What are the Stages of Ovarian Cancer?

Stages of Ovarian Cancer Explained

Ovarian cancer is characterized by the uncontrolled growth of cells in the ovaries, which can destroy adjacent healthy tissues aggressively. It is also referred to as a "silent disease" because its symptoms may not show up until the cancer has spread to advanced stages.  

 
According to the Indian Council of Medical Research (ICMR), the age-adjusted incidence of ovarian cancer in India has been estimated to be around 6.8 per 100,000 women. Early detection and knowledge about the stages of ovarian cancer and its symptoms, causes, risk factors, etc., are essential for improved treatment outcomes. 

 
Keep reading for better insight! 

TNM System  

 
In this system, T refers to the extent or size of the tumour. T determines whether the cancerous cells have gone beyond the ovaries or not. N refers to regional lymph node involvement, particularly retroperitoneal (pelvic and para‑aortic) lymph nodes. M refers to metastasis or distant sites, and it determines whether the cancer has spread to the lungs, bones or liver.  

 
FIGO (International Federation of Gynecology and Obstetrics) and AJCC (American Joint Committee on Cancer) both use this TNM system while staging ovarian cancer. 

Stages of Ovarian Cancer 

 
Ovarian cancer has four stages, which are further classified into sub-stages based on how far the cancer has spread from where it first started in the ovaries: 

1. Stage1 

 
This stage has three sub-stages (1A, 1B, and 1C). Stage 1A: Cancer is limited to one ovary or one fallopian tube." 

"Stage 1B: Cancer is found in both ovaries or both fallopian tubes. 

In stage 1C, the cancer is still confined to the ovary(ies) or fallopian tube(s) as in stage 1A or 1B, BUT with one of the following: the surgical removal caused the tumor to rupture (1C1), the tumor capsule is ruptured before surgery or there are cancer cells on the ovarian surface (1C2), or cancer cells are found in fluid washed from the abdomen (1C3). 

2. Stage2 

 
The second stage is also divided into some sub-stages. In stage 2A, cancer spreads from the ovary to the uterus. Additionally, in stage 2B, it gets spread to some other nearby areas within the pelvis. 

3. Stage3 

 
There are three sub-stages in stage 3. In stage 3A, cancer extends to the abdomen (microscopically) or to lymph nodes from beyond the pelvis. In stage 3B, the tumour remains up to 2 centimetres in size and can extend beyond the pelvis or to lymph nodes.  

 
Stage 3C refers to cancer that has spread beyond the pelvis with deposits larger than 2 cm and/or involvement of retroperitoneal lymph nodes. It may involve the surface of the liver or spleen . 

4. Stage4 

 
This is the most progressive stage of ovarian cancer. Stage 4 ovarian cancer indicates distant metastasis. Stage 4A means it is close to the lungs, while Stage 4B indicates that cancer has spread to lymph nodes in the groin or into the chest. 

Probable Causes of Ovarian Cancer  

 
Finding the exact cause of ovarian cancer is difficult, but still, medical experts have highlighted some of the possible environmental or genetic factors as follows:  

• Endometriosisis when uterine tissue starts to grow outside of the uterus.  
• Early menstruation or extremely late menopause.  
• BRCA1 and BRCA2 mutations that affect DNA structure. 
• Extreme obesity and an unhealthy lifestyle.  
• Lynch syndrome, where mutations in DNA lead to its replication. 

Symptoms of Ovarian Cancer 

 
Ovarian cancer tends to show no such major symptoms in the beginning. Therefore, the cancer is often not detected until it has grown and most likely spread to other parts of the body, developing into a life-threatening condition.  

 
Some common signs of ovarian cancer are: 

• Unexplained and frequent bloating
• Feeling too full after eating a small amount of food 
• Trouble eating or loss of appetite 
• Increased frequency or urgency of urination 
• Pain in the pelvis 
• Abdominal pain or cramps 
• Stomach upset or indigestion. 
• Nausea 
• Fatigue 
• Pressure in the lower back or pelvic region 
• Back pain 
• Constipation 
• Painful intercourse 
• Swelling of the abdomen 
• Menstrual cycle changes 
• Sudden weight loss  

Risk Factors for Ovarian Cancer 

 
The key factors that can contribute to the increasing risk of ovarian cancer include: 

• Olderage 
• Family history of ovarian cancer 
• Inherited gene changes 
• Being obese or overweight 
• Postmenopausal hormone replacement therapy 
• Endometriosis 
• Never having been pregnant.  

How to Diagnose Ovarian Cancer? 

 
Ovarian cancer is often difficult to diagnose due to the lack of a reliable screening test in the early stage:  

• If this is suspected, the doctor will extensively check the patient’s medical history and symptoms and perform a pelvic exam to determine whether there are abnormal growths.  

 
There is no reliable routine screening test for ovarian cancer for women at average risk. Diagnosis occurs when symptoms prompt a series of investigations. Medical professionals suggest a pelvic exam and lower abdominal USG to check the abnormalities. Here is a list of tests that might determine if someone is suffering from ovarian cancer: 

• Ultrasound  
• Magnetic Resonance Imaging (MRI)  
• Computed Tomography (CT) Scan 
•  Positron Emission Tomography (PET) Scan  
• Blood tests, such as the ones done for CA-125, is a tumor marker that may support diagnosis and treatment monitoring, but it is not specific and is not suitable as a standalone screening test.  
• In some cases, a laparoscopy is performed to confirm the diagnosis and evaluate the stage of cancer. 

Treatment of Ovarian Cancer 

 
Some common treatment methods used for ovarian cancer include: 

• Surgery: This usually involves removing the reproductive organs and any affected tissues. Surgeons may perform this procedure through laparoscopy, which is a less invasive method, or alternatively, laparotomy, which requires a larger abdominal incision. 
• Chemotherapy: Your doctor might suggest chemotherapy either before or after surgery. These drugs are designed to target and destroy cancer cells. Chemotherapy can be administered through an IV (intravenously) or taken as pills (orally). 
• Targeted Therapy: This treatment uses specific drugs to locate and attack cancer cells, altering how they grow and multiply. 
• Hormone Therapy:  Some ovarian cancers rely on hormones for growth. This therapy works by blocking those hormones, which can slow or halt cancer progression. 
• Radiation therapy: It is not commonly used in ovarian cancer but may be considered in selected cases, such as for symptom relief or localized recurrent disease. 

Ovarian Cancer Prevention 

The patient may not be able to prevent ovarian cancer entirely. However, they can reduce the risk by following some practical tips: 

1. Take oral birth control: Consult with your health professional if birth control pills (oral contraceptives) are right for you. Using birth control pills for five or more years may reduce the risk of ovarian cancer. 
2. Keep a check on your body: Maintaining a healthy weight through a balanced diet and regular exercise can also play a major role in reducing the risk of developing ovarian cancer. 
3. Avoid Smoking: Don’t smoke, as it can increase the risk of certain subtypes of ovarian cancer. 
4. Talk to your doctor: If you have a family history of breast or ovarian cancer, make sure to inform your doctor during consultation. The doctor may determine what this may mean for your own risk of cancer. 

It is advisable to consult with your healthcare professional about effective ways to reduce your risk of developing ovarian cancer. The above-mentioned practical tips may help lessen the chances of getting ovarian cancer, but they are not recommended for everybody, and risks and benefits are associated with each. 

Ovarian cancer cases have been increasing at an alarming rate lately in India. While the exact causes are often unknown, effective treatments for ovarian cancer are available, including surgery and chemotherapy. Early detection significantly improves treatment outcomes. 

Disclaimer: This article is intended for general informational and educational purposes only. Ovarian cancer diagnosis, staging, and treatment decisions vary based on individual medical history, test results, and clinical findings. If you experience symptoms or have concerns about ovarian cancer or your health, please consult a qualified doctor or oncologist for personalized advice. 

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