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Ovarian Cancer Staging

To plan the best treatment for ovarian cancer, your gynecologic oncologist needs to know the the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues or is being spread through the lymph system.

Typically, staging is done after surgery and after several other tests are completed. Other tests your doctor may order in addition to those done during the diagnosis process may include:

  • Lymph node testing: To see if cancer has spread to lymph nodes in the pelvic region, doctors may remove lymph node tissue for examination under a microscope. This is called a lymph node biopsy. If the lymph nodes show cancer, it may mean that the cancer is fast growing and could spread to other places in the body. This typically requires extra treatment with chemotherapy and/or radiation therapy.
  • CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
  • Chest x-ray: X-rays of the chest can show tumors or fluid.
  • Barium enema x-ray: Your doctor may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
  • Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if the ovarian cancer has spread to the colon or rectum.

These are the stages of ovarian cancer:

  • Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen. Stage I is divided into stages IA, IB, and IC.
    • Stage IA: Cancer is found inside a single ovary or fallopian tube
    • Stage IB: Cancer is found inside both ovaries or fallopian tubes
    • Stage IC: Cancer is found inside one or both ovaries or fallopian tubes and one of the following is true:
      • cancer is also found on the outside surface of one or both ovaries or fallopian tubes; or
      • the capsule (outer covering) of the ovary ruptured (broke open) before or during surgery; or
      • cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity)
  • Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Stage II cancers are divided into stages IIA and IIB.
    • Stage IIA: Cancer has spread from where it originated to other areas such as the uterus, fallopian tubes, and/or ovaries.
    • Stage IIB: Cancer cells have spread to organs in the peritoneal cavity (the space that contains the abdominal organs)
  • Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Stage III is divided into stages IIIA, IIIB, and IIIC.
    • In Stage IIIA, one of the following is true:
      • cancer has spread to lymph nodes in the area outside or behind the peritoneum only; or
      • cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis. Cancer may have spread to nearby lymph nodes.
    • Stage IIIB: Cancer has spread to the peritoneum outside the pelvis and the cancer in the peritoneum is no more than 2 centimeters. Cancer may have reached lymph nodes behind the peritoneum.
    • Stage IIIC: Cancer has spread to the peritoneum outside the pelvis and the cancer in the peritoneum is 2 centimeters or larger. Cancer may have also spread to regional lymph nodes, the liver, or the spleen.
  • Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs. Stage IV is divided into stages IVA and IVB.
    • Stage IVA: Cancer cells are found in extra fluid that builds up around the lungs.
    • Stage IVB: Cancer has spread to organs and tissues outside the abdomen, including lymph nodes in the groin.