Stages of Ovarian Cancer

In order to plan treatment and predict prognosis, a doctor determines a person’s cancer stage using the results of diagnostic tests, imaging scans, and samples taken from surgery.

For ovarian cancer, your doctor will likely use the American Joint Committee on Cancer (AJCC) or International Federation of Gynecology and Obstetrics (FIGO) staging systems. These systems help doctors assign a stage based on the tumor’s location and whether it has spread to nearby lymph nodes or other areas of the body.

Staging Details

• Stages: Overall stages are numbered 1-4.
• Substages: Further grouped into A, A1, A2, B, or C.
• Lower Stage: More localized cancer.
• Higher Stage: Cancer has spread.

This staging system also applies to fallopian tube cancer and primary peritoneal cancer.

Generally, ovarian cancer stage refers to its pathological stage (surgical stage), determined by tissue samples surgically removed and biopsied. If surgery is not possible, a clinical stage is assigned based on imaging and physical exams. Subsequent surgical biopsy results can update the pathological stage classification.

Note: Stages are referred to using Roman numerals (e.g., Stage I, Stage II, Stage III, Stage IV).

Understanding Survival Rates for Ovarian Cancer Stages


Survival rates vary by cancer stage. Survival rates, based on large studies, cannot predict individual outcomes. Early-stage disease generally has a better prognosis than advanced-stage disease. Additional factors influencing prognosis include:

• Surgical Outcomes: Complete removal of visible tumors improves survival.
• Cancer Characteristics: Specific type (e.g., serous, clear cell), grade, and mutations.
• Patient Factors: Genetic background and comorbidities.
• Patients should discuss their disease stage, tumor characteristics, and prognosis with their doctors.

For all ovarian cancer types combined:

• About 78% survive at least 1 year post-diagnosis.
• Over 60% survive at least 3 years.
• More than 50% live at least 5 years.

Patients diagnosed before age 65 generally have better outcomes than older women.

About Cancer Grading

Cancer grading is determined by examining cancer cells under a microscope. Pathologists classify cancer as Grade 1, 2, or 3:

• Grade 1: Less aggressive tumors.
• Grade 2: Intermediate characteristics.
• Grade 3: High-grade, very atypical cells, more likely to metastasize.

When a person has Stage 1 ovarian cancer, it means the cancer has only been found in one or both ovaries or fallopian tubes and has not spread to other sites. Only 17% of patients with ovarian cancer are diagnosed with Stage 1 disease.

• Stage 1: Cancer is confined to the ovary (or ovaries), or the fallopian tubes.
  • Stage 1A: Cancer is in one ovary or fallopian tube and confined within it.
  • Stage 1B: Cancer is in both ovaries or both fallopian tubes but not found on the outer surfaces.
  • Stage 1C: Cancer is in one or both ovaries or fallopian tubes, and either the tumor lining is disrupted during surgery (1C1); or cancer is found on the outer surface of ovary or fallopian tube, (1C2); or cancer is found in fluid (a condition called ascites) or washings from the abdomen or pelvis (1C3).

What is the survival rate for Stage 1 ovarian cancer?
Most women with Stage 1 ovarian cancer have an excellent prognosis, with an average 5-year survival rate of 93%. Survival rates are further determined by type of ovarian cancer.

Stage 1 Ovarian Cancer Treatment
Ovarian cancer patients generally undergo a total abdominal hysterectomy, salpingo-oophorectomy (removal of both ovaries and fallopian tubes), omentectomy (removal of the omentum), and lymph node biopsies to check for disease spread. If no cancer is found outside the ovary, the cancer is confirmed as Stage I.

For those of childbearing age with cancer in one ovary, fertility-sparing treatment may be offered, preserving the normal ovary and uterus while still performing necessary surgical staging, including omentectomy and lymph node biopsies.

Depending on the tumor features, some patients may need no further treatment. Chemotherapy is often recommended for high-grade tumors or if cancer is on the ovary’s surface or in abdominal fluid. Learn more about the different treatments and therapies.

Stage 2 ovarian cancer means the cancer is found in one or both ovaries or fallopian tubes and has spread to other areas of the pelvis, or it is primary peritoneal cancer that is confined to the pelvis. 19% of ovarian cancers are found at stage 2.

• Stage 2: Cancer is in one or both ovaries or fallopian tubes, and has spread to other organs within the pelvis.
  • Stage 2A: Cancer has spread to, or into, the uterus.
  • Stage 2B: Cancer is found in other sites in the pelvis but not beyond the pelvis.

What is the survival rate for Stage 2 ovarian cancer?
Stage 2 ovarian cancer is typically considered to be regional spread, which has a general 5-year relative survival rate of about 74%.

Stage 2 Ovarian Cancer Treatment
Stage 2 ovarian cancer treatment typically includes a hysterectomy, bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), tumor debulking, and lymph node and tissue sampling to check for cancer spread. Most patients receive chemotherapy after surgery.

Learn more about the different treatments and therapies.

Stage 3 ovarian cancer indicates that the cancer is in one or both ovaries and has spread outside the pelvis to the abdomen, nearby lymph nodes, or the surface of the liver.

• Stage 3A1: Cancer involves the ovaries, fallopian tubes, or may be primary peritoneal cancer that involves pelvic or para-aortic lymph nodes without spread to other sites in the abdomen or pelvis.
• Stage 3A2: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, with evidence of microscopic implants beyond the pelvic region. The cancer may also have spread to pelvic or para-aortic lymph nodes.
• Stage 3B: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and it has visibly spread to organs outside the pelvic region, but the cancer deposits are no larger than 2cm. The cancer may also have spread to pelvic or para-aortic lymph nodes.
• Stage 3C: Cancer is in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and it has visibly spread to organs outside the pelvic region with deposits larger than 2cm. The cancer may also have spread to pelvic or para-aortic lymph nodes, or to the surface of the liver or spleen.

What is the survival rate for Stage 3 ovarian cancer?
The average five-year survival rate for Stage 3 ovarian cancer is 41%.

Stage 3 Ovarian Cancer Treatment
Treatment for Stage 3 ovarian cancer includes surgery and chemotherapy. At surgery, a hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) is performed, along with resection of as much of the tumor as possible. In addition, lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer may be removed. Depending on the distribution of disease on imaging studies or other pre-operative assessments, some people may have chemotherapy prior to surgery. This often results in tumor shrinkage, which may enable a less aggressive surgery to be performed. Other people may have surgery first, followed by chemotherapy.

Learn more about the different treatments and therapies.

When a person is diagnosed with Stage 4 ovarian cancer, the cancer has spread to the lungs or to the inner part of the liver, or to other distant sites. Cancer cells in fluid around the lungs is also considered Stage 4 ovarian cancer.

• Stage 4A: Cancer cells are present in the fluid around the lungs (this condition is called a malignant pleural effusion) but have not spread to other areas such as the spleen, liver, or lymph nodes that are not in the abdomen.
• Stage 4B: Cancer is seen inside the spleen or liver, in lymph nodes outside the abdomen or pelvis, and/or in other sites outside the peritoneal cavity.

What is the survival rate for Stage 4 ovarian cancer?
The average relative 5-year survival rate for those diagnosed with distant spread ovarian cancer, which includes Stage 4 ovarian cancer, is about 31%. The SEER program under the National Cancer Institute does not report on survival data by stage, but instead tracks survival data according to whether the cancer is localized, regional, or has distant spread, at the time of initial diagnosis.

Stage 4 Ovarian Cancer Treatment
Treatment for Stage 4 ovarian cancer will usually consist of surgery to remove as much of the tumor as possible, in combination with chemotherapy. Learn more about the different treatments and therapies.