Treatment of recurrent ovarian cancer

Recurrence has always been a major problem for patients with advanced ovarian cancer, and recurrence usually occurs more than 6 months after stopping medication. Recurrence of ovarian cancer after surgery is generally caused by incomplete treatment.

Many ovarian cancer patients believe that the tumor has been removed through surgery and that further treatment is unnecessary. This understanding is wrong. Although the tumor has been removed, there are still cancer cells remaining in the patient's body, which need to be suppressed and killed through further treatment.

Because recurrent ovarian cancer is usually not curable, treatment aims to relieve symptoms and prevent complications such as bowel obstruction. A common sign of recurrence is an elevated serum CA125 level in the absence of symptoms and normal physical examination or CT scan. An elevated CA125 level is considered the only marker of recurrence and usually precedes clinically evident tumors by a median interval of at least 3 months.

Because the main goal of treatment for recurrent ovarian cancer is to relieve symptoms, and there is a lack of strong evidence that early use of cytotoxic chemotherapy is beneficial for typical recurrent patients with only elevated markers, hormonal therapy such as tamoxifen or aromatase inhibitors is usually considered in this setting. Although less than 20% of patients respond to hormonal therapy, occasionally the CA125 level decreases significantly, and some patients may have prolonged stable disease, thus avoiding the side effects of cytotoxic therapy.