Coping with Ovarian Cancer and the Risk of Recurrence
- A woman, 26, was diagnosed with ovarian cancer after a tumor the size of a baby’s head was discovered on one of her ovaries. She’s urging women to be mindful of their menstrual health, as ovarian cancer symptoms are subtle and often mimic typical menstrual symptoms.
- Ovarian cancer is often harder to catch in its early stages because of its subtle symptoms, such as bloating, weight gain, and abdominal pain that can mimic regular menstrual cycle fluctuations.
- Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal.
- After ovarian cancer patients complete initial treatment, maintenance therapy may be recommended to try and delay possible recurrence.
- Genetic testing helps doctors determine the most effective maintenance therapy.
A woman, 26, diagnosed with ovarian cancer is urging women to keep a close eye on their menstrual health after experiencing symptoms including stomach aches years before her diagnosis.
“I think there’s this perception that women shouldn’t complain about problems to do with their menstrual health – you’re meant to just suck it up. But I refuse to any longer,” Sarah Nally told the UK news outlet “The Sun.”
Read MoreView this post on InstagramNally says she had experienced tiredness, stomach aches, and back aches for two years before she finally got answers to what was making her feel bad. When she went to see her doctor, she underwent tests after first believing she was dealing with a urinary tract infection (UTI).
A UTI occurs when “bacteria, often from the skin or rectum, enter the urethra and infect the urinary tract,” according to the Centers for Disease Control and Prevention.
However, further tests and scans revealed Nally had a tumor the size of a “baby’s head” on one of her ovaries. She was diagnosed with an aggressive form of ovarian cancer, which spread to both her ovaries and the lining of her stomach.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
Many ovarian cancers begin in the fallopian tubes. A few cancerous cells first grow on the fallopian tubes. Then, as the fallopian tubes brush over the ovary, these cells stick to the ovaries and eventually form a tumor.
“The symptoms include things like feeling full earlier than you usually would when your appetite is strong and feeling bloated. Some changes in your bowel habits. Some pain in the pelvis. These are symptoms women may have every month. These are not very specific. But we’ve found this constellation of symptoms from multiple studies,” Dr. Karlan added.
The symptoms of ovarian cancer may include the following, according to SurvivorNet experts.
- A feeling of bloating or fullness
- Pain in the pelvis or abdomen
- Nausea
- Vomiting
- Changes in bowel habits
Helping Patients Understand Treatment Options for Ovarian Cancer
For treatment, she underwent a hysterectomy. A hysterectomy is the surgical removal of part or all of the uterus (or womb), often along with the cervix.
“I was told that if it had been caught earlier, it would have been easier to treat and may have been able to save my reproductive system,” Nally said.
After undergoing a hysterectomy, Nally’s chances of pregnancy were nil.
RELATED: Treating Ovarian Cancer, Preserving Fertility
After Nally’s procedure, she was given the “all clear” from her doctors. However, as a byproduct of treatment, she now deals with the early onset of menopause.
“Menopause means different things to different people. The average experience begins with sleep disturbances, hot flashes, night sweats, and cessation of periods. The actual medical definition of menopause is more than twelve months of no periods,” Cedars-Sinai Medical Center OB/GYN and oncologist Dr. Bobbie J. Rimel explains to SurvivorNet.
Nally says although no evidence of disease exists at this time, she knows the chances of ovarian cancer recurrence are high.
“Every time the phone rings, I wonder if it’s going to be the hospital telling me they’ve found something on one of my scans,” Nally said.
When Ovarian Cancer Comes Back
Ovarian cancer recurrence happens in “almost 25 percent of cases with early-stage diseases and in more than 80 percent with more advanced stages,” according to research published in Gland Surgery medical journal. With recurrence a strong possibility for this disease, especially in the later stages of ovarian cancer, certain drug treatments to deal with it are giving many women hope.
RELATED: Dealing with recurrence.
WATCH: Treating ovarian cancer.
Ovarian cancer is sub-categorized into two groups.
Platinum-Sensitive Ovarian Cancer: Your cancer does not return for more than six months after treatment with platinum-based chemotherapies, like carboplatin and cisplatin.
Platinum-Resistant Ovarian Cancer: Your cancer returns within six months of treatment with platinum-based chemotherapies, like carboplatin and cisplatin.“The mechanism that causes platinum resistance will cause someone to be resistant to other chemotherapies, as well. That’s why we’re looking for what we call targeted therapies – precision medicine,” Dr. Noelle Cloven from Texas Oncology-Fort Worth Cancer Center explained.
RELATED: Recurrent Ovarian Cancer Treatment Is Your Disease “Platinum-Sensitive”?
Targeted therapies or precision medicine specifically target the proteins controlling cancer cells’ growth, division, and spread.
Maintenance Therapy for Ovarian Cancer
Maintenance therapy is continued treatment after the patient finishes their initial treatment. After an ovarian cancer patient completes a round of treatments — such as surgery and chemotherapy — her doctor may recommend some form of maintenance therapy to try and delay possible recurrence. Maintenance therapy can involve taking an oral pill called a PARP inhibitor every day after chemotherapy and can keep cancer in remission longer.
Genetic testing helps doctors determine the best maintenance therapy.
“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Alpa Nick, a gynecological oncologist with Tennessee Oncology in Nashville, tells SurvivorNet.
The drugs have very different ways of combatting cancer cells. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
The Food and Drug Administration approved bevacizumab (Avastin) to be used in conjunction with olaparib (brand name LYNPARZA) in HRD (Homologous Recombination Deficiency) positive women who show a response to platinum-based chemotherapy. During clinical trials, the drug combination increased progression-free survival from an average of 17 months to 37 months.
“A patient really has to make a decision upfront, or near the beginning of their treatment, that they want bevacizumab maintenance treatment because they’ll have it with their primary chemotherapy,” Dr. Nick explains.
The drug is administered intravenously and can be given in combination with other chemotherapy drugs. Avastin affects the growth of blood vessels, starving tumors of the blood they need as nourishment.
The American Society of Clinical Oncology (ASCO) guidelines recommend PARP inhibitors be offered to women, with or without genetic mutations, who are newly diagnosed with stage III or IV ovarian cancer and have improved with chemotherapy.
Surgery offers another important decision point. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency,” known as HRD. If it does, that also suggests they would benefit from PARP inhibitor maintenance therapy,” says Dr. Nick.
Elahere (molecular name mirvetuximab) is an FDA-approved targeted therapy providing much-needed hope for patients with platinum-resistant ovarian cancer. This drug treatment is for women who test positive for a molecular factor called folate-receptor alpha (FRα). While many ovarian cancers test positive for the folate receptor, to be eligible for Elahere, you must have very high levels (>75%) of the folate receptor-alpha (FRα).
It is an antibody-drug conjugate. This kind of new anti-cancer drugs, known as “biological missiles,” is leading a new era of targeted cancer therapy.
Dr Lyons explains, “What that means is that the antibody part of the drug conjugates binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell. And then the drug that is conjugated with is the part that kills the tumor cells by affecting the tumor cell’s ability to divide.”
Questions for Your Doctor
If you have been diagnosed with ovarian cancer and need guidance to further educate yourself on the disease and treatment, consider these questions for your doctor.
- What type of ovarian cancer do I have?
- What stage is my cancer in?
- Do you recommend I get genetic testing for any gene mutations, such as the BRCA gene mutation?
- What initial treatment options do you recommend?
- What are the possible side effects of the recommended treatment, and how can they be coped with?
- Will insurance help cover my recommended treatment?
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