Ovarian Cancer Staging

Prior to planning your treatment, your doctor needs to know the stage or extent of your cancer.

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 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. You may receive contrast material by mouth and by injection into your arm or hand, which helps organs or tissues appear more clearly. Abdominal fluid or a tumor may be detected with a CT scan.
  • 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. This test is also used for colorectal cancer screening. After bowel-cleansing preparation, the physician inserts a long, lighted tube into the rectum and colon to see whether any abnormalities are present.

3 reasons why you need a gynecologic oncologist

Gynecologic oncologists undergo three to four additional years of subspecialty fellowship training to acquire the experience and expertise to manage all aspects of care for gynecologic cancers, including ovarian cancer. Multiple studies have shown that patients who receive ovarian cancer surgery from gynecologist oncologists:

  • have more thorough and accurate staging results
  • potentially avoid the need for a second staging surgery,
  • ultimately have better survival rates

Complication rates are also lowest when patients receive their surgery from high-volume surgeons operating at high-volume hospitals. Occasionally, ovarian cancer is discovered incidentally when a patient undergoes surgery for a different issue. In those cases, it is important to see a gynecologic oncologist for a second opinion to optimize treatment outcomes.

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Four stages of ovarian cancer

Your cancer’s stage is determined by where cancer cells are found.

Stage I ovarian cancer

Stage I 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 IA cancer is found in a single ovary or fallopian tube
  • Stage IB cancer is found in both ovaries or in both fallopian tubes
  • Stage IC 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 II ovarian cancer

Stage II 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 IIA cancer has spread from its initial site (ovaries or fallopian tubes) to another site (ovaries, fallopian tubes or uterus)
  • Stage IIB 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 III ovarian cancer

Stage III 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 IIIA 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 IIIB 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 IIIC 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 IV ovarian cancer

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

  • Stage IVA means that cancer cells are found in extra fluid that collects around the lungs
  • Stage IVB 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.
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