Treatment if your ovarian cancer comes back

Ovarian cancer can come back (relapse) after treatment. This is also called recurrent cancer.

Your cancer can come back in the same area. Or it can spread to other parts of the body. This is secondary or metastatic ovarian cancer. 

Recurrent ovarian cancer can’t be cured. Your treatment aims to: 

• shrink the cancer 
• control it for as long as possible
• help with any symptoms you have

Many people with recurrent ovarian cancer can live a normal life for a number of years.

Finding out your cancer has come back

It can be a big shock hearing that your cancer has come back. It may be very difficult having to face treatment again. 

You might need further tests and scans to find out more about where the cancer is. This also helps your doctors decide what your treatment options are.

Your healthcare team will talk to you about your test results. They will discuss your treatment options and what they involve. They will explain more about the aim of treatment, and help you make decisions.

Talk to your doctor or specialist nurse to understand:

• what your diagnosis means
• what is likely to happen
• what treatment is available
• how treatment can help you
• what the side effects of the treatment are

You might feel that you don’t want to know much information straight away. Tell your doctor or nurse. You will always be able to ask for more information when you are ready.

Everyone is different and there is no right way to feel.

Treatment options

Your treatment options depend on:

• what type of ovarian cancer you have
• where the cancer is in your body
• what treatment you’ve already had
• when you last had treatment
• how well you are

The treatment you might have includes:

• chemotherapy
• surgery
• targeted cancer drugs
• hormone therapy

Chemotherapy

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 with ovarian cancer. Carboplatin is a type of platinum chemotherapy. You might have it on its own or with another chemotherapy drug called paclitaxel.

When ovarian cancer comes back, doctors usually describe it as either:

• platinum sensitive
• platinum resistant

This depends on how long it is since you last had a platinum chemotherapy drug.

Your treatment depends on whether your cancer is platinum sensitive or platinum resistant.

What does platinum sensitive mean?

Platinum sensitive means your cancer has come back 6 months or more after 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. This is sometimes with another chemotherapy drug, such as:

• paclitaxel
• liposomal doxorubicin
• gemcitabine

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 within 6 months of your last carboplatin treatment
• 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, usually as a weekly treatment
• liposomal doxorubicin
• gemcitabine
• topotecan
• etoposide
• cyclophosphamide

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.

Surgery

You might be able to have surgery if your cancer comes back. Your specialist surgeon (gynaecological oncologist) will check where the cancer is in your tummy (abdomen) and remove as much of it as possible. 

This is called secondary cytoreductive surgery. You may also hear it called secondary debulking surgery.

Your surgeon looks at 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 for surgery
• how long it is since you last had treatment
• if you have any fluid build up in your abdomen (ascites)

Targeted cancer drugs

Targeted cancer drugs can help the body to control the growth of cancer that has come back. You might have a targeted cancer drug either: 

• with chemotherapy
• on its own after chemotherapy 

Types of targeted cancer drugs for ovarian cancer include:

• PARP inhibitors (including olaparib, niraparib and rucaparib)
• bevacizumab 
• trametinib

The type of targeted drug you have will depend on your type of cancer and any treatments you have already had. Access to these drugs can vary, depending on where you live in the UK.

Hormone therapy

Some ovarian cancers use hormones to grow or develop. This means the cancer is hormone sensitive or hormone dependent. Your doctor might suggest you have hormone therapy such as tamoxifen or letrozole.

This is not a common treatment for ovarian cancer.

Treating symptoms

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). Or you might have radiotherapy to shrink the cancer and reduce symptoms.

Research

Your doctor may ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to:

• improve treatment
• reduce the side effects of treatment
• develop new treatments

Getting a second opinion

Some people like to get an opinion from a second doctor. This is before they decide on their treatment. Most doctors are happy to refer you to another NHS specialist if you would find this helpful. 

Emotional support

Finding out that your cancer has come back 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
• your local hospice
• your GP practice
• charities
• support groups