Staging
Staging is a process that tells a doctor if the cancer has spread, and if it has, how far. Doctors usually stage ovarian cancer during surgery. Your doctor will remove the ovaries, uterus, fallopian tubes, omentum (the layer of fatty tissue around the stomach), and any other involved tissue to determine the extent of your cancer. Lymph node biopsies may also be performed. 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. Staging is an important part of evaluating prognosis and treatment options.
Stage Ia
Stage Ib
Stage Ic
Stage IIa
Stage IIb
Stage IIIa1
Stage IIIa2
Stage IIIb
Stage IIIc
Stage IVa
Stage IVb
Stage Ia
Click Image to Enlarge.
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. Almost everyone needs chemotherapy after surgery.
Stage Ib
Click Image to Enlarge.
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
Click Image to Enlarge.
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
Click Image to Enlarge.
Description
- Tumor is found in one or both ovaries and has spread to the surface of the uterus or fallopian tubes.
Treatment
- Surgery for staging and debulking, followed by at least 6 cycles of chemotherapy. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
Stage IIb
Click Image to Enlarge.
Description
- Tumor is found in one or both ovaries and 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 at least 6 cycles of chemotherapy. May be treated with IV (intravenous or in the vein) chemotherapy alone (usually six cycles) or with a combination of IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
Stage IIIa1
Click Image to Enlarge.
Description
Cancer has spread to the retroperitoneal (abdominal) lymph nodes and:
- The tumor in the lymph nodes is less than or equal to 10 mm in diameter.
- OR
- The tumor in the lymph nodes is greater than 10 mm in diameter.
Treatment
- Surgery followed by chemotherapy. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
Stage IIIa2
Click Image to Enlarge.
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. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
Stage IIIb
Click Image to Enlarge.
Description
- Macroscopic metastasis (cancer spread that can only 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. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
Stage IIIc
Click Image to Enlarge.
Description
- Macroscopic metastasis (cancer spread that can only 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. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
- Chemotherapy may be recommended first depending on such factors as a large amount of cancer in locations that can not 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, you will have a biopsy that shows ovarian cancer. You will have 3 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 have surgery followed by more of the same chemotherapy.
Stage IVa
Click Image to Enlarge.
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. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
- 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 can not be removed such as the bowel mesentery (fatty tissue that brings blood vessels to the bowel) or your medical condition (too sick to undergo surgery safely). In this situation, you will have a biopsy that shows ovarian cancer. You will have 3 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 have surgery followed by more of the same chemotherapy.
Stage IVb
Click Image to Enlarge.
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. May be treated with IV (intravenous or in the vein) chemotherapy (usually six cycles) alone or with IP (intraperitoneal or inside the abdomen and pelvis) chemotherapy and IV chemotherapy.
- 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 can not 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, you will have a biopsy that shows ovarian cancer. You will have approximately 3 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 have surgery followed by more of the same chemotherapy.
