Olympic Ice Dancer Piper Gilles Survived Ovarian Cancer. Here’s What to Know About the Disease.

What is ovarian cancer?

Historically, it’s been thought of as cancer that starts in the ovaries, but it's actually a group of cancers that can start in the ovaries, the fallopian tubes, or the peritoneum, which is the lining of the pelvis near the ovary. More than 50% start in the fallopian tubes. We’re starting to call them fallopian carcinomas, but at the societal level, they're still called ovarian cancer.

There are many different types, the most common of which is high-grade serous ovarian cancer.

What are some signs or symptoms of ovarian cancer?

It’s sometimes called the silent killer, because unfortunately, ovarian cancer doesn't have a lot of symptoms. It usually only develops symptoms once it's in its more advanced stage. Basically, it spreads by shedding cells from the fallopian tube or the ovary where it started, like petals from a dandelion, and latching on to other structures in the abdomen and pelvis, like the bowel or the stomach, forming small tumors that can produce a lot of fluid and cause pressure symptoms. These symptoms can include abdominal pain or discomfort, bloating, feeling like you get full fast when eating, or a change in bowel symptoms.

In some cases, the mass on the ovary itself becomes big enough that it pushes on the bladder and causes symptoms like bladder urgency or difficulty emptying the bladder. 

Sometimes women can pick up those signs early, but the problem is that they are pretty non-specific symptoms that can be explained by a lot of other, more common ailments. This can happen for some time before a patient becomes more symptomatic and the ovarian cancer gets diagnosed. The large majority of patients, unfortunately, are diagnosed at stage 3 to 4, which means the cancer has already spread throughout the abdomen, or even to organs outside the abdomen, like the lungs.

Is there a way to screen for ovarian cancer?

There is no effective screening mechanism at present. There have been large studies looking at the potential of things like pelvic ultrasounds and a tumor marker, Cancer Antigen 125, that we get from blood work, and they have found no ability to prevent cancer in the way that a Pap smear can screen for cervical cancer or colonoscopies can screen for colon cancer. These screening modalities have also not been found to change survival outcomes for patients ultimately diagnosed with ovarian cancer.

At the CU Anschutz Cancer Center, we are doing a lot of research – particularly my colleague, Kian Behbakht, MD, and the Ovarian Cancer Innovations Group – into prevention and screening, and have started to make some progress.

What are some key risk factors for ovarian cancer?

There are some hereditary risks. A minority of ovarian cancers are associated with hereditary genetic mutations, most commonly BRCA mutations. So anybody who has a significant family history of ovarian cancer should get tested for that, and anybody who is known to have that BRCA mutation, or any other mutation associated with ovarian cancer, is at risk and should see a gynecologist or a gynecological oncologist to talk about risk reduction strategies. 

We have a high-risk genetics clinic at the UCHealth Highlands Ranch Hospital, run by myself and my cancer center partners, Jill Alldredge, MD, and Nicole Marjon, MD, PhD, and we are always happy to see patients to discuss their risks. Our partner Jaime Arruda, MD, also sees high-risk patients at the CU Anschutz Cancer Center. 

Other risk factors associated with ovarian cancer are all related to increased lifetime number of ovulatory cycles, meaning an early age of first menstrual cycle or late menopause. For this same reason, things that suppress ovulation, like oral contraception and intrauterine devices, can decrease risk of ovarian cancer.

What groups of people are most likely to be diagnosed with ovarian cancer?

It’s most commonly diagnosed after menopause, especially high-grade serous ovarian cancer, the most common type. In that way, Piper Gilles’ case is unusual and her cancer was likely to be a rare type of ovarian cancer. Some less-common tumor types are more prevalent in younger women.

What is the outlook for someone with ovarian cancer?

It depends on what type of ovarian cancer. For the most common type, high grade serous ovarian cancer, most people present at stage 3 to 4. When I started medical school more than a decade ago, the survival for that sort of cancer was very commonly two years or less, but we have gotten so much better at treating this disease and have so many new therapies, so now the duration of survival can be much longer. 

How is high grade serous ovarian cancer typically treated?

The classic treatment is a combination of surgery and chemotherapy to start. It depends on what stage and disease distribution the patient is diagnosed with whether they get chemo and then surgery, and then more chemo, or whether they get surgery followed by chemo.

After that, they may go on a maintenance therapy, depending on their genetics and the molecular makeup of the tumor. And then typically they are in remission. This cancer does usually respond well to chemotherapy up front, so they go into remission. More commonly than not, the cancer comes back, and then we're talking about additional chemotherapy, or new targeted therapies called antibody-drug conjugates. Immunotherapy has not been shown to be very effective in treating ovarian cancer, at least for high grade serous ovarian cancer. 

There are other, uncommon cancer types where surgery is enough, especially if they present at early stage, and fortunately, that's what it sounds like for Piper Gilles.

At the CU Anschutz Cancer Center, we have a multidisciplinary conference for all our gynecologic cancers, bringing together specialists from many fields to help develop the best treatment plan for patients. We also have great clinical trials available, giving eligible patients access to new treatments. Patients are always welcome to come see us to talk about trials we have available.

Is there anything people can do to reduce the risk of ovarian cancer?

There is good data that both oral contraceptive pills and intrauterine devices (IUDs) can decrease your risk of ovarian cancer, probably because they prevent ovulation. My CU colleague Lindsay Brubaker, MD, published an article about this benefit of IUDs. 

Also, there is data, including a brand-new published article, showing that removing the fallopian tubes during other pelvic surgeries, such as a C section, can greatly decrease the risk of developing ovarian cancer, because a lot of these cancers start in the fallopian tubes. That could be an option when you’re done having children. It’s also something you can get done as a form of contraception.