Coping with the Possibility of Recurrence in Ovarian Cancer
- Olympic gymnast Shannon Miller, 46, was diagnosed with ovarian cancer in 2011. She underwent surgery and aggressive chemotherapy to help her reach remission. She credits her resiliency used in gymnastics to fuel her desire to fight 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 Gland Surgery medical journal.
- After ovarian cancer patients complete initial treatment, maintenance therapy may be recommended to try and delay possible recurrence.
- Bevacizumab (Avastin) or a PARP inhibitor are maintenance therapy options. PARP inhibitors prevent cancer cells from repairing their DNA, while Avastin blocks the formation of new blood vessels, starving tumors of nutrients.
- Genetic testing helps doctors determine the most effective maintenance therapy.
Olympic gymnastics star Shannon Miller, 46, has earned dozens of medals as a world-renowned gymnast. Her resilience and willingness to succeed proved worthy when she was diagnosed with ovarian cancer, which flipped her world upside down. She says she treated her cancer journey like preparation for a big gymnastics competition, which helped her beat the disease.
“I think sports teaches you so many great life lessons, things like goal setting and teamwork, positive mindset, resiliency, and I think those were the things that I relied on, I kind of tapped into and utilized during my cancer journey,” Miller told KSAT news.Read More
Ovarian cancer symptoms can be sneaky and are easy to overlook.
“Ovarian cancer does not have any specific symptoms,” Dr. Beth Karlan, a gynecologic oncologist at UCLA Medical Center, told SurvivorNet.
This cancer is often referred to as the “cancer that whispers” because its symptoms can be vague and won’t draw attention directly to the ovaries.
WATCH: Signs of ovarian cancer.
“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 what we’ve found from multiple studies is this constellation of symptoms,” Dr. Karlan added.
Luckily, Miller realized something was amiss when she started experiencing stomach pain, bloating, and weight loss. A feeling of bloating or fullness and pain in the pelvis or abdomen are both signs of ovarian cancer. These symptoms led to her eventual cancer diagnosis.
Helping Patients Understand Treatment Options for Ovarian Cancer
Miller’s Journey from the Olympics to Beating Cancer
Miller was diagnosed with germ-cell ovarian cancer in 2011 after her doctor removed a baseball-sized cyst on her left ovary.
The term ovarian cancer refers to several different tumors that grow in the ovary. Many ovarian cancers begin in the fallopian tubes. A few cancerous cells first develop in the fallopian tubes. Then, as the fallopian tubes brush over the ovary, these cells stick to the ovaries and eventually grow to form a tumor.
Regarding germ cell tumors, they develop in the cells that produce the eggs and are more likely to affect a single ovary than both ovaries. The good news is that most women with these types of ovarian cancers can be cured.
After her diagnosis, she underwent surgery and aggressive chemotherapy.
In a previous interview with SurvivorNet, Miller said the nausea was one of the hardest parts of her journey. She said she often felt weak.
“Here, I had swung around uneven bars for more than a decade, and now I couldn’t open a bottle of water,” Miller said, comparing it to the gravity she had defied as a gymnast.
She set small goals for herself to get through her treatment and took it all one day at a time.
“My goal on many days was to get up, get dressed, and walk twice around the dining room table. And if I did that, I could check the box, and that was a good day. I didn’t always get there, but that was the goal,” she said.
While she is now cancer-free, she said she still undergoes regular testing to make sure the cancer hasn’t returned.
“I still get tested twice a year, and there’s still tough days. For the most part, I’m doing well, feel fantastic, and have no complaints. But testing days can bring anxiety. Every time you get a stomachache, you have to wonder: Did it come back? And that can get really difficult,” Miller explained to Sports Illustrated.
Since overcoming ovarian cancer, Miller has used her platform to spread awareness about the disease. She began by sharing her own story, hoping it would make an impact on other women.
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 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.
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 conjugate 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 actually kills the tumor cells, by affecting the tumor cells 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?