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Ovarian cancer stages

This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on April 7, 2022.

Making an educated treatment decision begins with knowing the stage, or progression, of the cancer. The results from diagnostic tests are used to develop a treatment plan tailored to the patient, based on the stage of the disease and other factors. In most cases, ovarian cancer is staged during the initial surgery.

For patients who’ve been recently diagnosed, a pathology will also be reviewed to confirm that they’ve received the correct diagnosis and staging information. For those with a recurrence, comprehensive testing will be used to identify an individualized treatment approach.

Understanding the staging system

Most ovarian cancers are staged through the TNM system, which uses surgical results to determine the extent of the primary tumor (T), whether the cancer is present in the lymph nodes (N), and whether the cancer has metastasized (M) to other parts of the body, such as the liver, bones or brain. Once a patient’s T, N and M categories have been assigned, that information is used to stage the cancer according to a particular group, which is denoted by numbers and subcategorized.

This system is also used to stage fallopian tube cancer and primary peritoneal cancer.

Ovarian cancer stages

First, doctors use these criteria to determine the cancer’s progression:

  • Localized when no cancer has spread outside of the ovaries
  • Regional when the cancer has spread to nearby lymph nodes or structures
  • Distant when the cancer has spread to other parts of the body

Stage 1

In stage 1, the cancer is confined to the ovaries and hasn’t spread to the abdomen, pelvis or lymph nodes, nor to distant sites. It’s considered an early-stage cancer, which means that it offers the highest survival rate.

  • Stage 1A: Cancer is present in one ovary.
  • Stage 1B: Cancer is in both ovaries.
  • Stage 1C is diagnosed when one of the following occurs:
    • Stage 1C1: The tissue surrounding the tumor breaks during surgery and cancer may spread to the abdomen and pelvis (a process called a surgical spill).
    • Stage 1C2: Cancer exists on the surface of one or both ovaries.
    • Stage 1C2:The tissue surrounding the tumor has ruptured before surgery.
    • Stage 1C3: Cancer cells exist in the fluid of the abdomen and pelvis.

If a patient has a tumor, which may be removed during biopsy or surgery, then it typically is given a tumor grade. Grades may be low or high, ranging from levels 1 to 3. The latter two are high-grade, and may grow much faster.

Following surgery, additional treatment may not be required for stage 1 ovarian cancer, especially if a patient has a low-grade tumor. However, if a patient is diagnosed with stage 1B or 1C, then chemotherapy may be recommended, in addition to further surgery or other treatments.

Stage 2

In stage 2, the cancer has spread from one or both ovaries to other areas of the pelvis. However, the cancer hasn’t spread to nearby lymph nodes or distant sites.

  • Stage 2A: Cancer has spread to the uterus or the fallopian tubes.
  • Stage 2B: Cancer has spread to other nearby pelvic organs.

A patient may undergo surgery for staging and debulking, including a full hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of both fallopian tubes and both ovaries), as well as chemotherapy.

Stage 3

In stage 3, the cancer has spread to nearby lymph nodes and/or other parts of the abdomen, but it hasn’t spread to distant sites.

  • Stage 3A: Cancer has spread to lymph nodes in areas outside or behind the peritoneum, or cancer cells have spread outside of the pelvis.
  • Stage 3B: Cancer has spread to the peritoneum, where it’s 2 cm or smaller, and possibly the lymph nodes behind the peritoneum.
  • Stage 3C: Cancer has spread to the peritoneum, where it’s larger than 2 cm. It may have possibly spread to the lymph nodes in the abdomen, as well as to the surface of the liver or spleen.

Treatment for stage 3 is often similar to that of stage 2, but it may require more chemotherapy treatments and more monitoring for follow-up treatment.

Stage 4

 In stage 4, the cancer has spread beyond the abdomen. This is considered a metastatic cancer, which means the cancer has been found in areas outside of the primary cancer area.

  • Stage 4A: Cancer cells are detected in fluid around the lungs.
  • Stage 4B: Cancer has spread outside the abdomen and may exist in the lymph nodes in the groin.

Treatments for stage 4 ovarian cancer depend on individual needs and what the cancer team recommends. It may begin with surgery or chemotherapy.

Fallopian tube and primary peritoneal cancers are also treated similarly to ovarian cancer.

How stage affects ovarian cancer survival rates

Determining a cancer’s stage helps your care team decide on a treatment plan, but it also helps predict outcomes. Survival statistics are often calculated by stage and presented as five-year relative survival rates, based on the number of people alive five or more years after their diagnosis. While these numbers can help patients better understand their potential prognosis, they are only estimates based on averages rather than individuals. They also reflect the outcomes of patients in the past and may not account for recent advances in treatment.

In 2022, about 19,880 women in the United States will be diagnosed with ovarian cancer and about 12,810 will die, according to the American Cancer Society.

The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program places the overall five-year relative survival rate at 49.1 percent, meaning that 49 out of every 100 women with ovarian cancer will survive for at least five years after their diagnosis. However, survival rates vary depending on the stage:

  • Ovarian cancer that has not spread outside the ovaries (localized or stage 1) has a five-year relative survival rate of 92.6 percent.
  • For stage 2 or stage 3 ovarian cancers that have spread to nearby locations, the survival rate is 74.8 percent.
  • Stage 4 ovarian cancer has a survival rate of 30.3 percent.

The stage of cancer is an important predictor of outcome. Stage 1 ovarian cancer has a higher survival rate than stage 4 ovarian cancer. However, countless other factors also may influence an individual’s experience with cancer, such as the patient’s overall health, age and cancer subtype.

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