There are many effective treatments available, but which one you’ll receive is dependent on several different factors.
- the tumor subtype
- how aggressive the cancer is
- genetic factors, such as BRCA mutations and others
- active symptoms like bleeding
- other health conditions, such as diabetes
- your personal goals
Debulking surgery to remove the tumor is always optimal, even in advanced cases. Then, you’ll receive chemotherapy. This can be given intravenously or as an injection into the pelvic cavity, although this is rare.
Your doctor may recommend targeted therapies such as vascular endothelial growth factor (VEGF) and poly ADP-ribose polymerase (PARP) inhibitors in certain cases. They may also recommend endocrine therapy.
Radiation can be given for active symptoms of pain or bleeding. Researchers are constantly evaluating better uses for effective drugs, new drugs, and new combinations.
After a course of chemotherapy, imaging, such as a CT scan, tells your doctor if the cancer has responded.
The cancer may shrink and get smaller, which is known as a partial response. Sometimes, there’s no visible cancer at all on the scan, which is a complete response.
Maintenance therapy is a term for medication used after a response to a course of chemotherapy. The goal is to maintain the treatment response and extend and maximize the time before the cancer grows again or progresses.
PARP and VEGF inhibitors can be used for maintenance in different scenarios.
After a complete or partial response from chemotherapy, you and your doctor may prefer to watch-and-wait.
This means that you’d stay off treatment completely, without maintenance treatment. Your doctor will perform assessments at regular intervals to detect any progression of cancer. If you do experience progression, then you can start additional treatment.
There are many clinical, personal, or even financial reasons to choose a watch-and-wait approach. You may want a complete break from all treatment. Although maintenance therapy isn’t as harsh as chemotherapy, you may still experience some side effects.
Typically, you’ll need to see your doctor every 3 to 4 weeks if you’re on maintenance therapy, and every 2 to 3 months if you’re off treatment.
Either way, your doctor will check the status of your cancer with physical exams, labs, and scans to evaluate for progression. This usually occurs every 3 to 6 months. Of course, this schedule varies and may be different for everyone.
This is a question that everyone should discuss with their oncologist. Recurrence rates vary depending on individual tumor characteristics, like the type of tumor, grade, and your genetics. It also depends on the treatment you received and the way you responded to that treatment.
Without maintenance treatment, advanced ovarian cancer may progress in 5 to 8 months. PARP maintenance can extend time to progression to 12 to 22 months.
Most people will receive multiple courses of chemotherapy throughout their cancer journey in hopes of achieving a response or remission.
Sometimes doctors are able to reuse chemo combinations that worked well in the past, but most often they will administer a different chemotherapy regimen. As mentioned earlier, VEGF and PARP inhibitors can help to control disease, and radiation or additional surgery is also sometimes helpful.
It’s important to understand the possible side effects of every cancer treatment. Fortunately, many of our modern medications have fewer side effects than older types of chemotherapy.
Medications to prevent nausea are now available. It’s standard to mix these with the chemo itself and supply pills for you to take home at the first sign of queasiness.
Diarrhea, constipation, or both are common. These can usually be managed with over-the-counter remedies like laxatives and loperamide (Imodium). It’s crucial to frequently report your symptoms to your cancer care team.
My best advice is to openly discuss any and every issue with your cancer care team.
Try to fit in 20 minutes of light to moderate exercise three times a week if possible, like brisk walking. Also, avoid using tobacco or vape products.
Eat a well-balanced diet including whole grains, fruits, vegetables, and lean protein. Most cancer centers have a dietitian on staff to give a more tailored assessment and plan.
Don’t be afraid to mention problems with your stress levels or mood. Lastly, inquire about copay assistance, disability paperwork, financial programs, and Family and Medical Leave Act (FMLA) paperwork for your caregivers.
Dr. Ivy Altomare is an Associate Professor of Medicine at Duke University and the Assistant Medical Director of the Duke Cancer Network. She is an award-winning educator with a clinical focus on increasing awareness of and access to oncology and hematology clinical trials in rural communities.