Prognosis and survival in ovarian cancer

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the overall percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their age and family history of cancer). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The following are prognostic and predictive factors for ovarian, fallopian tube or primary peritoneal cancer.

Younger people who have ovarian, fallopian tube or primary peritoneal cancer have a better prognosis than older people.

People who have a BRCA2 gene mutation have a better prognosis than people who have a BRCA1 gene mutation. People who have a BRCA1 gene mutation have a better prognosis than people who don’t have a BRCA gene mutation.

A lowered level of CA125 after chemotherapy is a good prognostic factor.

During surgery, doctors collect samples of fluid that has built up in the abdomen (called ascites). They will also rinse the abdomen with salt water (saline) and collect a sample (called pelvic washings). The prognosis is poorer if cancer cells are found in the ascites or washings.

The amount of cancer that remains after surgery is called residual disease. No residual disease has a better prognosis than if there is cancer remaining after surgery.

Ovarian, fallopian tube or primary peritoneal cancer can spread to and grow into other organs in the pelvis and abdomen. The prognosis is poorer if the cancer has spread to several areas in the pelvis and abdomen.

The grade of the tumour is an important prognostic factor for ovarian cancer. Low-grade tumours are associated with a better prognosis than high-grade tumours.

Homologous recombination deficiency (HRD) status means the cancer cells have difficulty repairing DNA damage. This means the tumour is more sensitive to specific targeted therapies, such as PARP inhibitors. People who have a positive HRD status have a better prognosis than those who have a negative HRD status. 

Performance status is a measure of how well a person can perform ordinary tasks and carry out daily activities. Someone with a good performance status is more likely to respond to treatment, have fewer and less severe side effects and have a better prognosis.

If the cancer is responding to treatment after the first cycle of chemotherapy, it's considered a good prognostic factor.

The stage is the most important prognostic factor for ovarian, fallopian tube or primary peritoneal cancer. The prognosis for early-stage cancer is better than cancer diagnosed at a later stage.

Some types of ovarian cancer have a better prognosis. The characteristics of a particular type of tumour often relate to the grade or stage of the tumour. For example, most ovarian stromal tumours are low grade and have a good prognosis.