Ovarian cancer often comes back (relapses) after treatment. This is also called recurrent cancer.
The main treatment for recurrent ovarian cancer is anti cancer drug treatment (chemotherapy). You also might have surgery or targeted cancer drugs.
Finding out your cancer has come back
It might only be a few months since you finished treatment, or it might be many years. But whatever your situation, it can be a big shock hearing that your cancer has come back. It can feel very difficult having to face treatment again and cope with a range of feelings such as shock, frustration and fear.
You might need further tests to find out more about where the cancer is, and to help your doctors decide what your treatment options are.
Your specialist doctor and nurse will talk to you about your test results and tell you about your treatment options and what they involve. They will explain more about the aim of treatment, and help you make decisions about treatment.
Aim of treatment
The aim of treatment for recurrent ovarian cancer is usually to shrink the cancer and control it for as long as possible. Treatment also aims to control symptoms and help you feel better.
Deciding about treatment
When you have a more advanced cancer, it can be difficult to decide which treatment to try, or in some cases whether to have treatment at all.
Your doctor may decide to wait until you develop symptoms before starting treatment. Treatment can control symptoms and help you to feel better. It may also help you to live longer.
You will need to balance the benefits of treatment with the effects on your quality of life while you are actually having treatment. Side effects may make you feel ill and treatment may cause stresses, such as travelling back and forth to the hospital. It is very important for you to understand what the treatment can achieve.
Your doctor will discuss the options for treatment with you. It can be helpful to talk over difficult decisions with someone who is outside your circle of family and friends, for example your cancer specialist nurse or a counsellor.
Your treatment options depend on what treatment you’ve already had, when you last had treatment and how well you are. It also depends on where the cancer is in your body.
The most common treatment for recurrent ovarian cancer is chemotherapy. Some women have targeted drug therapy. You might have surgery, depending on your situation.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You will probably be able to have chemotherapy even if you already had some at an earlier stage in your illness.
You usually have a chemotherapy drug called carboplatin when you’re first diagnosed. Carboplatin is a type of platinum chemotherapy. You might have it on its own or with another chemotherapy drug called paclitaxel (Taxol).
When ovarian cancer comes back, doctors usually describe your cancer as either ‘platinum sensitive’ or ‘platinum resistant’. This depends on how long it is since you last had chemotherapy containing a platinum chemotherapy.
Your treatment for recurrent ovarian cancer will depend on whether your cancer is platinum sensitive or platinum resistant.
What does platinum sensitive mean?
Platinum sensitive means your cancer comes back 6 months or more since you had your last carboplatin treatment. Your doctor might describe your cancer as:
- partially platinum sensitive – if your cancer comes back between 6 and 12 months after finishing carboplatin
- platinum sensitive – if your cancer comes back more than 12 months after finishing carboplatin
Your specialist usually suggests you have carboplatin again - sometimes with another chemotherapy drug, such as paclitaxel, liposomal doxorubicin (Caelyx, Myocet or Doxil) or gemcitabine.
Some ovarian cancers are very sensitive to platinum chemotherapy. So you might be able to have this treatment multiple times over many years. But most women will develop a resistance to platinum drugs over time.
What does platinum resistant mean?
Platinum resistant means your cancer comes back within 6 months of finishing your last carboplatin treatment. Your doctor might describe your cancer as:
- platinum resistant – if your cancer comes back in less than 6 months after your last carboplatin
- platinum refractory – if your cancer comes back during treatment with carboplatin, or within 4 weeks of your last treatment
It's unlikely that you will have carboplatin again. Your specialist may suggest one or more of the following treatments:
- paclitaxel alone, usually as a weekly treatment
- liposomal doxorubicin
Not all these treatments are suitable for everyone. Your doctor will talk to you about what drug might be helpful in your situation.
Your doctor might offer you treatment as part of a clinical trial.
You might be able to have surgery if your cancer comes back. Your surgeon will consider several factors when deciding if you might benefit from surgery. These include:
- whether they think they can remove all the cancer they can see
- whether you are well enough
- how long it is since you last had treatment
You might also have surgery to help with symptoms such as a blocked bowel.
Targeted cancer drugs
Targeted cancer drugs can help the body to control the growth of cancer cells. You might have a targeted cancer drug either alongside chemotherapy, or after chemotherapy if your cancer has come back.
Types of targeted cancer drugs for ovarian cancer include:
- bevacizumab (Avastin)
- olaparib (Lynparza)
- niraparib (Zejula)
Access to these drugs varies, depending on where you live in the UK.
Occasionally doctors suggest radiotherapy for advanced ovarian cancer. Radiotherapy can shrink tumours and reduce symptoms. This is called palliative radiotherapy.
Your doctor might also use radiotherapy to treat cancer that has spread outside the abdomen.
Symptoms of advanced cancer can be difficult to cope with. But doctors and nurses can offer support and treatment to help you.
You might need treatment to help with symptoms such as fluid in your tummy (ascites) or a blocked bowel (obstruction).
There is always research going on into improving treatment for different types of cancer. Your doctor may talk about clinical trials and ask whether you would like to take part.
These may be trials for new combinations of chemotherapy drugs or looking at adding other cancer drugs such as targeted cancer drugs.
Finding out that cancer has come back or spread can be a big shock. It might help to talk to a close friend or relative about how you feel.
You can get emotional and practical support through your hospital, local hospice and GP practice. You can also get help from charities and support groups.