Current treatments for ovarian cancer, primarily surgery and chemotherapy, can reverse its progression.

In fact, about 80 percent of ovarian cancer cases will go into remission after initial treatment, according to the Fox Chase Cancer Center. However, approximately 60 percent of people will experience a recurrence.

Keep reading to learn how initial treatment for ovarian cancer can reverse its progression, and how maintenance therapy may help prevent its return.

What’s the difference between remission and cure in cancer?

“Partial remission” means the signs and symptoms of your cancer are reduced. “Complete remission” means all signs and symptoms of cancer have disappeared.

“Cure” means there are no traces of cancer or cancer cells in your body following treatment, and the cancer will never come back.

There are a number of ways doctors can approach treatment for ovarian cancer. Surgery is usually the first-line treatment, combined with chemotherapy or targeted therapies.

Chemotherapy may also be used before surgery to shrink the cancer and allow for a more successful surgery.

Doctors will look at a number of factors to determine your individual treatment. These include:

  • the type of ovarian cancer you have
  • the stage of your cancer at the time of diagnosis
  • whether you are pre- or postmenopausal
  • whether you plan to have children

Surgery

Surgical options used for ovarian cancer depend on where the cancer is and how far it has spread. Even for stage 1 ovarian cancer, surgery can be extensive. It may involve:

  • Unilateral salpingo-oophorectomy: removal of one ovary and one fallopian tube
  • Total abdominal hysterectomy (TAH): removal of the uterus and cervix
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO): removal of the uterus, cervix, fallopian tubes, and ovaries
  • Omentectomy: removal of part or all of the omentum (the tissue covering the intestines and other abdominal organs)
  • Lymph node sampling: to see whether cancer has spread to lymph nodes
  • Lymph node dissection: removal of lymph nodes in the abdominal cavity
  • Cytoreductive surgery: removal of cancer that has spread to other areas of the abdomen (also called debulking surgery)

Surgery is usually followed by at least six rounds of chemotherapy, as well as targeted therapies for up to 3 years.

Chemotherapy

Chemotherapy treatment uses powerful drugs that travel through your body looking for and destroying cancer cells. The treatment can be used before surgery to shrink large tumors, or after surgery to address any cancer cells that remain after tumor removal.

The type or combination of chemotherapy drugs your doctor prescribes often depends on the type of ovarian cancer you have. For example:

  • Epithelial ovarian cancer. This type of cancer begins in the cells on the outer lining of your ovaries. The standard chemo drug combination is carboplatin (Paraplatin) plus paclitaxel (Taxol) or docetaxel (Taxotere).
  • Germ cell ovarian cancer. Germ cells are ovarian cells that eventually form eggs. For cancer that starts here, the chemo drug combination used is typically cisplatin (Platinol), etoposide, and bleomycin.
  • Stromal cell ovarian cancer. Stromal cells release hormones and create ovarian tissue. The chemo drug combination used for cancers that start here is usually the same used for germ cell cancers.

Following surgery, and during and after chemo, blood tests checking for the CA-125 tumor marker may be done to check how the treatment is working. Other tests may also be performed, such as:

Radiation treatment

Radiation isn’t a primary treatment for ovarian cancer, but it can sometimes be used to treat symptoms when a tumor becomes resistant to chemotherapy.

This targeted treatment uses high-energy rays to shrink and destroy tumors.

Hormone therapy

Hormone therapy is designed to deprive ovarian tumor cells of the hormones they need to grow and replicate, such as estrogen. For example, one type of hormone therapy may lower estrogen levels in the body.

This type of treatment is mainly used for ovarian stromal tumors.

Targeted therapy

Targeted therapy uses specially designed drugs that can identify and attack cancer cells via specific traits that are different from healthy cells. Because these drugs mostly affect cancer cells, they may do less damage to healthy tissue than chemotherapy or radiation treatments.

Each type of drug used for targeted therapy works differently. Your doctor or cancer care team will choose which class of drugs will work best for your cancer, depending on the type and stage of cancer you have.

Targeted drugs for ovarian cancer include:

  • Bevacizumab (Avastin). This type of drug is an angiogenesis inhibitor. It helps shrink or stop the growth of tumors. This drug is given intravenously (through an IV).
  • PARP inhibitors. These drugs make it hard for cancer cells to repair damaged DNA, leading to the death of the cells. The drugs are taken orally in pill or capsule form.

Fertility preservation

Ovarian egg and tissue preservation is an option for people who wish to have children following treatment for ovarian cancer. Be sure to talk with your doctor about your preferences when discussing treatment options.

After initial treatment for ovarian cancer, your doctor may recommend maintenance therapy.

The primary reason for maintenance treatment is to help prevent cancer from returning, or to increase the amount of time between initial treatment and cancer recurrence.

Maintenance therapies may include the same chemotherapy drugs given during initial treatment, such as angiogenesis inhibitors or PARP inhibitors, or they may involve new medications.

What is ovarian cancer recurrence?

Cancer “recurrence” means the cancer has come back after treatment. The possible scenarios for ovarian cancer recurrence include:

  • cancer develops in the same place(s) as the initial diagnosis (“localized”)
  • cancer develops in distant areas from the original site, such as the bones or lungs
  • tumors didn’t completely go away during initial treatment
  • advanced ovarian cancer returns months to years after your initial treatment

In general, ovarian cancer most commonly recurs within the peritoneal cavity.

The chances of ovarian cancer coming back are based on the stage of cancer at initial diagnosis, as follows:

  • Stage 1: 10 percent chance
  • Stage 2: 30 percent chance
  • Stage 3: 70 to 90 percent chance
  • Stage 4: 90 to 95 percent chance

Other recurrence prevention strategies

While there’s no guarantee that cancer tumors won’t return after initial treatment, your doctor may recommend taking steps to boost and protect your overall health, such as:

  • Make follow-up appointments for physical exams and imaging scans.
  • Eat a nutritious diet.
  • Manage your weight, like losing weight, if your doctor recommends it.
  • Limit or avoid alcohol, if applicable.
  • Avoid smoking and secondhand smoke.
  • Get at least 150 to 300 minutes of moderate exercise per week.

If ovarian cancer returns, your doctor will base treatment recommendations on where the cancer is located and its severity.

Treatment options may include:

  • additional surgery
  • additional chemotherapy, such as using different chemo drugs than initially used if the cancer returns in under 6 months
  • targeted therapies
  • hormonal treatments
  • palliative treatments (these treatments focus on improving your quality of life)

What are the major risk factors for ovarian cancer?

While having a certain risk factor doesn’t mean you’ll automatically develop ovarian cancer, some known major risk factors for ovarian cancer include:

  • having an inherited genetic mutation, or a family cancer syndrome
  • having a personal or family history of breast, colorectal, or ovarian cancers
  • taking hormone replacement therapy or fertility treatments
  • never getting pregnant
  • smoking
  • overweight and obesity

How can I reduce my risk of developing ovarian cancer?

Maintaining a moderate weight and not smoking may help reduce your risk of developing ovarian cancer.

If you’re considered to have a higher risk for this type of cancer, you can talk with your doctor about other risk-reducing strategies, such as:

  • taking birth control pills
  • surgically removing your ovaries

How long do I need to stay on maintenance therapy?

Maintenance therapy may range from 1 to 3 years following initial treatment for ovarian cancer. To prevent recurrence, maintenance therapy is generally given until there are signs of the cancer returning.

Are there any new and promising treatments for ovarian cancer?

Yes. PARP inhibitors are relatively new and show great promise. These drugs interfere with a tumor’s ability to repair its DNA.

Current treatments for ovarian cancer make it possible to reverse ovarian cancer and put it into remission.

Partial remission means the signs and symptoms of your cancer are reduced. Complete remission means all signs and symptoms of cancer have disappeared.

Following initial treatment for ovarian cancer, your doctor may recommend maintenance therapy to prevent recurrence of the cancer. Risk for recurrence depends on the stage of your cancer at diagnosis and your body’s response to treatment.