Stages of Ovarian Cancer

If you or someone you love is diagnosed with ovarian cancer, it’s natural to be concerned about survival rate (prognosis), treatment, and whether a cure is possible. 

Understanding how ovarian cancer is staged and what each stage means can give you an idea of what to expect. Your stage can also help you find ovarian cancer clinical trials to participate in.

What Does Staging Mean in 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, which provide similar information. These systems help doctors assign a stage based on the location of tumors, including whether it has spread to nearby lymph nodes or to other areas of the body. 

Based on this information, doctors will assign an overall Stage of 1-4, and will further group the cancer into substages of A, A1, A2, B, or C. In general, a lower stage means the cancer is more localized, whereas a higher number means the cancer has spread. This staging system also applies to fallopian tube cancer and primary peritoneal cancer.

Another note on staging: generally speaking, ovarian cancer stage refers to its pathological stage, or surgical stage. This is largely determined by tissue samples that have been surgically removed and biopsied. If surgery is not possible, a doctor may assign the cancer a clinical stage, based on imaging and physical exam. If a patient then undergoes surgical biopsy, those results will then inform the cancer’s pathological stage classification.

Note: The medical standard is to refer to stages using Roman numerals, i.e., Stage I, Stage II, Stage III and Stage IV.

Understanding Survival Rates for Ovarian Cancer Stages

Many people with ovarian cancer want to know survival rates according to their cancer stage. In general, early stage disease is associated with a better prognosis than advanced stage disease. Additional information obtained at the time of surgery or during treatment can also provide information about a person’s prognosis.  For example, people in whom it is possible to remove all visible tumors at the time of surgery tend to have longer survival than people who have disease that cannot be safely resected. Information about the specific type of ovarian cancer (serous, clear cell, etc) and its grade, mutations found in the tumor, a person’s genetic background, and the effectiveness of chemotherapy can also provide additional prognostic information. Patients should talk to their doctors about their disease stage and tumor characteristics and how these impact their prognosis.

percentage of ovarian cancer cases by stage; includes 17% diagnosed as localized/confined to primary cancer site; 21% diagnosed as regional/spread to regional lymph nodes; 57% diagnosed as metastasized/distant cancer spread; 5% diagnosed as unknown/unstaged
Source: SEER 17 2012–2018, All Races, Females by SEER Combined Summary Stage
Ovarian Cancer Stage5-Year Survival
I89%
II71%
III41%
IV20%
Source: American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 6th Edition

Stage 1 Ovarian Cancer

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 only one ovary and is confined within the ovary, or cancer is in only one fallopian tube and is confined within the fallopian tube.
    • 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. 

Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a patient’s prognosis, including general health, grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 78% of those with ovarian cancer live for at least 1 year after diagnosis. More than 60% live for at least 3 years after being diagnosed, and over 50% of patients with ovarian cancer are still alive at least 5 years after diagnosis. Those diagnosed before age 65 do better than older women.

Stage 1 Ovarian Cancer Treatment

Generally patients with ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes (called a salpingo-oophorectomy), an omentectomy (removal of the omentum, a sheet of fat that covers some abdominal organs), and biopsy of lymph nodes and other tissues in the pelvis and abdomen to evaluate for evidence of disease spread. If an analysis of the surgical specimens determines that there is no evidence of cancer anywhere other than the ovary, this confirms that the cancer is stage I. In some people of childbearing age who wish to preserve their fertility and whose disease is confined to one ovary at surgery, fertility-sparing treatment may be offered. This preserves the normal ovary and uterus after the affected ovary is removed. Importantly, the other components of surgical staging are still performed, including omentectomy and lymph node biopsies, to look for microscopic evidence of tumor spread. Depending on the features of the tumor, some patients may require no further treatment. Chemotherapy is often recommended in cases of high-grade tumors, or cancer involving the surface of the ovary or present in abdominal fluid. Learn more about the different treatments and therapies.

Stage 2 Ovarian Cancer

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

Treatment for Stage 2 ovarian cancer typically includes: hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen to evaluate for spread of the cancer. After surgery, most people receive chemotherapy. Learn more about the different treatments and therapies.

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Stage 3 Ovarian Cancer

Stage 3 ovarian cancer means that the 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. It is also considered Stage 3 ovarian cancer when it has spread to the surface of the liver.

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  • 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 5-year survival rate for Stage 3 ovarian cancer is 41%.

Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 78% of women with ovarian cancer live for at least 1 year after diagnosis. More than 60% live for at least 3 years after being diagnosed, and over 50% of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

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.

Stage 4 Ovarian Cancer

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.

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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.

Survival rates are often based on studies of large numbers of people, but they can’t predict what will happen in any particular person’s case. Other factors impact a woman’s prognosis, including her general health, the grade of the cancer, and how well the cancer responds to treatment.

For all types of ovarian cancer taken together, about 78% of women with ovarian cancer live for at least 1 year after diagnosis. More than 60% live for at least 3 years after being diagnosed, and over 50% of women with ovarian cancer are still alive at least 5 years after diagnosis. Women diagnosed when they are younger than 65 do better than older women.

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.

About Cancer Grading

By looking at cancer cells under a microscope, a pathologist describes the cancer as Grade 1, 2, or 3. Grade 3 cancer cells are very atypical and high-grade are more likely to metastasize. Grade 1 tumors tend to be less aggressive, although these cancers may still be treated with chemotherapy.

Sources

  1. Cancer Stat Facts: Ovarian Cancer. Surveillance, Epidemiology, and End Results Program (SEER), National Cancer Institute. Bethesda, MD. 
  2. Survival Rates for Ovarian Cancer. American Cancer Society. 
  3. American Joint Committee on Cancer (AJCC). Cancer Staging Manual, 6th Edition.