Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Primary peritoneal cancer behaves very similarly to ovarian cancer and is staged using the same system. Doctors usually stage primary peritoneal cancer during surgery. Staging is an important part of evaluating prognosis and treatment options. In general, stage 1 is not relevant to peritoneal cancer. The majority of primary peritoneal cancers are higher stage (stage 2 and above). The grade of the tumor will also be determined. Grade is how abnormal the cells look under a microscope. Low grade is least abnormal and high grade is most abnormal.
Stage Ia
Stage Ib
Stage Ic
Stage IIa
Stage IIb
Stage IIIa1
Stage IIIa2
Stage IIIb
Stage IIIc
Stage IVa
Stage IVb
Unstaged
Stage Ia
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Description
- Tumor is found in only one ovary. Tumor is encapsulated (not ruptured) and no tumor is found on the outer surface of the ovary. No cancer cells are found in peritoneal washings (fluid put into the pelvis by the surgeon and then removed to be checked for the presence of cancer cells).
Treatment
- Surgery or surgery followed by chemotherapy (3-6 cycles), depending on the grade of the cancer cells.
Stage Ib
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Description
- Tumors are found in both ovaries. Tumors are encapsulated (not ruptured) and no tumors are found on the outer surface of the ovaries. No cancer cells are found in peritoneal washings (fluid put into the pelvis by the surgeon and then removed to be checked for the presence of cancer cells).
Treatment
- Surgery or surgery followed by chemotherapy (3-6 cycles), depending on the grade of the cancer cells. Almost everyone needs chemotherapy after surgery.
Stage Ic
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Description
Tumor(s) found in one or both ovaries and any of the following:
- IC1: Tumor was ruptured during surgery and malignant cells have spilled into the abdomen.
- IC2: Tumor was ruptured before surgery, or tumor is found on the outer surface of the ovary. (See image)
- IC3: Malignant cells are found in peritoneal washings.
Treatment
- Surgery to stage and remove the cancer, followed by chemotherapy (3-6 cycles).
Stage IIa
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Description
- Tumor has spread to the surface of the uterus or fallopian tubes.
Treatment
- Surgery for staging and debulking, followed by chemotherapy. May be treated with a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy, or with IV chemotherapy alone (usually three to six cycles).
Stage IIb
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Description
- Tumor has spread to other intraperitoneal (within the abdominal cavity) tissues in the pelvis, such as the surface of the bladder, rectum, or colon.
Treatment
- Surgery for staging and debulking, followed by chemotherapy. May be treated with a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy, or with IV chemotherapy alone (usually six cycles).
Stage IIIa1
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Description
Cancer has spread to the retroperitoneal (abdominal) lymph nodes and:
- IIIA1(i): The tumor in the lymph nodes is less than or equal to 10 mm in diameter.
- IIIA1(ii): The tumor in the lymph nodes is greater than 10 mm in diameter.
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Stage IIIa2
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Description
- Microscopic metastases (cancer spread that can only be seen with a microscope) are detected on the peritoneum (lining of the abdominal cavity) or on the surface of organs in the upper abdomen. Cancer may or may not have spread to the retroperitoneal (abdominal) lymph nodes.
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Stage IIIb
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Description
- Macroscopic metastasis (cancer spread that can be seen with the naked eye) less than or equal to 2 cm in diameter detected on the peritoneum (lining of the abdominal cavity) or on the surface of organs in the upper abdomen. Cancer may or may not have spread to the retroperitoneal (abdominal) lymph nodes.
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Stage IIIc
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Description
- Macroscopic metastasis (cancer spread that can be seen with the naked eye) greater than 2 cm in diameter detected on the peritoneum (lining of the abdominal cavity) or on the surface of organs in the upper abdomen. Cancer may or may not have spread to the retroperitoneal (abdominal) lymph nodes.
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Stage IVa
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Description
- Cancer has spread to fluid in the lungs. If there is fluid in the lungs, cancer cells must be identified in the fluid when examined under the microscope.
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Stage IVb
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Description
- Cancer has spread to organs or lymph nodes outside the abdomen. Some common sites are the inguinal (groin) lymph nodes, inside the liver (not just the surface), and inside the spleen (not just the surface).
Treatment
- Surgery followed by chemotherapy or chemotherapy followed by surgery. Chemotherapy may be a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV (intravenous or in the vein) chemotherapy or IV chemotherapy alone (usually 6 cycles).
- Chemotherapy may be recommended first depending on such factors as pleural effusions (cancer cells in fluid removed from around the lung), a large amount of cancer in locations that cannot be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or the patient's medical condition (too sick to undergo surgery safely). In this situation, the patient has a biopsy that shows ovarian cancer. You will have 3-6 cycles of chemotherapy and then have a CT scan to see if the tumors are shrinking. If the tumors are responding to the chemotherapy (are shrinking), you may have surgery followed by more of the same chemotherapy.
Unstaged
Description
- This occurs when a patient has chemotherapy first but is unable to undergo surgery after treatment. This may be because the patient is medically unable to undergo surgery safely or because the tumors do not respond (shrink) after chemotherapy treatment.
