Ovarian Cancer Stages

Ovarian cancer stages are used by doctors to determine how far advanced the overall cancer is in the body. It helps determine the prognosis, the treatments available, whether surgery is required, and the survival rate of the patient.

The doctor can determine these factors by using valuable tests, including a biopsy, imaging, blood and other tests. These will also help decide the relapse or recurrence rate of the cancer.

Ovarian cancer stages use three internationally recognized rating systems. The first is the initial stage classification. The second is the TNM determination. The third is the stage groupings. They are as follows:

Stage classifications

Stage I: the cancer is only found in one (or both) ovary

Stage II: the cancer spread includes only the pelvic area and organs (uterus, cervix, fallopian tubes, etc.)

Stage III: the cancer spread includes the pelvic area and organs, and the abdominal organs (liver, bowels, lymph nodes, etc.)

Stage IV: the cancer spread includes other body areas and organs (neck lymph nodes, brain, lungs, etc.)

If the cancer is eliminated, but returns, an additional stage - recurrent - is used. However, the original stage diagnosis remains constant, even if the cancer spreads throughout the body. Any changes in the original cancer determination and tumor size/spread/affects are governed by the other rating systems.

TNM determination rating system

Ovarian cancer stages are further defined by the TNM determination rating system. TNM is defined to mean to tumor size, node inclusion, metastasis or spread status and grade of the tumor. Each part is defined as follows:

Tumor size

T1: the tumor is in one (or both) ovary

T1a: the tumor is only inside one ovary, not spread to the outer surface; the tumor has not split; no cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T1b: the tumor is only inside both ovaries, not spread to the outer surface; the tumor has not split; no cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T1c: the tumor is inside one (or both) ovary; the tumor has split; the tumor has spread to the ovary's surface; and/or cancerous cells have been found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T2: the tumor is inside one (or both) ovary; the tumor spread include the pelvic region

T2a: the tumor is inside one (or both) ovary; the tumor spread includes the fallopian tubes and/or the uterus; no cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T2b: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region; no cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T2c: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region; cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T3: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region, outside the pelvic region and lymph node (s); cancerous cells are found in the abdominal fluids (ascites) or the abdominal cavity washes (peritoneal lavage)

T3a: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region, outside the pelvic region and beyond the pelvic region

T3b: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region, outside the pelvic region and beyond the pelvic region that are now a maximum size of up to 2cm, and can be seen without a microscope

T3c: the tumor is inside one (or both) ovary; the tumor spread includes tissues in the pelvic region, outside the pelvic region and beyond the pelvic region that are now a 2cm or more in size, and can be seen easily

Node inclusion

N0: the tumor has not spread to include the local lymph nodes

N1: the tumor has spread to include the lymph nodes

Metastasis or spread determination -

M0: no metastases have been found anywhere

M1: metastases have been found somewhere

Grade of the tumor

The grading of a tumor shows the maturity of the cancerous cells inside the ovary(s). Though there are variations in this system around the world, the common grades include:

Grade 1: varied cells, mainly normal cells; a few cancerous cells are present

Grade 2: a combination of both normal and cancerous cells; cancerous cells account for about every other cell

Grade 3: very few normal cells if any are left; most or all cells are cancerous

The lower the grade, the slower a tumor will grow, and the better the patient's chance of survival. The higher the grade, the quicker the tumor may grow or spread, and the chances of survival are greatly diminished.

Stage groupings

The stage groupings are used to show the order of the varied factors included in the TNM determination rating system. They are grouped into four sections:

Stage I -

Stage Ia: T1a, N0, M0

Stage Ib: T1b, N0, M0

Stage Ic: T1c, N0, M0

Stage II -

Stage IIa: T2a, N0, M0

Stage IIb: T2b, N0, M0

Stage IIc: T2c, N0, M0

Stage III -

Stage IIIa: T3a, N0, M0

Stage IIIb: T3b, N0, M0

Stage IIIc: T3c, N0, M0, or T(varied), N1, M0

Stage IV -

Stage IV: T(varied), N(varied), M1

Cancer