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Ovarian Epithelial Cancer Treatment (Patient) (cont.)

Stages of Ovarian Epithelial Cancer

After ovarian epithelial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.

The process used to find out if cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be done:

  • Laparotomy: The doctor cuts into the abdomen and carefully looks at all the organs to see if they contain cancer. The doctor will also do a biopsy (cut out small pieces of tissue so they can be looked at under a microscope to see whether they contain cancer). Usually the doctor will remove the cancer and organs that contain cancer during the laparotomy. (See the Treatment Options by Stage section.)
  • Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for ovarian epithelial cancer:

Stage I

Three-panel drawing of stage IA, IB, and IC ovarian cancer; first panel shows a stage IA tumor inside one ovary. The second panel shows two stage IB tumors, one inside each ovary. The third panel shows two stage IC tumors, one inside each ovary, and one tumor has a ruptured capsule. An inset shows cancer cells floating in the peritoneal fluid surrounding abdominal organs. Also shown are the fallopian tubes, uterus, cervix, and vagina.
Ovarian cancer stage IA, IB, and IC. In stage IA, cancer is found inside a single ovary. In stage IB, cancer is found inside both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage I, cancer is found in one or both ovaries. Stage I is divided into stage IA, stage IB, and stage IC.

  • Stage IA: Cancer is found inside a single ovary.
  • Stage IB: Cancer is found inside both ovaries.
  • Stage IC: Cancer is found inside one or both ovaries and one of the following is true:
    • cancer is also found on the outside surface of one or both ovaries; or
    • the capsule (outer covering) of the ovary has ruptured (broken open); 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

Three-panel drawing of stage IIA, IIB, and IIC ovarian cancer; first panel shows two stage IIA tumors, one inside each ovary, that have spread to the uterus and fallopian tube. The second panel shows two stage IIB tumors, one inside each ovary, that have spread to the uterus, fallopian tube, and colon. The third panel shows two stage IIC tumors, one inside each ovary, that have spread to the uterus and colon. An inset shows cancer cells floating in the peritoneal fluid surrounding abdominal organs. Also shown are the cervix and vagina.
Ovarian cancer stage IIA, IIB, and IIC. In stage IIA, cancer is found inside one or both ovaries and has spread to the uterus and/or the fallopian tubes. In stage IIB, cancer is found inside one or both ovaries and has spread to other tissues within the pelvis. In stage IIC, cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis, and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.

  • Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).
  • Stage IIB: Cancer has spread to other tissue within the pelvis.
  • Stage IIC: Cancer is found in one or both ovaries and has spread to the uterus and/or fallopian tubes, or to other tissue within the pelvis. Also, one of the following is true:
    • cancer is also found on the outside surface of one or both ovaries; or
    • the capsule (outer covering) of the ovary has ruptured (broken open); 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).

Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and lime
Pea, peanut, walnut, and lime show tumor sizes.

Stage III

In stage III, cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

  • Stage IIIA: The tumor is found in the pelvis only, but cancercells that can be seen only with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen), the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.
    Stage IIIA ovarian cancer; drawing shows tumors inside both ovaries that have spread to the uterus, colon, and the surface of the peritoneum. Also shown are the fallopian tubes, small intestine, and bladder.
    Stage IIIA ovarian cancer. In stage IIIA, cancer is found in one or both ovaries and has spread to other tissue within the pelvis. Cancer cells that can only be seen with a microscope have spread to the surface of the peritoneum. Cancer that has spread to the surface of the liver is also considered to be stage III.
  • Stage IIIB: Cancer has spread to the peritoneum and the cancer in the peritoneum is 2 centimeters or smaller.
    Stage IIIB ovarian cancer; drawing shows tumors inside both ovaries that have spread to the uterus, colon, small intestine, and the peritoneum, where they are 2 centimeters or smaller in diameter. An inset shows 2 centimeters is about the size of a peanut. Also shown are the fallopian tubes and bladder.
    Stage IIIB ovarian cancer. In stage IIIB, cancer is found in one or both ovaries and has spread to other tissue within the abdomen and to the peritoneum, where it is 2 centimeters or smaller in diameter. Cancer that has spread to the surface of the liver is also considered to be stage III.
  • Stage IIIC: Cancer has spread to the peritoneum and the cancer in the peritoneum is larger than 2 centimeters and/or cancer has spread to lymph nodes in the abdomen.
    Stage IIIC ovarian cancer; drawing shows tumors inside both ovaries that have spread to the uterus, colon, small intestine, lymph nodes in the abdomen, and the surface of the peritoneum, where they are larger than 2 centimeters in diameter. An inset shows 2 centimeters is about the size of a peanut. Also shown are the fallopian tubes and bladder.
    Stage IIIC ovarian cancer. In stage IIIC, cancer is found in one or both ovaries and has spread to (a) the peritoneum, where it is larger than 2 centimeters in diameter, and/or (b) lymph nodes in the abdomen. Cancer that has spread to the surface of the liver is also considered to be stage III.

Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.

Stage IV

Stage IV ovarian cancer; drawing shows parts of the body where ovarian cancer may spread, including the liver, lung, lymph nodes, and bone. An inset shows a close-up of cancer spreading through the blood and lymph to other parts of the body.
Stage IV ovarian cancer. Cancer is found in one or both ovaries and may spread to other parts of the body, such as the lymph nodes, lung, liver, and bone. Cancer cells may also be found in an area between the lungs and the chest wall that has filled with fluid.

In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver.

Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer.

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