Staging is very important because ovarian cancers have a different prognosis at different stages and are treated differently. The accuracy of the staging may determine whether or not a patient will be cured. If the cancer is not properly staged, then cancer that has spread outside the ovary may be missed and not treated. Once a stage has been assigned it does not change, even when the cancer recurs or spreads to new locations in the body.

Ask your cancer care team to explain the staging procedure. Also ask them if they will perform a thorough staging procedure. After surgery, ask what your cancer's stage is. In this way, you will be able to take part in making informed decisions about your treatment.

Ovarian cancer is staged according to the AJCC/TNM System. This describes the extent of the primary Tumor (T), the absence or presence of metastasis to nearby lymph Nodes (N), and the absence or presence of distant Metastasis (M). Another system called the FIGO system has been used but is being replaced by this one.

Tx: No description of the tumor's extent is possible because of incomplete information

T1: The cancer is confined to the ovaries -- one or both

T1a. The cancer is in one ovary and doesn’t penetrate outside the ovary and is not in fluid taken from the pelvis

T1b The cancer is in both ovaries but doesn’t penetrate outside them and is not in fluid taken from the pelvis

T1c The cancer is in one or both ovaries and has penetrated outside them or is in fluid taken from the pelvis

T2: The cancer is in one or both ovaries and is extending into pelvic tissues and/or has also spread to the surface of the pelvic lining.

T2a. The cancer has spread to the uterus and/or the fallopian tubes and is not in fluid taken from the pelvis

T2b. The cancer has spread to other pelvic tissues and is not in fluid taken from the pelvis

T2c. The cancer has spread to the uterus and/or fallopian tubes and/or other pelvic tissues and is in fluid taken from the pelvis.

T3. The cancer is in one or both ovaries and has spread to the abdominal lining outside the pelvis.

T3a. The spread cancers are very small and can not be seen except under a microscope

T3b. The spread cancers can be seen but are smaller than 2 centimeters (0.8 inches).

T3c. The spread cancers are larger than 2 centimeters (0.8 inches).

N categories indicate whether or not the cancer has spread to regional (nearby) lymph nodes and, if so, how many lymph nodes are involved.

Nx: No description of lymph node involvement is possible because of incomplete information

N0: No lymph node involvement

N1: Cancer cells found in regional lymph nodes close to tumor

M categories indicate whether or not the cancer has spread to distant organs, such as the liver, lungs, or non-regional lymph nodes.

Mx: No description of distant spread is possible because of incomplete information

M0: No distant spread

M1: Distant spread is present

Grade 1: Well differentiated -- looks similar to normal ovarian tissue.

Grade 2: Not as well differentiated -- looks less like ovarian tissue

Grade 3: Poorly differentiated -- little resemblance to ovarian tissue

Once a patient's T, N, and M categories have been determined, this information is combined in a process called stage grouping to determine the stage, expressed in Roman numerals from stage I (the least advanced stage) to stage IV (the most advanced stage). The following table illustrates how TNM categories are grouped together into stages.

Stage I: The cancer is still contained within the ovary (or ovaries).

Stage IA: Cancer has developed in one ovary, and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. Laboratory examination of washings from the abdomen and pelvis did not find any cancer cells.

Stage IB: Cancer has developed within both ovaries without any tumor on their outer surfaces. Laboratory examination of washings from the abdomen and pelvis did not find any cancer cells.

Stage IC: The cancer is present in one or both ovaries and one or more of the following are present:

• Cancer on the outer surface of at least one of the ovaries
• In the case of cystic tumors (fluid-filled tumors), the capsule (outer wall of the tumor) has ruptured (burst)
• Laboratory examination found cancer cells in fluid or washings from the abdomen.

Stage II: The cancer is in one or both ovaries and has involved other organs (such as the uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis.

Stage IIA: The cancer has spread to or has actually invaded the uterus or the fallopian tubes, or both. Laboratory examination of washings from the abdomen did not find any cancer cells.

Stage IIB: The cancer has spread to other nearby pelvic organs such as the bladder, the sigmoid colon, or the rectum. Laboratory examination of fluid from the abdomen did not find any cancer cells.

Stage IIC: The cancer has spread to pelvic organs as in stages IIA or IIB and laboratory examination of the washings from the abdomen found evidence of cancer cells.

Stage III: The cancer involves one or both ovaries, and one or both of the following are present: (1) cancer has spread beyond the pelvis to the lining of the abdomen; (2) cancer has spread to lymph nodes.

Stage IIIA: During the staging operation, the surgeon can see cancer involving the ovary or ovaries, but no cancer is grossly visible (can be seen without using a microscope) in the abdomen and the cancer has not spread to lymph nodes. However, when biopsies are checked under a microscope, tiny deposits of cancer are found in the lining of the upper abdomen.

Stage IIIB: There is cancer in one or both ovaries, and deposits of cancer large enough for the surgeon to see, but smaller than 2 cm (about 3/4 inch) across, are present in the abdomen. Cancer has not spread to the lymph nodes.

Stage IIIC: The cancer is in one or both ovaries, and one or both of the following are present:

• Cancer has spread to lymph nodes.
• Deposits of cancer larger than 2 cm (about 3/4 inch) across are seen in the abdomen.

Stage IV: This is the most advanced stage of ovarian cancer. The cancer is in one or both ovaries. Distant metastasis (spread of the cancer to the inside of the liver, the lungs, or other organs located outside of the peritoneal cavity) has occurred. Finding ovarian cancer cells in pleural fluid (from the cavity that surrounds the lungs) is also evidence of stage IV disease.

Recurrent ovarian cancer: This means that the disease has come back (recurred) after completion of treatment.

Five-year survival rates for women with ovarian cancer have continued to improve since 1974. At that time, only 36.9% of women diagnosed with ovarian cancer could expect to live five years. In 1995-2000, 44% of women diagnosed with the disease were five-year survivors. Women older than 65 had a much shorter 5-year survival (29%) than younger women (56%) The survival of patients also goes down as the stage number goes up. Below are listed approximate 5-year survivals of patients with various stages of ovarian cancer. These are only approximate figures and will vary with the health and age of the patient. Stage for stage, older patients have a shorter survival and younger patients a longer one.