Ovarian cancer

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Stages of ovarian cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for ovarian cancer is the FIGO system. For ovarian cancer there are 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

This staging system applies to both epithelial and stromal ovarian tumours, including tumours of borderline malignancy. It is also used to stage cancers that start in the peritoneum (called primary peritoneal carcinoma).

Ovarian cancer is staged during surgery to remove the ovaries and as much cancer that has spread as possible. All tissues removed will be tested for cancer. The stage is based on the results of the tests. Some women who appear to have early stage disease (stage 1) may be assigned a higher stage after complete surgical staging.

Find out more about staging cancer.

Stage 1

The tumour is only in 1 ovary or both ovaries.

For stage 1A, the tumour is only inside 1 ovary and nowhere else. The capsule that surrounds the ovary has not broken (ruptured) (it stays intact).

For stage 1B, tumours are inside both ovaries and nowhere else. The capsule that surrounds each ovary has not broken.

For stage 1C, the tumour is in 1 ovary or tumours are in both ovaries with any of the following:

  • The capsule surrounding an ovary broke during surgery (called a surgical spill).
  • The capsule surrounding an ovary broke before surgery. Or cancer cells are seen on the surface of 1 or both ovaries.
  • Cancer cells are in ascites or peritoneal washings (a saltwater solution used to wash the peritoneal cavity and check for cancer cells at the time of surgery).

Stage 2

The cancer involves 1 ovary or both ovaries and has grown into the surrounding pelvic organs.

For stage 2A, the tumour has grown into the uterus, fallopian tubes or both.

For stage 2B, the tumour has grown into other organs in the lower part of the pelvis, such as the rectum.

Stage 3

The cancer involves 1 or both ovaries or it started in the peritoneum. The cancer has spread to the peritoneum outside the pelvis, the lymph nodes in the back of the abdomen (called retroperitoneal lymph nodes) or both. It may have grown on the capsule surrounding the liver or spleen, but not inside these organs.

Stage 3 can be divided into stages 3A, 3B and 3C depending on the amount of cancer in the peritoneum and the size of the lymph nodes containing cancer.

Stage 4

The cancer has spread to other parts of the body (called distant metastasis) outside the abdomen and pelvis.

Stage 4 can be divided into stage 4A and 4B depending on where the cancer has spread.

Recurrent ovarian cancer

Recurrent ovarian cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started or close to where it started, it’s called local recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.

peritoneum

The membrane that lines the walls of the abdomen and pelvis (parietal peritoneum), and covers and supports most of the abdominal organs (visceral peritoneum).

ascites

Abnormal buildup of fluid in the abdomen.

peritoneal cavity

The space between the parietal peritoneum (the membrane that lines the walls of the abdomen and pelvis) and the visceral peritoneum (the membrane that covers and supports most of the abdominal organs).

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