Ovarian cancer recurrence

Relapse (from the Latin recidere) is a return of a disease that occurs after complete recovery (remission). This process is possible for almost any disease. Relapse of ovarian cancer is also recorded quite often - a severe and life-threatening pathology for the patient. In this article, we will try to get acquainted with the essence of the problem in more detail and analyze possible ways to solve it.

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Ovarian cancer recurrence rate

The recurrence of the disease is typical for almost any type of cancerous lesion of the body. But the probability of a secondary disease and the nature of its development largely depend on the affected organ, the scale of the disorders in the body, the presence of metastases, the time period of recognition of the disease and the beginning of treatment (at what stage of cancer it was detected and attempts to stop it were made).

For example, as disease monitoring shows, the recurrence rate of ovarian cancer detected at an early stage is from 20 to 50%. Such an impressive spread in statistics is associated with the characteristics of the patient's body, the level of sensitivity to the administered drug, the correct choice of treatment method and many other factors, including the woman's attitude to recovery.

If we are talking about stage I-IIA ovarian cancer, then the rates of relapse-free five-year and ten-year life with adequate treatment are about 27% and 7%, respectively. As the same medical statistics show, the maximum percentage of relapses of the early stage of recognition occurs in the first three years after the pathology is established. At the same time, half of the recurrent ovarian cancers occur during this period. This factor requires urgent and adequate treatment. After undergoing treatment, a woman should be under constant supervision of a gynecologist, undergoing regular examinations.

When the disease is diagnosed at a later stage, the risk of cancer recurring increases.

Causes of Ovarian Cancer Recurrence

Relapses of malignant ovarian lesions are quite common. Due to the rapid spread of metastases, the frequency of relapses of such a disease is high. And it is because of this that in most cases the disease is diagnosed at a late stage of manifestation, which leads to a fairly high mortality rate of patients.

Many of the causes of ovarian cancer recurrence are still unknown, but a number of them can still be named:

1. For a long time (over the course of several years), high levels of hormones (especially estrogens) were observed in the woman’s body.
2. Mechanical, chemical or thermal damage to the ovary.
3. Hereditary predisposition to this disease. If close relatives have already had ovarian or breast cancer. This fact significantly increases the risk of recurrence.
4. Metastases penetrated the peritoneum and spread to the lymph nodes.
5. Incomplete elimination of affected cells or organ parts. The remaining mutated cells continue to develop and provoke a new round of the disease.

In order to prevent or minimize the fact of relapse, doctors tend to resect not only the affected ovary itself, but also the surrounding tissues. Such radicalism allows increasing the woman's chances for a full recovery.

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Symptoms of Ovarian Cancer Recurrence

If after a certain period of time after the disease has been stopped, a woman begins to develop pathological symptoms, there is no time to hesitate. You should consult your doctor as soon as possible. The main thing is not to miss the early stage of the pathology. In this case, special attention should be paid to a number of factors. The symptoms of ovarian cancer relapse are as follows:

1. Growing malaise.
2. The appearance of heaviness and pain symptoms in the lower abdominal cavity.
3. Feeling of increased fatigue.
4. If menopause has not yet occurred or resection was not performed during the treatment period, menstrual cycle disorders are possible.
5. This discomfort may be accompanied by problems affecting organs located in the pelvic area.
6. There may be problems with urination or defecation.
7. In some cases, the appearance of metastatic pleurisy or ascites is observed.

The appearance of symptoms of ovarian cancer recurrence can manifest itself many years after the first case of detection of the disease. Therefore, a woman with an increased risk of recurrence should be especially attentive to her health, although approximately 25% of patients at the early stage of the disease do not experience any pathological symptoms at all, which further increases the danger of this disease.

Recurrence of mucinous ovarian cancer

The only difference between this type of malignant tumor and other types is that this pathology involves the presence of mucin in the cytoplasm of cancer cells. At its first manifestation, it is characterized by a high rate of spread, a fairly smooth surface of the neoplasm and noticeable dimensional indicators of the tumor. The mucinous type of malignant ovarian tumor is a fairly rare form of the disease, which affects 5-10% of all cancer pathologies of this organ.

The high rate of development and spread of the disease leads to the fact that a relapse of mucinous ovarian cancer in a short period of time leads to a fatal outcome for the patient.

As medical oncostatistics show, the five-year survival rate in the case we are considering is quite frightening:

• When diagnosing stage I of the disease, it is about 84%.
• When diagnosing stage II, this figure is close to 55%.
• Patients with stage III cancer show a five-year survival rate of 21%.
• At the last stage (IV) this figure does not exceed 9%.

Treatment of recurrent ovarian cancer

After a woman has visited an oncologist for the second time, the health worker first clarifies the question of the time interval that has passed since the initial treatment of the disease.

For example, if chemotherapy with drugs such as cisplatin and carboplatin was carried out at least five months before, then the treatment of recurrent ovarian cancer in this case can be carried out with the same drugs. Moreover, the longer this interval, the higher the probability that similar treatment will bring its positive result and, perhaps, will still lead to a complete recovery.

The antineoplastic agent carboplatin-KMP is included in the treatment protocol for the patients discussed in this article, with a dosage calculated at 400 mg per square meter of the patient's body surface. The drug is administered intravenously. The rate of administration of carboplatin-KMP should be slow and, depending on the dose and the patient's condition, this procedure may take from a quarter to a full hour. Repeated infusion may be performed no earlier than four weeks later, and in the case of a satisfactory patient's condition.

If a woman falls into the risk zone with increased suppression of bone marrow hematopoiesis, the amount of the drug volume allowed for administration is reduced. A lower dose of the drug is also allowed in combination with other antitumor drugs.

Carboplatin-KMP is not used in its pure form; immediately before infusion, the drug is diluted with 0.9% sodium chloride solution or 5% glucose solution. This is done to maintain the recommended administered concentration of the drug to a concentration of no more than 0.5 mg/ml.

Contraindications to the introduction of carboplatin-KMP into the treatment protocol include severe myelosuppression, serious renal dysfunction, as well as individual intolerance to the components of the drug, including platinum.

If the interval between the end of treatment and full recovery is less than five months, or in the process of stopping the problem, further progression of the disease was noted (refractory cancer), then in this case many oncologists turn their attention to paclitaxel (Taxol), which in most recurrent cases shows a positive treatment result.

Antitumor herbal medicine paclitaxel is dripped intravenously as a three-hour or twenty-four-hour infusion. The use of this drug in concentrated form is not allowed, so before use it is diluted to the required concentration with 0.9% sodium chloride solution or 5% glucose solution. The recommended content of the drug is from 0.3 to 1.2 mg / ml.

Contraindications to the introduction of paclitaxel into the treatment protocol include severe neutropenia, a history of Kaposi's sarcoma in the patient's medical history, as well as individual intolerance to the components that make up the drug.

The volumes of the prescribed medication are strictly individual and are selected based on the results of the primary chemotherapy (or lack thereof) and the state of the hematopoietic system.

In case of refractory cancer, another drug of this pharmacological group may be prescribed. This may be epirubicin (farmorubicin), fluorouracil with calcium folinate (leucovorin), ifosfamide, altretamine (hexamethylmelamine), etoposide, tamoxifen.

Today, new drugs have come to the aid of the oncologist, which have already demonstrated their high efficiency in the field of stopping the problem discussed in this article: docetaxel, vinorelbine, topotecan, gemcitabine (gemzar), liposomal doxorubicin, irinotecan (campto), oxaliplatin (eloxatin), cycloplatam.

These drugs are used in the treatment protocol both as monotherapy and as one of the drugs in complex treatment.

For example, as a basic element of monotherapy, altretamine (hexamethylmelamine) is prescribed to the patient at a rate of 6-8 mg per kilogram of the patient's weight orally, every day for three to four weeks.

The dosage of cisplatin is calculated at 75-100 mg per square meter of the patient's body surface. The drug is administered intravenously. The procedure is performed with hydration and forced diuresis once. The next invasion is allowed after three weeks.

One of the many options for combined treatment (chemotherapy) is the use of antitumor drugs such as paclitaxel (infusion dosage of 175 mg per square meter, diluted with special pharmacological substances) with premedication. The second drug in this treatment protocol is cisplatin, prescribed at a rate of 75 mg per square meter, administered by drip hydration every three weeks.

Reoperation for recurrent ovarian cancer

Quite often, when establishing a diagnosis of a malignant neoplasm in the ovary area, the oncologist raises the issue of a complete resection of the diseased ovary, including nearby tissues. If this was not done, or the operation was not performed at the proper level, or for some reason all mutated cells were not removed, there is a high probability of the disease returning. Therefore, a repeat operation for a relapse of ovarian cancer is a very real treatment option.

Many women, in order to preserve their reproductive functions, force the surgeon-oncologist to perform an organ-preserving operation. During this operation, mutated tissues are removed. But in this case, the risk of relapse of the disease remains quite high. Therefore, if the disease returns, the doctor insists on performing a hysterectomy, that is, complete strangulation of the uterus, appendages and testicles. This approach, especially in light of the relapse, is often the only way to save a woman's life and lead to a full recovery, even if you lose the female reproductive organ or simply give the woman a few extra years or months.

Survival in recurrent ovarian cancer

As monitoring and medical statistics show, the survival rate for recurrent ovarian cancer is quite low, since this pathology is classified as an incurable disease. When the oncological progression of a neoplasm localized in the ovaries returns, the life expectancy of patients is usually within a period of eight to fifteen months. In most cases, doctors still resort to repeated chemotherapy, which allows them to prolong the lives of such patients. Although, as experience shows, the effectiveness of this method is somewhat lower with repeated treatment than with the primary relief of the problem.

Comprehensive, timely and adequate treatment can increase life expectancy by an average of six months in seven out of ten patients. This figure depends on many factors, including the patient's desire to live.

Of course, it is very difficult for any woman to get used to the idea that her reproductive organs will be removed. And not only on a physical but also on an emotional level, but if a woman does not plan to give birth in the future, it would be right to agree to the operation. In this case, a relapse of ovarian cancer is highly likely to become just a ghostly fear. But if there was no surgical intervention, or an organ-preserving operation was performed, or for any other reason, the risk of the disease returning remains very high. Such a woman should be more attentive to her health. Regular visits to an oncologist, with periodic full examination, contacting a doctor even with minor discomfort. This is the only way, if not to protect yourself, to significantly prolong the life of such a patient. Be more attentive to yourself, fight! We wish that the pathology discussed in this article does not affect either you or your loved ones!