About Ovarian Cancer

What is ovarian cancer: Staging
 

Ovarian cancer is staged at surgery. Staging is based on classifications devised by FIGO (International Federation of Gynecology and Obstetrics)

Stage I - Cancer is limited to one or both ovaries.

• IA - Cancer is limited to one ovary and the tumor is confined to the inside of the ovary. (There is no cancer on the outer surface of the ovary.) There is no ascites present containing malignant cells. The surface of the tumor is unruptured.
• JR - Cancer is limited to both ovaries without any tumor on their outer surfaces. There is no ascites present containing malignant cells. The surface of the tumor is unruptured.
• IC - The tumor is classified as either Stage 1 A or 1 B and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) at least one of the tumors has ruptured; and (3) there is ascites present or abdominal (peritoneal ) washings containing malignant cells.

Stage II - The tumor involves one or both ovaries with extension to other pelvic structures.

• IIA - The cancer has extended to and/or involves the uterus or the fallopian tubes or both.
• IIB - The cancer has extended to the bladder or rectum.
• JIC - The tumor is classified as either Stage IIA or LIB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) at least one of the tumors has ruptured; and (3) there is ascites containing malignant cells or with abdominal (peritoneal) washings containing malignant cells.

Stage III - The tumor involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to the lymph nodes. The tumor is limited to the true pelvis but with histologically-proven malignant extension to the small bowel or omentum.

• IIIA - During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has no spread to the lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal (peritoneal) surfaces.
• IIIB - The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.
• IIIC - The tumor is in one or both ovaries, and one or both of the following is present: (1) the cancer has spread to lymph nodes; (2) the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.

Stage IV- Growth of the cancer involves one or both ovaries and distant metastases to the liver or lungs have occurred. Finding ovarian cancer cells in the excess fluid accumulated around the lungs (pleural fluid) is also evidence of stage IV disease.

The stage of ovarian cancer at diagnosis is also the most important indicator of prognosis (prediction of duration, course and outcome of the disease)

Sources

New Directions in Ovarian Cancer Research from Report of Strategic Planning Conference December 8-9, 1997, Sponsored by National Cancer Institute, Society of Gynecologic Oncologists, and PHS Office of Women’s Health.

Everyone’s Guide to Cancer Therapy: How Cancer Is Diagnosed, Treated and Managed Day to Day. 3rd ed. Malin Dollinger, M.D., Ernest H. Rosenbaum, M.D., Greg Cable et al.