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Stages


Ovarian cancer is commonly diagnosed through laparotomy. The gynecologic oncologist makes an abdominal incision, usually at the level of or just above the umbilicus (navel) down to the pubic area. Because ovarian cancer can spread throughout the abdominal cavity and leave seeds, or rice-sized implants of tumor, on the surfaces of any abdominal organs, the goal of the surgery is to remove as much tumor as possible and to send the fluid in the abdomen for microscopic evaluation.

Studies have shown that women with ovarian cancer who have surgeries that reduces tumor volume to less than 1 cm (called maximal tumor debulking) have a much better chance for cure or prolonged remission than women who do not. Ovarian cancer is categorized based on the spread of the disease that is discovered during surgery (surgical staging).

The International Federation of Gynecology and Obstetrics (FIGO) has defined staging criteria that are accepted as the standard worldwide. Surgery for ovarian cancer usually involves removal of the ovaries, fallopian tubes, uterus, cervix, and any other sites of tumor implantation. In women who desire to retain fertility and who have very early-stage disease or tumors of low malignant potential, it is possible to remove the affected ovary and take some tissue samples to check for metastatic disease.

For women who are diagnosed with Stage I disease, surgery may be performed with the intent of preserving fertility. All ovarian tumors are assigned a histologic grade that refers to the degree of maturity of the cells forming the malignant ovarian tumor.

There are three (3) grades of ovarian cancer:

Grade 1 is “well-differentiated”

Grade 2 is “moderately differentiated” 

Grade 3 is “poorly differentiated”.

The lower the grade, the slower the tumor grows and the better the prognosis.

Once the surgical diagnosis is made, the stage, type, and grade of the cancer are used to determine which treatment is best.

Stages and Grades of Ovarian Cancer

Stage I: The cancer is confined to one or both ovaries.

Stage IA: tumor is limited to being only on the inside of one ovary

Stage IB: tumor is limited to being on the inside of both ovaries

Stage IC: tumor is limited to one or both ovaries and may appear on the surface of the ovary, a fluid-filled capsule may have burst, or cancer cells may be found in the fluid in the abdomen

Stage II: Ovarian cancer has spread to another area within the pelvis without spreading elsewhere in the abdomen.

Stage IIA: tumor has spread to the uterus or fallopian tubes or both

Stage IIB: tumor has spread to the bladder, rectum, or colon

Stage IIC: tumor has spread to any of the above and may appear on the surface of the ovary, a fluid-filled capsule may have burst, or cancer cells may be found in the fluid in the abdomen

Stage III: Cancer has spread from one or both ovaries to the lining of the abdomen or lymph nodes.

Stage IIIA: tumor has spread to the lining of the abdomen, but not the lymph nodes

Stage IIIB: tumor(s) 3/4 inch or smaller have spread into the abdomen, but not the lymph nodes

Stage IIIC: tumor(s) larger than 3/4 inch have spread into the abdomen, or cancer has spread to the lymph nodes, or both

Stage IV: Ovarian cancer has spread to the lung, liver, or other distant organs.
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