Navigating an Ovarian Cancer Diagnosis and Treatment
- Actress Cobie Smulders, who is in remission from ovarian cancer after being diagnosed nearly 20 years ago, will reportedly be joining the fourth season of the American legal drama television series “The Lincoln Lawyer” on Netflix.
- In 2007, Smulders started noticing unusual symptoms such as low energy and fatigue, which kickstarted her journey to learning she was facing early-stage ovarian cancer.
- Ovarian cancer symptoms are harder to detect, especially during its early stages. Symptoms may include feeling bloated or full, pain in the pelvis or abdomen, nausea, vomiting, or changes in bowel habits.
- Ovarian cancer treatment usually involves surgery called a “debulking procedure” that removes most of the tumor. Chemotherapy often follows surgery to get any remaining bits of cancer.
- PARP inhibitors are drugs that treat ovarian cancer at the genetic level. They work by stopping rapidly dividing cancer cells from repairing their own genetic damage, preventing them from replicating.
- Advanced ovarian cancer patients may also turn to a type of antibody-drug conjugate called Elahere (molecular name mirvetuximab soravtansine) that has been shown to help patients live longer without their disease progressing.
Smulders battled ovarian cancer when she was 25 years old, a diagnosis she received in 2007, and despite only having one-third of her ovaries after beating the disease, she was able to give birth naturally to her two kids. Following multiple surgeries and going into remission in 2019, it’s incredible to see how far she’s come since.
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Tudum by Netflix also reported that the new season will consist of 10 episodes and be based on the sixth book in Michael Connelly’s Lincoln Lawyer series, called “The Law of Innocence.”
Although production is confirmed to be underway, a precise release date has not been disclosed.
“The Lincoln Lawyer,” a TV series created for television by David E. Kelley and developed by Ted Humphrey, first premiered on Netflix on May 13, 2022.
The first season was based on Connelly’s 2008 novel The Brass Verdict, while the second season was based on the author’s 2011 novel called The Fifth Witness.
The third season was based on season on his 2013 novel The Gods of Guilt.
Smulders’ Ovarian Cancer Journey
While Smulders was filming “How I Met Your Mother,” she began experiencing unusual symptoms that made her feel as though “something was off,” she previously recounted in an essay for Lenny Letter.
She wrote, “Anyone who has been diagnosed with cancer or even known someone who has been diagnosed with cancer is aware of its total mental, physical and emotional possession.
“Hell, even if you haven’t been closely affected, I’m sure you can easily conceptualize the thundercloud of shit that rains down on you.”
As for how her cancer journey started, she explained, “My energy was low, I was just so tired all the time, and I felt a constant pressure on my abdomen that I could not explain.”
Being proactive about her symptoms, she went to see her doctor, which led to her ovarian cancer diagnosis.
Expert Ovarian Cancer Resources
- ‘An Important Step Forward’: New Drug Combo Shows Promise For The Treatment of Some Ovarian Cancer
- 11 Ovarian Cancer Tests Used for Patient Diagnosis
- 3 Common Myths About Ovarian Cancer Screening
- 7 Well-Known Women Who Battled Ovarian Cancer, Including Actresses Kathy Bates, Cobie Smulders & Activist Coretta Scott King; What to Know About the Disease
- A Comprehensive Guide to an Advanced Form of Ovarian Cancer Known as ‘Folate Receptor-Alpha Positive’
- A Healthy Diet During Ovarian Cancer
- A Key Marker for Ovarian Cancer– What is CA-125?
- Administering Chemotherapy for Ovarian Cancer
- Advances in Ovarian Cancer Treatment
- Anxiety After Ovarian Cancer — What Can I Do?
Smulders, a mother of two, ultimately had to balance her busy work schedule in addition to her cancer treatment appointments, which she handled well.
She was diagnosed in 2007. Following treatment, Smulders said she was given a “clean bill of health.”
“The thing is, I don’t know if I will ever be free of my cancer – or, to be more specific, free from the fear of my cancer’s return. Still, it has become, for many people, a livable disease, something that you learn to manage. And that’s what I have done,” Smulders said.

Meanwhile, Smulders welcomed her first child, Shaelyn, in May 2009. She later gave birth to her second child, Janita, in January 2015. The mom of two shares her children with her actor/comedian husband Taran Killam, who she’s been married to since 2012.
In an earlier interview with People, Smulders said she thanks her “great” oncologist for helping her through cancer. However, she recalls not being able to easily obtain information on her disease and fertility options.
“I remember doing mad, crazy Google searches on my disease and trying to understand it better,” she explained. “And obviously I was talking to my doctors, but there wasn’t at the time and it was very bleak.”
Smulder’s surgery to remove her cancer took a toll on her reproductive system.
“I ended up keeping a third of one of my ovaries, and through that, was able to have two children naturally. Which, when I say that out loud, I can’t even believe that happened,” Cobie told Coping magazine. “When I was able to have kids, that was everything. And it still is everything.”
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Treating Ovarian Cancer
Ovarian cancer is called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages, making treatment more difficult. However, when it comes to the standard of care for treating ovarian cancer, surgery is often considered to be the first step.
If a doctor is confident that they can remove the ovarian tumor completely without initial cycles of chemotherapy, the doctor will go ahead with a surgical procedure. “If we think we can do that, we do what we call a debulking procedure or cytoreductive surgery,” gynecological oncologist Dr. Rauh-Hain explains. “That’s usually through an open incision.”
This surgical procedure often does not remove the tumor entirely. Ovarian cancer patients undergoing the debulking procedure usually undergo chemotherapy after the surgery to make sure the cancerous tissue is fully treated in a process called adjuvant chemotherapy. This process treats microscopic diseases that cannot be seen with the eye, which the clinician knows will persist in the body after an optimal surgical cytoreduction.
Dr. Dana Chase, gynecologic oncologist at Arizona Oncology, says that “80% of patients” go into remission after chemotherapy for “at least a period of time.”
The standard treatment for ovarian cancer is made up of two drugs working in combination for “initial chemotherapy” — Carboplatin and Paclitaxel. The typical course of chemotherapy is made up of three to six treatment cycles based on what stage of cancer the patient has, but different drugs have different treatment cycles.
After initial treatment, patients may receive maintenance therapy to help ensure the cancer does not return.
“We use some maintenance therapies with chemo and then continue them after chemo, such as Avastin, while others we use after chemo, such as Olaparib,” Dr. Chase says.
WATCH: How PARP inhibitors impact ovarian cancer treatment.
PARP inhibitors are options for women as maintenance therapy after the first chemotherapy or platinum-sensitive recurrence or as a treatment for recurrence. PARP inhibitors stop rapidly dividing cancer cells from repairing their own genetic damage, preventing them from replicating.
The benefit a woman may see from PARP inhibitors varies greatly, with the biggest determinant being the presence of an inherited or tumor mutation in BRCA. BRCA gene mutation increases a woman’s risk of breast and ovarian cancer. Experts tell SurvivorNet that every woman with ovarian cancer should get a genetic test to determine if they have a BRCA gene mutation because the mutation enables PARP inhibitors to function much more powerfully.
Advancements in Ovarian Cancer Treatment
Promising advancements have offered new hope to patients who typically haven’t had many options. Remember, many ovarian cancer patients are diagnosed once the cancer has advanced into later stages. Cancer that has spread to other body parts is more challenging to treat.
MORE: Treating Recurrent Ovarian Cancer
For advanced ovarian cancer that has a tendency to come back and has become resistant to platinum-based chemotherapy, more has to be done during treatment.
Cancer that comes back within six months of treatment with a platinum-based chemotherapy drug is called platinum-resistant. If the cancer returns after six months following platinum-based chemotherapy is finished, it is called platinum-sensitive.
Women with these stubborn tumors have additional treatment options thanks to advancements in ovarian cancer treatment. The cancer drug Elahere (molecular name mirvetuximab soravtansine) was approved by the Food and Drug Administration (FDA) for certain patients with platinum-resistant disease who had received one to three previous treatments.
Dr. Anna Berkenblit, Chief Medical Officer at ImmunoGen, explained to SurvivorNet what Elahere, an antibody-drug conjugate, did for patients in a pivotal trial called MIRASOL.
“We have longer progression-free survival, which means the patients are living longer without their cancer progressing. And most importantly, we have demonstrated that patients are living longer,” she said.
WATCH: Investigating New Ovarian Cancer Treatments
Elahere targets the folate receptor alpha protein located on the tumor cell’s surface. It offers effective treatment for a large population of women with advanced ovarian cancer.
“It is approved now for patients with high folate receptor alpha level expression, and that’s about 35% to 40% of all ovarian cancer patients,” Berkenblit explained.
“Available therapies for these (platinum-resistant) patients are typically single-agent chemotherapies. And now we’ve shown that Elahere is better than the available therapies,” Dr. Berkenblit said.
The MIRASOL trial looked at how Elahere performed compared to giving chemotherapy alone in patients with folate receptor alpha-positive platinum-resistant ovarian cancer.
In the trial, more than one-third of patients (36%) receiving Elahere (who had previously been treated with the targeted therapy bevacizumab) experienced improved progression-free survival (how long a patient goes without their disease worsening), and more than one-fourth (26%) experienced improved overall survival (how long the patient lives).
In another, smaller group of patients who had not previously been treated with bevacizumab, progression-free survival was 34% better, and overall survival was 49% better than when patients received standard chemotherapy.
Thriving After Cancer: Finding Vitality and the ‘Pathway’ to Resilience
Psychiatrist Dr. Samantha Boardman suggests that people working on their mental health practice positive psychology. Positive psychology focuses on encouraging patients to feel positive and finding what brings a sense of vitality to their lives.
Dr. Boardman explains them as “pathways to embrace your everyday resilience.” In other words, these are tools people who may be struggling with mental health issues can embrace to help maintain a certain sense of positivity. And those positive feelings can go a long way when people are facing a health challenge like a cancer diagnosis.
According to Dr. Boardman, these three wellsprings of vitality are:
- Connecting. This involves how you’re connecting with others and having meaningful interactions. It involves being a good listener and being engaged with the people around you who you care about.
- Contribution. How are you adding value to the people around you? Are you helping them in ways that feel meaningful to them? This entails contributing/engaging with others in a meaningful way.
- Feeling challenged. Being “positively challenged” could involve learning something new (perhaps by taking a new class or reading an interesting book) and expanding your mind in some way.
“Those are the cores of vitality and the core pathways to enhance your everyday resilience,” Dr. Boardman said.
Finding Joy During & After Cancer
When faced with a cancer battle, whether you’re an adult or a child, it can be difficult to focus on life outside of your disease. However, it’s important to remember that your mental state can actually impact your success as a patient.
“I’m pretty good at telling what kind of patients are going to still have this attitude and probably going to live the longest, even with bad, bad disease,” Dr. Zuri Murrell, a colorectal surgeon at Cedars-Sinai Medical Center, previously told SurvivorNet. “And those are patients who, they have gratitude in life.”
Dr. Dana Chase, a gynecologic oncologist at Arizona Oncology, also advocates for cancer warriors to prioritize their mental health. She noted that emotional well-being has been studied as a factor in patient outcomes.
“We know from good studies that emotional health is associated with survival, meaning better quality of life is associated with better outcomes,” Dr. Chase told SurvivorNet in an earlier interview.
“So, working on your emotional health, your physical well-being, your social environment [and] your emotional well-being are important and can impact your survival. If that’s related to what activities you do that bring you joy, then you should try to do more of those activities.”
According to Dr. Chase says doing things that bring you joy is important, and there’s no right or wrong ways to do so. Paying attention to your emotional health could look like spending time with friends and dancing. Others might turn to painting, writing, watching movies, or playing sports.
Dr. Chase recommends writing down ten things that make you happy and intentionally making the time to do those activities throughout the day.
What Still Brings You Joy? Your Emotional Health is So Important to Living with Ovarian Cancer
“Sometimes I will talk to a patient about making [a] list of the top ten things that bring them joy,” Chase says. “And trying to do those ten things, to make at least 50 percent of their experiences positive throughout the day.”
“Sometimes I will talk to a patient about making [a] list of the top ten things that bring them joy,” she continues. “And trying to do those ten things, to make at least 50 percent of their experiences positive throughout the day.”
Contributing: SurvivorNet Staff
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