By Nicole Ireland
Canadian-American figure skater Piper Gilles announced earlier this week that she had her left ovary removed after she was diagnosed with Stage 1 ovarian cancer in January.
Gilles, 31, said she feels "lucky" that her cancer was detected early and hopes disclosing her diagnosis will help raise awareness so that other women can get diagnosed earlier too.
It's very difficult to screen for ovarian cancer and early detection often depends on women and their health-care providers paying close attention to symptoms they might otherwise dismiss, said Barbara Vanderhyden, Corinne Boyer Chair in Ovarian Cancer Research at the University of Ottawa.
That's why, unlike Gilles, many women don't get a diagnosis until they are in later stages of the cancer.
WHAT ARE THE SYMPTOMS?
Ovarian cancer tends to have subtle symptoms at first, which women may either dismiss as caused by perimenopause or other conditions, said Vanderhyden, who is also on the board of Ovarian Cancer Canada.
"They are also the same symptoms that are shared with a number of much more common disorders."
According to Ovarian Cancer Canada, common early symptoms can include:
-- Bloating
-- Abdominal or pelvic pain or discomfort
-- Difficulty eating
-- Feeling full more quickly than normal
-- Urinary habit changes
Other less common symptoms can include nausea, changes to bowel habits, unexplained weight loss, bleeding after menopause, back pain, fatigue, indigestion and pain during sex or bleeding afterward.
"Know your body," Vanderhyen said.
If symptoms are new, persist for more than three weeks and are happening more frequently, see your doctor and don't hesitate to raise the concern about potential ovarian cancer.
"Self advocacy is important," she said.
WHAT ARE THE RISK FACTORS?
Age is a risk factor, as women between 50 and 79 are more likely to have ovarian cancer.
Genetics also play a significant role.
"Women are often identified as high risk because they've had other family members who have developed breast or ovarian cancer," Vanderhyen said.
Genetic mutations, including harmful variants in BRCA 1 and BRCA 2 genes, increase the risk of both ovarian and breast cancer. Ovarian Cancer Canada encourages women to talk to their primary-care providers about genetic testing.
Endometriosis is correlated with certain types of ovarian cancer, but the reason for that is not yet clear, Ovarian Cancer Canada says.
HOW COMMON IS OVARIAN CANCER IN CANADA?
Ovarian cancer is diagnosed in about 3,000 Canadians a year, according to the Canadian Cancer Society.
In 2022, ovarian cancer killed about 1,950 people in Canada, the society said.
The five-year survival rate is 44 per cent, it said.
HOW IS OVARIAN CANCER DIAGNOSED?
According to the Canadian Cancer Society, tests that can find ovarian cancer include a pelvic exam, a transvaginal ultrasound and a cancer antigen 125 test, which measures the amount of a specific protein in the blood.
It cannot be detected by a Pap smear, which is used to detect potential cervical cancer.
HOW IS OVARIAN CANCER TREATED?
Surgery is usually used to remove the tumour. It generally requires removing at least one of the ovaries as well as the Fallopian tubes. Often surgeons will do a total hysterectomy, meaning they also remove the uterus.
Chemotherapy and/or radiation are also used in treating ovarian cancer.
There are also medications that some patients take to inhibit new or recurring ovarian cancers or new blood vessels that feed cancer cells.
HOW IS OVARIAN CANCER PREVENTED?
If genetic testing shows a woman has a genetic mutation that puts them at higher risk of ovarian cancer, they may talk to their doctor about proactively removing their ovaries and Fallopian tubes, Vanderhyen said.
There is also a growing movement to be even more proactive, she said, by encouraging women who have already had their children or will not be having children and are having abdominal surgery of any kind to talk to their doctor about having the tips of their Fallopian tubes removed at the same time. That's because ovarian cancer commonly starts there.
ARE THERE DIFFERENT TYPES OF OVARIAN CANCER?
There are several different types of ovarian cancer, named based on the cells where the cancer starts. They include:
-- Epithelial ovarian cancer (starts in the cells that cover the lining of an ovary or Fallopian tube)
-- Germ cell ovarian cancer (starts in the cells where eggs are formed in the ovaries)
-- Stromal cell ovarian cancer (a rare type that starts in the cells that hold the ovaries together and produce female hormones)
-- Fallopian tube and primary peritoneal cancers (also considered forms of ovarian cancer, according to Ovarian Cancer Canada.)
WHAT TYPES OF OVARIAN CANCERS ARE MOST COMMON?
Epithelial ovarian cancer is the most common, making up about 85 to 95 per cent of cases, Ovarian Cancer Canada says.
The most common subtype is called "high grade serous epithelial ovarian cancer," which often starts in the Fallopian tube rather than the ovary itself. It tends to be diagnosed in later stages, when it has spread.
Another subtype of epithelial ovarian cancer, called "clear cell carcinoma," makes up 10 to 13 per cent of cases, Ovarian Cancer Canada says. It's often diagnosed in earlier stages "and therefore has a better prognosis." It's often associated with endometriosis.
Germ cell ovarian cancer makes up about five to 10 per cent of ovarian cancer cases and tends to start in younger women (in their 20s).
-With files from John Chidley-Hill.
Banner image: Piper Gilles practises a dance routine during a training session at the 2022 Winter Olympics, Thursday, Feb. 3, 2022, in Beijing. THE CANADIAN PRESS/AP/Bernat Armangue
This report by The Canadian Press was first published May 11, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
