Ovarian Cancer Recurrence: Discussion With an Expert

Most cases of ovarian cancer are caught in the later stages, and as a result, many women end up facing a recurrence, which can bring about a new set of physical and emotional challenges for these patients, according to Scott Richard.

"A lot of women have a fear of recurrence," Anitra Hunt, of the National Ovarian Cancer Coalition said, emphasizing the need for more research that will bring about newer and more effective treatments.

How common is ovarian cancer recurrence, and is there a certain population that is more at risk?

CURE spoke with Scott Richard, M.D., associate professor at the Sidney Kimmel Medical College at Thomas Jefferson University about ovarian cancer recurrence, and what more needs to be done in the field.Unfortunately, about 70 percent of all ovarian cancer patients are found at a very advance stage — stage 3 or 4 – and the majority of those, about 80 percent will recur. So ovarian cancer recurrence is something that most women with ovarian cancer will deal with.

I think regarding risk, it is just the fact that we catch the majority of these cancers at a very high stage.

Is this part of the discussion during their initial diagnosis?

That's actually a very interesting question. When we [oncologists] first discuss the diagnosis, we focus on initial treatment and talk about the five-year survival rates and how we're going to treat the cancer. Oftentimes we don't spend a lot of time talking about recurrence and that treatment. But if someone asks, I, personally in my practice, will let them know that there is a high likelihood that this cancer will come back.

What kind of prognosis do these patients typically face?

Unfortunately, when we talk about a recurrence of cancer, no longer can we talk about curing the cancer. But the prognosis is actually pretty decent. Some of our current treatment regimens that we're doing with women who have a very good response upfront to surgery and chemotherapy, survival can be greater than seven, eight years for these women. So even in the setting of recurrence, we can usually get these women into remission and keep them in remission for a period of time. So although we no longer talk about curing the disease, we still have a very good long-term prognosis for these women and still manage to give them a decent lifespan with good quality of life.

What more needs to be done in this field?

What we really need to focus on with ovarian cancer is being able to treat these women a little bit better. We've been focusing a lot of efforts on trying to get a diagnosis tool, like a pap smear or a mammogram or a colonoscopy for ovarian cancer, but as far as we know, that is not something that we're going to be able to identify because the majority of women with high-grade ovarian cancer can have normal test results and three or six months later have widespread cancer.

So, a lot of our efforts should be about doing better with treatment for ovarian cancer, both upfront and in the recurrent setting. I think part of that is coming up with targeted agents that will do better in treating those cancers.

What is the difference the second time around with ovarian cancer?

A lot of the medications they get can be similar to what they had the first time around if they are platinum-sensitive. Oftentimes, though, because they've been treated with chemotherapy before, their quality of life can be affected with that chemotherapy the second time around. There can be more side effects, and more problems in the recurrent stage. So a lot of our efforts as oncologists are focusing on the treatment aspects of the recurrent settings. We try to focus on questions like: What are the effects that the treatment is having on the patients? What can we do better as far as nausea or neuropathy and other side effects?

What are some of the largest barriers that women with recurrent ovarian cancer face, and what kind of advice can you give to them?

The biggest barrier, particularly in recurrence, is that the worst case scenario for these patients has come back. First they had a cancer diagnosis, and with all efforts to have that cancer cured, it still came back. So the biggest barrier, I think, is definitely an emotional aspect. With focusing on the patients’ social status, making sure they have a good support network and we ask the proper questions about how they're doing, really focusing on quality of life issues are a very big aspect to help them overcome the barriers of the recurrence of their cancer. I definitely think a lot of it is an emotional more than a physical barrier that we encounter in the recurrent setting.

Ideally, what should be done for this population of patients?

In an ideal world, we'd be able to find the individual nature of each cancer that makes a cancer different from one woman to the other and be able to treat that cancer. Like treat Mrs. Smith or Mrs. Jones in the exact way Mrs. Smith or Mrs. Jones' cancer should be treated, thereby identifying the things that may make it more likely to recur and treating those upfront.

Unfortunately, when we have a diagnosis like ovarian cancer, we treat the majority of women the same upfront. What we're realizing is that ovarian cancer is not just ovarian cancer. It has a lot of different individual characteristics for each patient. When we can identify those factors upfront is when we're going to be able to get a higher cure rate. Today we don't have that.