[2023-08-28] Three years after ovarian cancer surgery
Three years ago today, gynecologic oncology surgeons operated on me to remove my ovaries, fallopian tubes, uterus, cervix, omentum (a layer of fatty tissue that covers abdominal organs) and numerous malignant tumours. It was the first step in treating me for ovarian cancer.
When I was informally diagnosed with ovarian cancer 30 days earlier, my CA125 (a measure of cancer antigen in my blood) was 920. A normal level is below 35. A month after surgery, my level had dropped, but only to 862. Chemotherapy would contend with all the smaller cancerous nodules that had not been removed during surgery. I suppose that's why my ovarian cancer surgery is called "debulking": surgeons remove the bulk of the tumours but leave the next line of therapy to take care of the smaller growths.
Chemotherapy began 34 days after surgery: six rounds, every three weeks. After three rounds of chemotherapy, my CA125 had dropped to 19—in the normal range. And after six rounds, it had dropped to the single digits, where it has remained since February 2021.
Maintenance therapy began 29 days after the end of chemotherapy: four pills (600 mg) daily of the PARP inhibitor olaparib (marketed as Lynparza by the manufacturer). I'm eligible for olaparib because I have a faulty BRCA (breast cancer) gene. While I would have preferred not to have had a mutation in my BRCA2 gene and not to have gotten ovarian cancer at all, this gene change is a silver lining. People with a BRCA mutation who develop ovarian cancer respond better to chemotherapy and have the additional treatment option of a PARP inhibitor, which contributes to a lower rate of recurrence.
Why recall the anniversary of surgery for ovarian cancer? Well, every year without a recurrence of cancer (and the rates of recurrence for people with ovarian cancer are very high) is a reason to have hope that it won't come back. And, if nothing else, it's worth celebrating simply being alive.
The longer I go without a recurrence, the less I worry about the possibility, though I never completely forget it. In its article Why some cancers come back, Cancer Research UK acknowledges that it can be difficult for people to live with the fact that their cancer could come back. But it goes on to say that:
For most people who are in this situation, each day lowers the risk of a recurrence. Most cancers that are going to come back will do so in the first 2 years or so after treatment. After 5 years, you are even less likely to get a recurrence. For some types of cancer, after 10 years your doctor might say that you are cured.
In August 2020, Dr. Faught of The Ottawa Hospital's gynecologic oncology team told me that the chances of a recurrence are highest in the first 12 to 18 months, adding that if an ovarian cancer patient gets to two to three years without a recurrence, they have a better chance of longer-term remission.
So being three years beyond my ovarian cancer surgery without a recurrence feels pretty remarkable.
