Stages of Ovarian Cancer

In order to plan treatment and predict prognosis, a doctor determines a person’s cancer stage using the results of diagnostic tests, imaging scans, and samples taken from surgery.

For ovarian cancer, your doctor will likely use the International Federation of Gynecology and Obstetrics (FIGO) staging systems. These systems help doctors assign a stage based on the tumor’s location and whether it has spread to nearby lymph nodes or other areas of the body.

Staging Details

• Stages: Overall stages are numbered 1-4.
• Substages: Further grouped into A, A1, A2, B, or C.
• Lower Stage: More localized cancer.
• Higher Stage: Cancer has spread.

This staging system also applies to fallopian tube cancer and primary peritoneal cancer.

Generally, ovarian cancer stage refers to its pathological stage (surgical stage), determined by tissue samples surgically removed and biopsied. If surgery is not possible, a clinical stage is assigned based on imaging and physical exams. Subsequent surgical biopsy results can update the pathological stage classification.

Note: Stages are referred to using Roman numerals (e.g., Stage I, Stage II, Stage III, Stage IV).

About Cancer Grading

Cancer grading is determined by examining cancer cells under a microscope to understand how quickly they may grow and spread. Pathologists classify cancer as Grade 1, 2, or 3:

• Grade 1: Less aggressive tumors.
• Grade 2: Intermediate characteristics.
• Grade 3: High-grade, very atypical cells, more likely to metastasize.

When a person has Stage 1 ovarian cancer, it means the cancer has only been found in one or both ovaries or fallopian tubes and has not spread to other sites. Only 17% of patients with ovarian cancer are diagnosed with Stage 1 disease.

• Stage 1: Cancer is confined to the ovary (or ovaries), or the fallopian tubes.
  • Stage 1A: Cancer is in one ovary or fallopian tube and confined within it.
  • Stage 1B: Cancer is in both ovaries or both fallopian tubes but not found on the outer surfaces.
  • Stage 1C: Cancer is in one or both ovaries or fallopian tubes, and either the tumor lining is disrupted during surgery (1C1); or cancer is found on the outer surface of ovary or fallopian tube, (1C2); or cancer is found in fluid (a condition called ascites) or washings from the abdomen or pelvis (1C3).

Stage 1 Ovarian Cancer Treatment
Ovarian cancer patients generally undergo a total abdominal hysterectomy, salpingo-oophorectomy (removal of both ovaries and fallopian tubes), omentectomy (removal of the omentum), and lymph node biopsies to check for disease spread. If no cancer is found outside the ovary, the cancer is confirmed as Stage 1.

For those of childbearing age with cancer in one ovary, fertility-sparing treatment may be offered, preserving the normal ovary and uterus while still performing necessary surgical staging, including omentectomy and lymph node biopsies.

Depending on the tumor features, some patients may need no further treatment. Chemotherapy is often recommended for high-grade tumors or if cancer is on the ovary’s surface or in abdominal fluid. Learn more about the different treatments and therapies.

Stage 2 ovarian cancer means the cancer is found in one or both ovaries or fallopian tubes and has spread to other areas of the pelvis. 19% of ovarian cancers are found at stage 2.

• • Stage 2: Cancer is in one or both ovaries or fallopian tubes, and has spread to other organs within the pelvis.
    • Stage 2A: Cancer is in the ovaries and has spread to the fallopian tubes or uterus.
    • Stage 2B: Cancer is found in other sites in the pelvis but not beyond the pelvis.

Stage 2 Ovarian Cancer Treatment
Stage 2 ovarian cancer treatment typically includes a hysterectomy, bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), tumor debulking, and lymph node and tissue sampling to check for cancer spread. Most patients receive chemotherapy after surgery.

Learn more about the different treatments and therapies.

Stage 3 ovarian cancer indicates that the cancer is in one or both ovaries and has spread outside the pelvis to the abdomen, nearby lymph nodes, or the surface of the liver.

• Stage 3A1(i): Cancer involves the ovaries, fallopian tubes, or may be primary peritoneal cancer that involves pelvic or para-aortic lymph nodes without spread to other sites in the abdomen or pelvis. Cancer in the lymph nodes is 10 mm or smaller.
• Stage 3A1(ii): Cancer involves the ovaries, fallopian tubes, or may be primary peritoneal cancer that involves pelvic or para-aortic lymph nodes without spread to the other sites in the abdomen or pelvis. Cancer in the lymph nodes is larger than 10 mm.
• Stage 3A2: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, with evidence of microscopic implants beyond the pelvic region. The cancer has spread to tissue lining the abdomen, is so small it can only be seen with a microscope, and may also have spread to pelvic or para-aortic lymph nodes.
• Stage 3B: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and it has visibly spread to organs outside the pelvic region, but the cancer deposits are no larger than 2cm. The cancer is visible on tissue lining the abdomen and may also have spread to pelvic or para-aortic lymph nodes.
• Stage 3C: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and it has visibly spread to organs outside the pelvic region with deposits larger than 2cm. The cancer may also have spread to pelvic or para-aortic lymph nodes, or to the outer surface of the liver or spleen, and there is visible cancer on the tissue lining the abdomen.

Stage 3 Ovarian Cancer Treatment
Treatment for Stage 3 ovarian cancer includes surgery and chemotherapy. At surgery, a hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) is performed, along with resection of as much of the tumor as possible. In addition, lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer may be removed. Depending on the distribution of disease on imaging studies or other pre-operative assessments, some people may have chemotherapy prior to surgery. This often results in tumor shrinkage, which may enable a less aggressive surgery to be performed. Other people may have surgery first, followed by chemotherapy.

Learn more about the different treatments and therapies.

When a person is diagnosed with Stage 4 ovarian cancer, the cancer has spread to the lungs or to the inner part of the liver, or to other distant sites. Cancer cells in fluid around the lungs is also considered Stage 4 ovarian cancer.

• Stage 4A: Cancer cells are present in the fluid around the lungs (this condition is called a malignant pleural effusion).
• Stage 4B: Cancer has spread to the inside of the spleen or liver, in lymph nodes outside the abdomen or pelvis, and/or in other sites outside the abdomen.

Stage 4 Ovarian Cancer Treatment
Treatment for Stage 4 ovarian cancer will usually consist of surgery to remove as much of the tumor as possible, in combination with chemotherapy. Learn more about the different treatments and therapies.

Survival rates vary by cancer stage. Early-stage disease generally has a better prognosis than advanced-stage disease. Survival rates are based on large studies and cannot predict individual outcomes.