Washington Woman Who Beat Ovarian Cancer Went Nine Years ‘Cancer-Free’ Until Pain In Her Back Kickstarted a Second Diagnosis – Coping With Recurrence

“It is hard to know what to do, what to think, how to feel, where to go, and why to bother when given such news,” Dano said, according to West Virginia News.

After nine years cancer‑free, sudden back pain sent her back to the doctor, where scans revealed a large tumor near her aorta — the body’s largest blood vessel. Learning she would need more chemotherapy was devastating, and she says the side effects, including nausea and neuropathy, were even tougher the second time around.

WATCH: Ovarian cancer’s subtle symptoms.

Ovarian cancer has been called the “cancer that whispers” because women often don’t experience symptoms until their cancer has already reached its late stages. The symptoms that do appear at first are hard to identify as cancer.

“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.

There are more than 30 types of ovarian cancer, but three forms are most common:

• Epithelial tumors — about 90% of cases; they form on the ovary’s surface and can spread quickly.
• Stromal tumors — rare growths that develop in hormone‑producing connective tissue.
• Germ cell tumors — typically found in younger women and often highly curable.

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

The standard of care for ovarian cancer patients is chemotherapy, which helps many patients reach remission.

WATCH: Treating ovarian cancer.

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 the 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.

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.

New Treatment for Hard-to-Treat Form of Ovarian Cancer

A newly approved treatment by the U.S. Food and Drug Administration (FDA) for patients with platinum-resistant ovarian cancer. Platinum resistance is typically defined as progression within 6 months of receiving platinum-based chemotherapy. The Phase III ENGOT‑ov65/KEYNOTE‑B96 trial has shown great promise for this difficult-to-treat form of ovarian cancer, exploring adding immunotherapy, where the patient’s own immune cells are reengineered to fight cancer, to chemotherapy.

For patients whose tumors had a PD-L1 (protein on the surface of some cancer cells) CPS combined positive score (measures how much PD-L1 a tumor expresses) of 1 or higher, treatment with pembrolizumab helped them go longer without the cancer growing. Their median progression-free survival was 8.3 months compared with 7.2 months for those who received a placebo, a difference that was statistically meaningful.

“In the platinum-resistant setting, I believe these will be favored regimens, so as a second-line therapy…Ultimately, cross-trial comparisons will drive some of the influence of those trials and the sequencing of therapy. This will likely be further augmented by biomarker expression, which we expect to be more robust as time goes on,” Dr. Dana Chase, a professor of gynecologic oncology at UCLA Health, explains to SurvivorNet.

WATCH: Ovarian Cancer – The Importance of Increasing Diversity in Clinical Trials

Dr. Chase adds that the sequencing of treatment matters when or if it is added to other treatment options.

“The sequencing of the treatment is really dependent on the patient’s tumor biomarker profile. We will need to take into consideration: biomarker profile, prior toxicities, patient’s performance status, and goals of treatment.” Depending on those three factors, doctors can best decide which treatment to pursue first.

Genetic Testing and Ovarian Cancer

Genetic testing—analyzing a patient’s DNA or biopsy tissue—can reveal critical insights about cancer: how it forms, how it behaves, and how best to treat it.

“There are certain cancer-causing genes that can be passed down from generation to generation,” explains Dr. Derrick Haslem, the director of medical oncology at Intermountain Healthcare in Salt Lake City.

As researchers uncover more about these inherited mutations, they’re not only pinpointing who might be most at risk—they’re also refining how cancers are detected and treated.

When it comes to ovarian cancer, this information is especially vital.

WATCH: What genetic testing reveals about your cancer?

“There are a lot of mutations that put people at a higher risk for ovarian cancer,” says Dr. Haslem. That’s why your medical team asks about your family history—because genetic red flags can run in families. “If you have a family history of ovarian cancer or breast cancer, that’s a really important thing to bring up with your healthcare provider.”

Mutations in the BRCA1 and BRCA2 genes are among the most common genetic links to ovarian cancer. Another factor, homologous recombination deficiency (HRD), can occur in women with BRCA mutations and further disrupts the cells’ ability to repair their DNA.

If you do have a strong family history, your doctor may recommend testing for BRCA mutations or other inherited syndromes like Lynch syndrome, which can also increase risk for ovarian, colorectal, and breast cancers.

Sometimes, testing positive for a high-risk mutation may lead to conversations about preventive steps. “If you were tested and you had that gene, then somebody might talk to you about prophylactic surgery to remove the ovaries and fallopian tubes,” says Dr. Haslem. This kind of preventive surgery can significantly reduce future cancer risk in those genetically predisposed.

Beyond risk assessment, genetic findings also guide treatment. “Certain chemotherapies and targeted therapies are much more effective in those types of cases,” Dr. Haslem adds. For example, PARP inhibitors—designed to block DNA repair in cancer cells—have shown strong results in patients with BRCA mutations and HRD.

Ultimately, genetic testing isn’t just about knowing your risk—it’s a tool that helps tailor treatment and potentially saves lives.

Ovarian Cancer Recurrence and Treatments to Help

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 the 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.

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 plays a critical role in helping ovarian cancer patients stay in remission after completing their initial treatment, which often includes surgery and chemotherapy.

“Maintenance therapy is continued treatment after the patient finishes their initial treatment,” explains Dr. Alpa Nick, a gynecologic oncologist with Tennessee Oncology in Nashville.

WATCH: PARP inhibitors are now options as part of ovarian cancer treatment for a growing number of women.

One common form of maintenance therapy is a daily oral medication known as a PARP inhibitor, which works by preventing cancer cells from repairing their DNA.

“The biggest question is: How do you choose between bevacizumab (brand name, Avastin) or a PARP inhibitor for maintenance therapy?” Dr. Nick says.

Both are effective options, but they take very different approaches. While PARP inhibitors target cancer cells’ internal repair systems, Avastin works externally by blocking new blood vessel growth, essentially starving tumors of the needed nourishment.

Genetic testing is key to determining which treatment is most effective. “When patients have their surgery, we can test their tumor to decide if their tumor has a homologous recombination deficiency (HRD),” says Dr. Nick. If HRD is present, patients are more likely to benefit from PARP inhibitors.

Some women may be candidates for a combination approach. The Food and Drug Administration (FDA) has approved Avastin in combination with olaparib (brand name Lynparza) for women with HRD-positive tumors who respond to platinum-based chemotherapy.

This pairing increased progression-free survival in clinical trials from 17 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,” adds Dr. Nick.

American Society of Clinical Oncology (ASCO) guidelines now recommend that PARP inhibitors be offered to women newly diagnosed with stage III or IV ovarian cancer, regardless of their genetic status, if they’ve responded well to chemotherapy.

Meanwhile, another breakthrough therapy is offering new hope for patients with platinum-resistant ovarian cancer: Elahere (mirvetuximab). This targeted treatment is designed for women who test positive for high levels of folate receptor-alpha (FRα), a molecular marker found on some ovarian cancer cells.

“What that means is that the antibody part of the drug conjugate binds to the folate receptor on the tumor cells, and then that gets taken up into the tumor cell,” says Dr. Lyons.

“And then the drug that is conjugated with is the part that actually kills the tumor cells, by affecting the tumor cells’ ability to divide.” Often described as “biological missiles,” these antibody-drug conjugates are ushering in a new age of precision therapy.

Ovarian Cancer Recurrence

When cancer returns, it is referred to as recurrence. It often occurs because some cancer cells are left behind after treatment. Those cells grow over time and are eventually detected in follow-up scans received by patients in remission.

Ovarian cancer patients faced with a recurrence will likely need to restart chemotherapy or consider another surgical procedure.

WATCH: Ovarian cancer recurrence.

The type of treatment recommended for recurrence can depend on several factors:

• The period within which the cancer recurred
• The kind of chemotherapy the woman underwent in the past
• Side effects that came as a result of past treatments
• The length of time between the last treatment the woman underwent and the recurrence
• The specific mutations and molecular features of your cancer

If a woman’s time between remission and recurrence is more than six months, then the ovarian cancer is categorized as “platinum-sensitive” (that is, responsive to a platinum-based chemotherapy treatment), and that patient will be treated with chemotherapy and another platinum-based drug.

If the recurrence time happens less than six months into remission, the ovarian cancer is classified as “platinum-resistant.” At that point, women are usually treated with another type of chemotherapy and encouraged to enter a clinical trial. Alternatively, women might be platinum-refractory, which refers to a disease that grows while the patient is on chemotherapy and has a particularly poor prognosis.

Determining the probability that a woman’s cancer will recur depends on the stage at which they were initially diagnosed. According to most data:

• Women with stage 1 ovarian cancer have a 10 percent chance of recurrence.
• Women in stage 2 have a 30 percent chance of recurrence.
• Women in stage 3 have a 70 to 90 percent chance of recurrence.
• Women in stage 4 have a 90 to 95 percent chance of recurrence.

WATCH: Clinical trials can be life-saving.

Clinical trials are an option for women facing ovarian cancer with a high probability of recurrence. If you fall into this category, ask your doctor about possible clinical trial eligibility. Clinical trials help doctors better understand cancer and discover more effective treatment methods. They also allow patients to try a treatment before it’s approved by the U.S. Food and Drug Administration (FDA), which can potentially be life-changing.

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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