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The staging, grading and prognosis of ovarian cancer

Staging

The tests completed by your specialist show whether you have ovarian cancer and whether it has spread to other parts of the body. This process is called staging and it helps your health care team plan the best treatment for you.

In most instances, your doctor will not have enough information to work out the stage of the ovarian cancer until after surgery.

The staging system most commonly used for ovarian cancer is the International Federation of Gynecology and Obstetrics (FIGO) system It divides ovarian cancer into four stages:

stage 1Cancer is in one or both ovaries only.
stage 2Cancer is in one or both ovaries and has spread to other organs in the pelvis (uterus, fallopian tubes, bladder or bowel).
stage 3Cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen (peritoneum) or to nearby lymph nodes.
stage 4The cancer has spread further to distant organs such as the lung or liver.

Stages 1–2 mean it is early ovarian cancer. Stages 3–4 mean the cancer is advanced. About 7 out of 10 cases of ovarian cancer are diagnosed at stage 3 or 4.

The four stages of ovarian cancer in the FIGO system may be further divided into sub-stages, such as A, B, C, which indicate increasing amounts of tumour.

Grading ovarian cancer

The cancer will also be given a grade based on how the cancer cells look compared to normal cells under a microscope. This suggests how quickly the cancer may grow.

Grade 1 (or low grade) ovarian cancer is likely to grow relatively slowly. Grade 2 (moderate grade) might grow more quickly. Grade 3 (high grade) is likely to grow quickly.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease in a particular person.

Your doctor will consider many factors in assessing your prognosis. These include test results; the type of ovarian cancer and its stage and grade; genetic factors; your response to treatment; and other factors such as your age, fitness and overall health.

Epithelial cancer – If epithelial ovarian cancer is diagnosed and treated before the cancer has spread outside the ovary (stage 1), it has a good prognosis. Many cases of more advanced cancer may respond well to treatment, but the cancer often comes back (recurs) and further treatment is needed.

Germ cell and stromal cell tumours – These can usually be treated successfully, although there may be a small risk the cancer will come back and need further treatment.

Borderline tumour – This can usually be treated successfully with surgery alone.

Discussing your prognosis and thinking about the future can be challenging and stressful. It may help to talk with family and friends. You can also call Cancer Council 13 11 20 if you or your family or friends need more information or emotional support.

This information is reviewed by

This information was last reviewed April 2020 by the following expert content reviewers: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; A/Prof Penny Blomfield, Gynaecological Oncologist, Hobart Women’s Specialists, and Chair, Australian Society of Gynaecologic Oncologists, TAS; Dr Robyn Cheuk, Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital, QLD; Kim Hobbs, Clinical Specialist Social Worker, Gynaecological Cancer, Westmead Hospital, NSW; Sonja Kingston, Consumer; Clinical A/Prof Judy Kirk, Head, Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, and Sydney Medical School, The University of Sydney, NSW; Prof Linda Mileshkin, Medical Oncologist and Clinical Researcher, Peter MacCallum Cancer Centre, VIC; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Support Team, Ovarian Cancer Australia; Emily Stevens, Gynaecology Oncology Nurse Coordinator, Department of Obstetrics and Gynaecology, Flinders Medical Centre, SA; Dr Amy Vassallo, Fussell Family Foundation Research Fellow, Cancer Research Division, Cancer Council NSW; Merran Williams, Consumer.