapy and surgery. First-line chemotherapy usually consists of a drug that contains platinum, such as Paraplatin (carboplatin), and possibly a type of chemotherapy drug called a taxane, such as Taxol (paclitaxel). The goal of first-line therapy may be to completely eliminate all cancer cells from your body, or it may be to slow the growth of an advanced tumor.

Maintenance Therapy

If first-line treatments have been successful, and your cancer has disappeared, your doctor will probably put you on maintenance therapy. The goal of these treatments is to keep you in remission and prevent your cancer from recurring.

There are two main types of maintenance therapy used for ovarian cancer. One of these is Avastin (bevacizumab). This drug stops tumors from using blood vessels to feed themselves and grow. Another type of maintenance therapy is a category of drugs called poly (ADP-ribose) polymerase, or PARP, inhibitors. PARP inhibitors include Lynparza (olaparib), Zejula (niraparib), and Rubraca (rucaparib). PARP inhibitors make it harder for cancer cells to repair DNA damage, leaving them more vulnerable. These drugs are especially effective in treating cancers with mutations in the BRCA gene.

Treatments Following Ovarian Cancer Relapse

If your ovarian cancer comes back, the treatments you receive may be the same as they were the first time around, or they may be different. The treatment you receive may depend on factors like how well first-line treatments worked, what side effects you experienced in the past, and how much your cancer has spread since it came back. The goals of treatment may also change. For recurrent disease, the goals are often to:

• Slow down or stop growth of the cancer
• Reduce cancer-related symptoms
• Treat or prevent side effects from medications or other treatment
• Achieve the best quality of life possible

Chemotherapy

Chemotherapy is often used to treat ovarian cancer that has relapsed. If your cancer took more than six months to come back, it is called platinum-sensitive. This means that the platinum-based drugs used the first time around, like Carboplatin, will probably work again.

If cancer returned within six months after the first treatment, it is called platinum-resistant or refractory. If you have platinum-resistant disease, you will probably receive a different chemotherapy regimen that includes other drugs like paclitaxel, Lipodox or Doxil (doxorubicin), Gemzar (gemcitabine), Platinol (cisplatin), Hycamtin (topotecan), VP-16 (etoposide), or Cytoxan (cyclophosphamide).

Chemotherapy is not the right choice for everyone. These drugs may do more harm than good for people who are older, have other health conditions, or have platinum-resistant ovarian cancer.

Surgery

If you have recurrent ovarian cancer, you may have debulking surgery to remove the cancer. Whether or not you have surgery depends on:

• Your general health
• How much of the cancer can be removed
• How long it took you to have a recurrence

People with ovarian cancer may also have other types of surgery to address symptoms. This may include a surgery to fix a blocked bowel.

Targeted Therapy

Targeted therapy drugs can seek out and kill cancer cells. These medications are also used in maintenance therapy, and may include:

• Avastin (bevacizumab)
• Lynparza (olaparib)
• Zejula (niraparib)
• Rubraca (rucaparib)

You may receive targeted therapy during treatment the first time around, or you may receive it later, if ovarian cancer recurs.

Radiotherapy

You may receive radiotherapy treatments to make tumors smaller. Radiotherapy uses high-energy beams to kill cancer cells. It may also help reduce symptoms or kill cancer that has spread to other places in the body.

Palliative Care

No matter the stage of your ovarian cancer, you can also consider palliative care. Palliative, or supportive, care is not the same as hospice care, and doesn’t necessarily mean that you’re at the end of your life. It focuses on reducing cancer symptoms, such as pain, and it can be used along with any other treatments you may want to pursue. It can help people have a better quality of life and may even lead to better outcomes.

Coping With Recurrent Ovarian Cancer

Fighting cancer is hard enough the first time around, and it can be even more challenging the next. Many people with recurrent ovarian cancer have a hard time managing tests, treatments, and an uncertain future. It’s common to feel depressed, sad, angry, or scared.

Ask your oncologist about support services available through your hospital or cancer care center, or for referrals. Social workers, therapists, and chaplains can help you manage the emotions and practical challenges of recurrent ovarian cancer.

Connecting with other people who know what you’re going through can also help. At MyOvarianCancerTeam, you can connect to other people living with ovarian cancer, ask questions, or offer advice for other people who may be struggling.

Were you recently diagnosed with recurrent ovarian, fallopian tube, or peritoneal cancer? Have you previously been treated for ovarian cancer and are now worried about it coming back? Comment below or start a conversation on MyOvarianCancerTeam.