Ovarian Cancer Stages

Ovarian cancer begins in the ovaries, a pair of small female reproductive glands that produce eggs and hormones, such as estrogen and progesterone. Although the exact cause is not fully understood, some factors may increase the risk, including advanced age, endometriosis, a family history of ovarian or breast cancer and certain genetic mutations, such as BRCA1 and BRCA2. Additionally, a woman who has never been pregnant may be at higher risk of developing ovarian cancer. The reason is unclear.

In many cases, ovarian cancer begins with very few or subtle symptoms. Possible warning signs include abdominal bloating, pelvic pain, changes in bowel habits and frequent urination. Because these symptoms are nonspecific, the condition is frequently diagnosed in a late stage, underscoring the importance of promptly discussing any unusual changes with a physician.

“Once you were part of the Moffitt family, you never felt alone.”

-Donna, Ovarian Cancer Survivor

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To diagnose ovarian cancer, the physician may use a combination of pelvic examination, computed tomography (CT) or ultrasound imaging, blood testing (including CA-125) and a biopsy of suspicious tissue. Once the diagnosis is confirmed, the physician will stage the tumor. Ovarian cancer staging provides important information that the physician can use to assess the extent of the tumor and plan treatment.

Typically, ovarian cancer is staged using the tumor (T), node (N) and metastasis (M) system, commonly known as the TNM system, which was developed by the American Joint Committee on Cancer (AJCC). This method involves an assessment of the size and extent of the primary tumor (T), whether nearby lymph nodes are involved (N) and whether the cancer has spread to distant areas of the body (M). The physician will then evaluate these factors collectively and assign a numerical stage.

Ovarian cancer stages include:

Stage 1 ovarian cancer

At stage 1, the tumor remains confined to one or both ovaries. The cancer has not spread into the pelvis, invaded nearby lymph nodes or reached distant organs. Stage 1 is generally considered the most treatable stage of ovarian cancer. However, because the symptoms are often unnoticeable or very mild, many cases go undiagnosed until the cancer has progressed.

Stage 1 ovarian cancer is further divided into three substages:

• Stage 1A – Cancer is present in only one ovary.
• Stage 1B – Cancer is found in both ovaries.
• Stage 1C – The tumor is classified as stage 1A or 1B and cancer is found on the outer surface of one or both ovaries, the tumor has ruptured or cancerous cells have invaded the abdominal fluid.

Some women with stage 1 ovarian cancer experience subtle symptoms, such as abdominal discomfort, bloating or irregular menstrual periods, although the condition is often “silent” at this early stage. The diagnosis may be confirmed through imaging tests and a tissue biopsy. Treatment usually involves surgical removal of the affected ovary or ovaries. In some cases, chemotherapy may be given after surgery to reduce the risk of cancer recurrence. With prompt and appropriate treatment, the outlook for stage 1 ovarian cancer is generally favorable.

Stage 2 ovarian cancer

Stage 2 indicates moderate cancer progression. The tumor has spread beyond the ovaries to other pelvic organs, but it has not yet reached lymph nodes or distant areas of the body.

Within stage 2, there are three substages:

• Stage 2A – The cancer has spread to the uterus and/or fallopian tubes.
• Stage 2B – The cancer has reached other pelvic organs, such as the bladder, rectum and/or sigmoid colon.
• Stage 2C – The tumor is classified as stage 2A or 2B and cancer is found on the outer surface of one or both ovaries, the tumor has ruptured or cancerous cells have invaded the abdominal fluid.

In addition to abdominal or pelvic pain, bloating, changes in bowel habits and frequent urination, some women with stage 2 ovarian cancer experience unexplained weight loss or a feeling of fullness after eating only a small amount of food.

Managing stage 2 ovarian cancer often involves a multimodal treatment approach, which may include surgery to remove the cancerous tissues and chemotherapy to target any remaining microscopic cancer cells.

Stage 3 ovarian cancer

Stage 3 ovarian cancer is characterized by tumor spread beyond the pelvis and into the abdominal cavity and/or nearby lymph nodes. At this advanced stage, the cancer may have reached the surface of the liver, the layer of fatty tissue lining the abdomen (omentum) or the lining of the abdominal cavity (peritoneum).

Within stage 3, there are three substages:

• Stage 3A – Microscopic cancer deposits are found outside the pelvis in the abdomen or nearby lymph nodes.
• Stage 3B – One or more tumors measuring less than 2 centimeters in diameter are visible in the abdomen.
• Stage 3C – One or more tumors measuring 2 centimeters or larger in diameter are found in the abdomen and/or the cancer has spread to regional lymph nodes.

At stage 3, ovarian cancer symptoms are usually more pronounced. Some women have severe abdominal or pelvic pain, persistent bloating, urinary urgency, urinary frequency and/or difficulty eating.

Treatment for stage 3 ovarian cancer typically involves cytoreductive or debulking surgery to remove as much of the tumor as possible, along with chemotherapy to target any remaining cancer cells. In some cases, targeted therapy may also be considered, particularly if the tumor has certain cellular characteristics or genetic mutations. Although stage 3 ovarian cancer has progressed, it can often be treated effectively, especially when the cancer responds well to initial therapies.

Stage 4 ovarian cancer

Stage 4 is the most advanced form of ovarian cancer, indicating that tumor cells have metastasized beyond the pelvis and abdominal cavity to distant organs and tissues. While early-stage ovarian cancer often spreads within the abdominal cavity, stage 4 involves more widespread metastasis.

Stage 4 is generally divided into two substages:

• Stage 4A – Cancer cells are found in the fluid around the lungs.
• Stage 4B – Cancer has spread to organs and tissues outside the abdominal cavity, such as the spleen, brain and/or bones.

Despite its advanced classification, stage 4 ovarian cancer is often treatable, and many patients respond well to a combination of therapies. Typically, treatment includes cytoreductive or debulking surgery to remove as much of the tumor as possible followed by systemic therapy, such as chemotherapy, targeted therapy and/or immunotherapy. The goals of treatment are to control the cancer progression, alleviate the symptoms and improve the patient’s quality of life.

Because stage 4 ovarian cancer can potentially impact several areas of the body, its symptoms can vary based on the affected organs and tissues. In addition to fatigue, some patients may experience shortness of breath, abdominal distention and/or digestive issues. While late-stage cancer generally presents more challenges in treatment, ongoing advancements in oncology continue to improve outcomes and provide new options for managing stage 4 ovarian cancer.

Where does metastatic ovarian cancer spread to?

Metastatic ovarian cancer can spread beyond the ovaries to other areas of the body. Common sites of metastasis include:

• Abdominal cavity – Ovarian cancer frequently spreads within the abdomen, affecting organs and tissues such as the intestines, bladder and peritoneum.
• Bones and brain – In rare cases, ovarian cancer may metastasize to the bones or brain.
• Lungs and pleural cavity – In late stages, ovarian cancer may reach the lungs and invade the space surrounding them, sometimes causing fluid buildup (pleural effusion).
• Lymph nodes – Cancer cells may travel through the lymphatic system to reach nearby or distant lymph nodes.
• Upper abdominal organs – The liver and spleen may be affected by ovarian cancer, either on their surface or internally, especially in advanced stages.

The specific pattern of ovarian cancer metastasis can vary and may influence treatment planning as well as the overall prognosis.

How do I know if my ovarian cancer has spread?

Ovarian cancer may have spread if certain symptoms appear, but confirmation requires a thorough medical evaluation by an experienced physician. Possible signs of metastasis include:

• Persistent abdominal bloating or distention
• Loss of appetite or feeling full quickly when eating (early satiety)
• Changes in bladder or bowel habits, such as increased urgency or frequency
• Unexplained fatigue
• Pain in the pelvis, abdomen, back or legs
• Shortness of breath, which may indicate fluid buildup around the lungs
• Unintended weight loss

It is important to note that these symptoms are not exclusive to metastatic cancer and can have many other causes. To determine whether ovarian cancer has spread, the physician may order:

• Imaging tests
• Blood tests, such as CA-125
• Biopsy or surgical evaluation

Early and ongoing communication with the healthcare team is essential to monitor for ovarian cancer progression and adjust the treatment plan as needed.

What is the prognosis for metastatic ovarian cancer?

The prognosis for metastatic ovarian cancer can vary based on several factors, including the extent of the tumor and the patient’s age, overall health and response to therapy. While a diagnosis of advanced-stage ovarian cancer can seem overwhelming, many patients respond well to treatment and can manage the condition effectively.

Advances in surgery, chemotherapy, targeted therapies and maintenance treatments are continually improving outcomes and providing new options for many patients with metastatic ovarian cancer. Some individuals may achieve remission, while others may experience periods of stability with ongoing management. Regular follow-up care and monitoring can allow for timely treatment plan adjustments as needed to control any side effects or complications. With personalized treatment and supportive care, many patients can maintain a good quality of life and continue their daily activities.

Benefit from world-class care at Moffitt Cancer Center

As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt is firmly positioned at the forefront of cancer research. Our scientists and clinicians are committed to advancing the treatment options for all stages of ovarian cancer through our robust clinical trials program, which provides our patients with unique opportunities to be among the first to benefit from promising new therapies that are not yet available elsewhere.

If you would like to learn more about ovarian cancer stages, you can request an appointment with a specialist in our gynecological clinic by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.