Epithelial ovarian carcinomas are graded on a scale from 1 to 3, depending on how much the cancer cells look like normal tissue. The more the cancer cells look like normal cells (Grade 1), the better the prognosis. The less they do (Grade 3), the worse the prognosis.
Epithelial ovarian carcinomas are also “staged”. The International Federation of Gynecologists and Obstetricians (FIGO) has developed a system for identifying the stages of ovarian cancer known as the FIGO system. It is a way of describing how far the cancer has spread.
These stages are pathological, not clinical. This means that the disease is staged during and after surgery, with samples taken from the pelvis and the abdomen then examined later by a pathologist. Pathological staging is more accurate than clinical staging, which relies on imaging tests. It is particularly important in determining whether the cancer has spread beyond the ovary.
In all stages, cancer has developed in either or both of the ovaries.
In Stage I, the cancer is contained in the ovary or ovaries. There are three substages.
Stage Ia describes a situation where the ovary’s outer surface shows no sign of cancer, based on the laboratory examinations of washings from the pelvis and the abdomen. In Stage Ib, both ovaries are affected but no tumors have been found in their outer surfaces or in washings from the pelvis and the abdomen. In Stage Ic, the cancer is present in either ovary or both, the outer wall of the tumor has ruptured, or cancer cells have been found in washings or fluid from the abdomen.
In Stage II, other organs within the pelvis, such as the fallopian tubes, the bladder, and the uterus, among others, have already been infected. In other words, the cancer is no longer contained in the ovaries. There are three substages.
In Stage IIa, the cancer has spread to either the fallopian tubes or the uterus, or both, but washings from the abdomen show no cancer cells under laboratory examination. Stage IIb means that the cancer has reached nearby organs such as the rectum or the bladder, but the abdomen still shows no sign of cancer cells. In Stage IIc, cancer cells have been found in washings or fluid from the abdomen.
When the cancer has spread to the lining of the abdomen or to the lymph nodes, or both, then the cancer is in Stage III.
Stage IIIa means that there are no indications of cancer having spread to the abdomen or to the lymph nodes, although biopsies show small cancer deposits in the upper abdomen. Stage IIb means that cancer deposits in the abdomen are large enough to be seen but are smaller than 2 cm; the lymph nodes have not yet been affected. In Stage IIIc, the cancer has reached the lymph nodes and deposits of more than 2 cm may already be seen in the abdomen.
In Stage IV, the most advanced stage, distant metastasis has occurred. This means that the cancer, which has developed in one or both ovaries, has spread to distant organs such as the liver or the lungs. The discovery of cells in pleural fluid may also suggest an advanced stage of cancer.
Recurrent ovarian cancer refers to that condition where the disease returns following treatment.
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Reviewed by:
Jiade J. Lu, M.D.
Diplomate, American Board of Radiology (Radiation Oncology)
Medical Director
The Cancer Information Network
Date Modified: 06/14/04
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