By News18,Swati Chaturvedi

Copyright news18

Recurrent ovarian cancer is a condition that occurs when cancer cells start growing back, despite surgery and chemotherapy. The reason this happens is that it’s impossible to know during surgery whether all cancer has been removed, and it only takes one microscopic cell left behind to start growing months or years later. Even though women are offered chemotherapy, sometimes cancer cells can be resistant, and despite treatment, they may continue to grow. Ovarian cancer can recur after initial treatment in about 70–80% of advanced-stage cases within 18 months of therapy.
Dr. Sunny Jain, Sr. Consultant & HOD, Medical Oncology, Accord Super Speciality Hospital, Faridabad, shares all you need to know:
There are several risks for recurrence. First, we look at the stage of cancer. In stage one, which is the early stage, the risk of recurrence is quite small, and the majority of patients are cured with surgery alone. Some may also need chemotherapy. As the stage advances (up to stage four), the risk of cancer returning increases.
It is also important to consider the grade of the tumor, which looks at the shape and behavior of the cells. Grade one tumors grow relatively slowly, while grade three tumors grow rapidly. Faster-growing cancer cells carry a higher risk of recurrence.
Women who are unable to undergo surgery, perhaps due to other health conditions, have a much higher risk of recurrence. Similarly, not receiving optimal chemotherapy for example, due to complications or other medical conditions also increases recurrence risk.
Main Treatment Options
We assess all patients for surgery when cancer comes back. The most important factor is how much time has passed since the cancer returned. If recurrence occurs within a few months, surgery offers limited benefit. If it has been a year or longer, surgery may be considered. Surgery is only advisable if the surgeon is confident that all cancer can be removed. Secondary debulking surgery may be possible once, but subsequent surgeries become increasingly risky.
Chemotherapy can be used multiple times. As long as it is effective, it can be repeated.
There are also targeted treatments, such as trametinib, which is available for low-grade tumors, and PARP inhibitors, which target an enzyme (PARP) that cancer cells use to repair themselves. Hormone therapy can also be used for slow-growing cancers; low-grade carcinomas may respond well, slowing growth or shrinking the tumor. These treatments must be carefully assessed individually.
Radiotherapy is a highly targeted treatment, usually used for a single site of disease—for example, a lymph node while chemotherapy is more commonly used.
With recurrent ovarian cancer, it’s crucial to establish whether the tumor is still sensitive to chemotherapy. Regardless of whether it is the first recurrence or after multiple lines of chemotherapy, the time it takes for cancer to return helps determine which chemotherapy is likely to be effective.
Platinum-resistant cancer recurs within six months (approximate) and is less responsive to chemotherapy.
Platinum-sensitive cancer recurs after 12–18 months and is more likely to respond to chemotherapy.
Chemotherapy may be administered as a single drug or in combination, usually two, and sometimes three drugs. Each drug carries toxicity, so careful selection is necessary to minimize side effects.
When the tumor is chemo-sensitive, patients typically receive two drugs. If it is chemo-resistant, one or two carefully chosen drugs may be used depending on the cancer’s behavior, volume, and symptoms. Drugs can be reused or changed as needed, and effectiveness depends on the patient’s response.
Tips to Reduce the Risk of Ovarian Cancer Recurrence
Maintain a healthy body weight through regular exercise. Being overweight or underweight can increase inflammation, insulin sensitivity, and estrogen levels, as fat cells produce estrogen.
Targeted exercise: Combine strength training (bodyweight exercises) with low-intensity cardio (such as walking), starting as soon as possible, as advised by your doctor.
Balanced diet: Include more vegetables—ideally half your plate at every meal.
Avoid processed foods, red meat, refined grains, sugary drinks, and foods high in saturated and trans fats.
Avoid tobacco and alcohol in any form.