Ovarian Cancer Recurrence: What You Need to Know When Cancer Returns

Ovarian cancer recurrence happens when cancer returns after a period of remission or after completing initial treatment. This is unfortunately common with ovarian cancer, making it crucial to understand what recurrence means, how to recognize it, and what treatment options are available if you experience it.

For many women diagnosed with ovarian cancer, the possibility of recurrence can be one of the most concerning aspects of their cancer journey. This crucial information can hopefully help you face this challenge and understand what to expect in the future.

How Common is Ovarian Cancer Recurrence?

According to research, recurrence occurs in about 25% of cases with early-stage disease and in more than 80% with more advanced stages. However, it’s important to keep in mind that the recurrence rate for ovarian cancer varies significantly depending on the stage at diagnosis and the type of ovarian cancer. (Learn more about ovarian cancer staging.)

In any event, these numbers highlight why ongoing monitoring is so important after completing initial treatment.

When Can Ovarian Cancer Recur?

There’s no set timeline for when ovarian cancer might return. For some women, it can happen weeks after completing treatment. For others, the cancer may not return for years.

Most recurrences happen within the first few years after treatment. According to research, about 80% of people with ovarian cancer experience a recurrence, with many of these occurring within the first 18 months after completing treatment.

The time between your last platinum-based chemotherapy treatment and recurrence is particularly important. Doctors often use this timeline to classify recurrences and guide treatment decisions:

• If cancer returns less than 6 months after platinum treatment: This is called “platinum-resistant” recurrence
• If cancer returns during treatment or within 1 month of platinum treatment: This is called “platinum-refractory” recurrence
• If cancer returns 6 months or more after platinum treatment: This is called “platinum-sensitive” recurrence

This distinction plays a crucial role in determining your treatment options. 

Where is Ovarian Cancer Likely to Recur?

When ovarian cancer returns, it can appear in different places throughout the body. The location of recurrence can affect both symptoms and treatment approaches.

The most common sites for ovarian cancer recurrence include:

• ​​The pelvis or abdomen (most common, occurring in a little more than half of the recurrences)
• Lymph nodes
• Liver
• Lungs

Less common sites include:

• Brain
• Bones
• Skin
• Breast

Sometimes, recurrence can happen in multiple locations simultaneously. Even if the cancer appears in a new area, it’s still considered ovarian cancer because it originated from ovarian cancer cells. For example, if ovarian cancer spreads to the lungs, it’s not lung cancer; it’s ovarian cancer that has metastasized to the lungs.

Can Ovarian Cancer Return if My Ovaries Have Been Removed?

Yes, ovarian cancer can return even if your ovaries have been surgically removed. This is a common question and an important point to understand.

Recurrence happens when microscopic cancer cells remain in your body after your initial treatment. These cells are too small to be detected by current imaging and testing methods. Over time, these remaining cells can multiply and grow, eventually becoming detectable tumors.

Even after a total hysterectomy with removal of both ovaries (bilateral salpingo-oophorectomy), these microscopic cells can remain in the pelvis, abdomen, or other parts of the body. When they begin to grow, they create a recurrence of the original ovarian cancer.

This is why your doctor will continue monitoring you after surgery, even when there’s no visible evidence of disease. Regular check-ups and being aware of potential symptoms can help catch any recurrence as early as possible.

Ovarian Cancer Recurrence Symptoms

The symptoms of recurrent ovarian cancer can be similar to those experienced during the initial diagnosis. Being familiar with these warning signs can help you seek medical attention promptly if they appear.

Common symptoms of ovarian cancer recurrence include:

• Abdominal bloating or swelling
• Pelvic or abdominal pain
• Feeling full quickly when eating
• Urinary symptoms (urgency or frequency)
• Changes in bowel habits (constipation or diarrhea)
• Unexplained weight loss
• Fatigue
• Nausea or vomiting
• Back pain

If cancer recurs in a new area of the body, you might experience symptoms specific to that region. 

For example, if cancer spreads to the lungs, you might develop a pleural effusion, which is fluid buildup between the two layers of membrane surrounding the lungs. This is very common with ovarian cancer and can be life-threatening if untreated. Symptoms may include worsening shortness of breath (especially when lying down), fever, or leg swelling, though some women may have no symptoms at all. When this fluid is drained, it would contain ovarian cancer cells that confirm the spread to the lungs.

It’s important to note that having these symptoms doesn’t necessarily mean your cancer has returned. Many of these symptoms can be caused by other conditions. However, if you experience persistent symptoms, especially ones similar to what you felt before your initial diagnosis, it’s essential to contact your healthcare provider promptly.

How is Ovarian Cancer Recurrence Diagnosed?

If you experience symptoms that might indicate recurrence, your healthcare team will use various methods to determine if the cancer has returned. These typically include:

• Blood tests: The CA-125 blood test is commonly used to monitor for ovarian cancer recurrence. This test measures the level of the protein CA-125, which is often elevated in women with ovarian cancer. Rising CA-125 levels might indicate recurrence, even before symptoms appear. Sometimes, treatment can be started based on CA-125 levels alone (called biochemical recurrence).
• Imaging tests: Your doctor will typically order imaging tests to look for signs of cancer, including CT scans or PET scans. These are usually combined with CA-125 results to confirm progression before starting treatment.
• Physical examination: Your doctor may perform a thorough examination, including a pelvic exam, to check for any physical signs of recurrence.
• Biopsy: A tissue sample is rarely needed to confirm recurrence unless there’s concern for a second primary cancer or if secondary debulking surgery is being considered.

Early detection of recurrence is essential, so maintaining your follow-up appointments is crucial. Your doctor will typically recommend a schedule of regular check-ups after completing treatment, often every 2 to 4 months for the first two years, then every 3 to 6 months for the next three years, and annually after five years.

Treatment Options for Recurrent Ovarian Cancer

If your ovarian cancer returns, there are several treatment options available. Your treatment plan will depend on several factors, including when your cancer recurred, where in your body the cancer has returned, what treatments you’ve had previously, and your overall health and preferences.

According to current National Comprehensive Cancer Network (NCCN) guidelines, oncologists have multiple treatment pathways available for recurrent ovarian cancer. The approach typically depends on whether your recurrence is classified as platinum-sensitive, platinum-resistant, or platinum-refractory. 

For platinum-sensitive recurrences, doctors often recommend platinum-based chemotherapy combinations. For platinum-resistant or refractory cases, alternative chemotherapy drugs may be used. Targeted therapies, including PARP inhibitors and bevacizumab (an anti-angiogenic agent that works to stop the tumor from growing new blood vessels), have also improved outcomes for many women and may be incorporated into treatment plans based on your specific tumor characteristics and genetic profile.

The best approach for your situation requires close collaboration with your healthcare team. Your oncologist will consider the latest evidence-based guidelines along with your circumstances to develop a personalized treatment plan. This might include chemotherapy, targeted therapy, surgery, or participation in clinical trials that offer access to promising new treatments. The goal is to find the most effective approach while maintaining your quality of life throughout treatment.

Living with Recurrent Ovarian Cancer

A diagnosis of recurrent ovarian cancer brings emotional challenges, but many women live for years with this disease. Treatments have improved significantly, allowing longer lives with better quality than previously possible.

To cope effectively:

• Build a support network of family, friends, and healthcare providers
• Consider joining a support group for women with recurrent ovarian cancer
• Stay informed about your disease and treatment options
• Maintain physical health through nutrition and appropriate exercise

Getting Support and Specialized Care

Seeking a second opinion from a gynecologic oncologist can provide valuable perspective, additional treatment options, and access to clinical trials. Most doctors support patients seeking second opinions.

Women who receive care from gynecologic oncologists typically have better outcomes than those treated by physicians without specialized training. Consider treatment at a center specializing in gynecologic cancers.

At Not These Ovaries, we’re funding research to improve outcomes for women with ovarian cancer. Advances in targeted therapies, immunotherapy, and personalized medicine offer hope for better management with fewer side effects.

Stay vigilant about symptoms, maintain follow-up appointments, and keep open communication with your healthcare team. With the right support and care, many women live meaningful lives despite recurrent disease.