Ovarian Cancer Staging

Prior to planning your treatment, your doctor needs to know the stage or extent of your cancer, as well as the grade, which refers to how the cells look under a microscope.

Your doctor may order one or more of the following to determine your cancer’s stage:

• Surgery is necessary in many cases (laparotomy or laparoscopy) to adequately determine your cancer’s stage. Surgery to stage your cancer should be performed by a gynecologic oncologist rather than a general gynecologist or surgeon. Many samples of tissue are taken from the pelvis and abdomen to examine closely for cancer. If cancer is found during surgery, your surgeon may commence the surgical treatment, called “debulking.”
• Computed Tomography (CT) is essentially an x-ray machine linked to a computer which takes several pictures that the computer puts together in order to produce a clear pictures, or cross-sectional views, of organs and tissues in the pelvis, abdomen, or chest.
• Chest x-ray can detect tumors or fluid in the lungs or chest
• Colonoscopy is used to examine the inside of your colon to learn whether cancer has spread to this organ. 

Ovarian cancer stages

Ovarian cancers are described as 4 possible stages, based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Your cancer’s stage is determined by where cancer cells are found.

Stage 1 ovarian cancer

Stage1 means that cancer is found in one or both ovaries or fallopian tubes, or in fluid collected from the abdomen. Stage 1 ovarian cancer is classified into the following three sub-stages:

• Stage 1A cancer is found in a single ovary or fallopian tube
• Stage 1B cancer is found in both ovaries or in both fallopian tubes
• Stage 1C cancer is found in one or both ovaries or fallopian tubes plus one of the following is true:
  • cancer is also found on the outside surface of one or both ovaries or fallopian tubes
  • the outer capsule-like covering of the ovary broke open before or during surgery
  • cancer cells are found in the fluid from the peritoneal cavity, or in washings from the tissue lining of the peritoneal cavity.

Stage 2 ovarian cancer

Stage 2 means that cancer has spread from where it first formed to other tissues in the pelvis. Finding cancer only in the peritoneum, called primary peritoneal cancer, is also considered Stage II. This stage has two sub-stages:

• Stage 2A cancer has spread from its initial site (ovaries or fallopian tubes) to another site (ovaries, fallopian tubes or uterus)
• Stage 2B cancer has spread from its initial site (ovaries or fallopian tubes) to other abdominal organs, such as the intestines, liver, stomach, gallbladder or pancreas

Stage 3 ovarian cancer

Stage 3 means that the cancer has spread outside the pelvis and is found in other parts of the abdomen, nearby lymph nodes, or on the surface of the liver or spleen. This stage has three categories:

• Stage 3A cancer includes one of the following:
  • cancer has spread to only the lymph nodes outside or behind the peritoneum
  • microscopic cancer cells have spread to the peritoneum surface or omentum the pelvis
• Stage 3B cancer has spread to the peritoneum outside the pelvis but this tumor is 2 centimeters (cm) or smaller, and may have spread to lymph nodes outside the peritoneum.
• Stage 3C cancer has spread to the peritoneum outside the pelvis, and this tumor is larger than 2 cm, and the cancer may have spread to lymph nodes outside the peritoneum or to the liver or spleen surface.

Stage 4 ovarian cancer

Stage 4 cancer has spread beyond the abdomen to other body areas, and is grouped in to these two sub-stages:

• Stage 4A means that cancer cells are found in extra fluid that collects around the lungs
• Stage 4B means the cancer has spread to distant organs and tissues, such as the liver, lungs or other organs, including the lymph nodes in the groin.

What is my cancer's grade?

Your cancer’s grade refers to how different the tumor cells look compared to normal cells:

Grade 1 cancer cells look similar to normal cells; these are often called low grade; they tend to grow slowly and are less likely to spread.

Grade 2 cancer cells are intermediate, between grades 1 and 3. They look more abnormal, grow faster, and are more likely to spread than grade 1 cells, but not as much as grade 3 cells.

Grade 3 cancer cells look very different from normal cells; these are called high grade; they grow faster and are most likely to spread.

Treatment options