Stages of Ovarian Cancer
If diagnosed with ovarian cancer, patients will want to know their tumour “stage”. The stage of ovarian cancer describes how far the cancer has grown and spread in the body at the time of diagnosis. To determine the stage this may involve a pelvic examination, medical imaging scans, biopsies, blood tests and possibly further tests.
The stage of the cancer will help us work out the most efficient and least harmful treatment options for patients. The earlier the cancer is diagnosed, the easier it is to treat and the greater the chances of a good outcome.
In ovarian cancer we use a numbered staging system, with stage 1 indicating the most limited cancer and stage 4 indicating disseminated cancer.
Ovarian cancer is staged by FIGO (International Federation of Gynecology and Obstetrics) as follows:
Stage 1 (I) cancer
The cancer is still small and contained within the ovary or the fallopian tube, where it originally developed.
It has not spread to any lymph nodes, organs, or other areas of the body. This is often called early stage cancer. Based on additional risk factors, some patients might still need further treatment to reduce the risk of a cancer recurrence.
In Stage 1 ovarian cancer, the cancer is in one or both ovaries and has not spread to other organs or tissues.
Stage 2 (II) and 3 (III) cancer
Stage 2 or 3 cancer means that the cancer is larger or has spread into nearby tissues or lymph nodes (metastases).
Many of stage 2 and 3 cancers are still curable, depending on the location of the metastases, the cell type and whether the cancer responds to chemotherapy treatment.
In Stage 2 ovarian cancer, the cancer is present in the ovaries but has spread to other organs in the pelvis, such as the uterus, fallopian tubes, bladder or colon.
In Stage 3 ovarian cancer, the cancer is in the ovaries but has spread outside the pelvis to other parts of the abdomen or nearby lymph nodes or the omentum, which is a fat pad arising from the stomach.
Stage 4 (IV) cancer
Stage 4 cancer means that the cancer has spread to areas outside the pelvis and abdomen (for example the chest or lymph nodes outside the belly).
The treatment of stage 4 gynaecological cancer may be curative (aiming for cure) or palliative (aiming for symptom control).
In Stage 4 ovarian cancer, the ovarian cancer has spread to parts of the body beyond the pelvis and abdomen, such as the lungs or liver. This is the most advanced stage.
Stage 1-3 of ovarian cancer in the FIGO system are also further divided into sub-stages, (such as A, B, C) which indicate increasing amounts of tumour.
Cancer can also be referred to as ‘localised’ where the cancer is limited to the organ where it developed originally (no spread), ‘regional’ where the cancer has spread to lymph nodes, tissues or organs, and ‘distant’, where the cancer has spread throughout the body.
Grading ovarian cancer
The cancer will also be given a grade by looking at the cells under a microscope to see how ‘abnormal’ the cells are which suggests how quickly the cancer may grow or spread. Grade does not refer to the extent of tumour dissemination.
Grade 1 (low grade) ovarian cancer looks similar to normal cells and is likely to grow relatively slowly.
Grade 2 (moderate grade) appears slightly abnormal and might grow more quickly.
Grade 3 (high grade) looks different from normal cells and may be likely to grow quickly.
Number of women diagnosed at advanced stages
Cancer Council NSW reports that about 7 out of 10 cases of ovarian cancer are diagnosed at stage 3 or 4, which are advanced stages.
A gynaecological oncologist can discuss the most suitable treatment options based on your cancer stage, along with the type of ovarian cancer, whether fertility is to be preserved if possible, genetic test results, and overall health.
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