OVARIAN CANCER STAGING

easy to understand ovarian cancer staging explanation from OCRA's

If you or someone you love is diagnosed with ovarian cancer, it’s natural to be concerned about survival rate, outlook (prognosis), and whether a cure is possible.

Understanding how ovarian cancer is staged and what each stage means can give you an idea of what to expect. Your stage can also help you find clinical trials to participate in.

What Does Staging Mean in Cancer?

In order to plan treatment and predict prognosis, a doctor determines a person’s cancer stage using the results of diagnostic tests, imaging scans, and samples taken from surgery.

For ovarian cancer, your doctor will likely use the AJCC (American Joint Committee on Cancer) or FIGO (International Federation of Gynecology and Obstetrics) staging system.

Below are the four stages of ovarian cancer. Each of these stages, except Stage 4, is divided into A, B, and C.

Note: The medical standard is to refer to stages using Roman numerals, i.e., Stage I, Stage II, Stage III and Stage IV.

Stage 1 Ovarian Cancer

When a person has Stage 1 ovarian cancer, it means the cancer has been found in one or both ovaries. 15% of women with ovarian cancer are diagnosed with Stage 1.

Stage 1A: Cancer is found inside a single ovary.
Stage 1B: Cancer is found inside both ovaries.
Stage 1C: Cancer is found inside one or both ovaries and one of the following is true:
- cancer is also found on the outside surface of one or both ovaries; or
- the capsule (outer covering) of the ovary has ruptured (broken open); or
- cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

What is the survival rate for Stage 1 ovarian cancer?

Most women with Stage 1 ovarian cancer have an excellent prognosis. Stage 1 patients with grade 1 tumors have a 5-year survival of over 90%, as do patients in stages 1A and 1B. Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 3 in 4 (72.4%) women with ovarian cancer live for at least 1 year after diagnosis. Almost half (46.2%) of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

StageRelative 5-Year Survival Rate

1 90%

1A 94%

1B 92%

1C 85%

Source: American Cancer Society

Stage 1 Treatment

Generally women with Stage 1 ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes (called a salpingo-oophorectomy), an omentectomy (removal of the omentum, a sheet of fat that covers some abdominal organs), biopsy of lymph nodes and other tissues in the pelvis and abdomen. Women of childbearing age who wish to preserve their fertility and whose disease is confined to one ovary may be treated by a unilateral salpingo-oophorectomy without a hysterectomy. (Omentectomy and the other parts of the staging procedure are still performed.) Depending on the pathologist’s interpretation of the tissue removed, there may be no further treatment if the cancer is low grade, or if the tumor is high grade the patient may receive combination chemotherapy.

Stage 2 Ovarian Cancer

Stage 2 ovarian cancer means the cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage 2 is a small group, compromising 19% of ovarian cancer diagnoses.

Stage 2A: Cancer has spread to the uterus and/or fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
Stage 2B: Cancer has spread to other tissue within the pelvis.
Stage 2C: Cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes, or to other tissue within the pelvis. Also, one of the following is true:
- cancer is found on the outside surface of one or both ovaries; or
- the capsule( outer covering) of the ovary has ruptured (broken open); or
- cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

What is the survival rate for Stage 2 ovarian cancer?

Most women diagnosed with Stage 2 ovarian cancer have a five-year survival rate of approximately 70%. Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 3 in 4 women with ovarian cancer live for at least 1 year after diagnosis. Almost half (46.2%) of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

StageRelative 5-Year Survival Rate

2 70%

2A 78%

2B 73%

2C 57%

Source: American Cancer Society

Stage 2 Treatment

Treatment for Stage 2 ovarian cancer includes: hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After the surgical procedure, treatment may be one of the following: 1) combination chemotherapy with or without radiation therapy or 2) combination chemotherapy.

Stage 3 Ovarian Cancer

Stage 3 ovarian cancer means that the cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. It is also considered Stage 3 ovarian cancer when it has spread to the surface of the liver. 60% of all cases of ovarian cancer are diagnosed when they are Stage 3.

Stage 3A: The tumor is found in the pelvis only, but cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen), the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.
Stage 3B: Cancer has spread to the peritoneum and the cancer in the peritoneum is 2 centimeters or smaller.
Stage 3C: Cancer has spread to the peritoneum and the cancer in the peritoneum is larger than 2 centimeters and/or cancer has spread to lymph nodes in the abdomen.

What is the survival rate for Stage 3 ovarian cancer?

Most women diagnosed with Stage III ovarian cancer have a five-year survival rate of approximately 39%. Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 3 in 4 women with ovarian cancer live for at least 1 year after diagnosis. Almost half (46%) of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

StageRelative 5-Year Survival Rate

3 39%

3A 59%

3B 52%

3C 39%

Source: American Cancer Society

Stage 3 Treatment

Treatment for Stage III ovarian cancer is the same as for Stage II ovarian cancer: hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After surgery, the patient may either receive combination chemotherapy possibly followed by additional surgery to find and remove any remaining cancer.

Stage 4 Ovarian Cancer

When a person is diagnosed with Stage 4 ovarian cancer, the cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver. Cancer cells in the fluid around the lungs is also considered Stage 4 ovarian cancer.

What is the survival rate for Stage 4 ovarian cancer?

Most women diagnosed with Stage 4 ovarian cancer have a five-year survival rate of approximately 17%. Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

StageRelative 5-Year Survival Rate

4 17%

Source: American Cancer Society

Stage 4 Treatment

Treatment for Stage 4 ovarian cancer will consist of surgery to remove as much of the tumor as possible, followed by combination chemotherapy.

About Cancer Grading

By looking at the cells in the tissue and fluid under a microscope, a pathologist describes the cancer as Grade 1, 2, or 3. Grade 1 is most like ovarian tissue and less likely to spread; Grade 3 cells are more irregular and more likely to metastasize. However, many ovarian cancers are categorized simply as “low grade” or “high grade.” Chemotherapy is often not used to treat low grade Stage I cases.

Sources:

Cancer Stat Facts: Ovarian Cancer. Surveillance, Epidemiology, and End Results Program (SEER), National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/statfacts/html/ovary.html

Survival Rates for Ovarian Cancer. American Cancer Society. https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/survival-rates.html