The stages of ovarian cancer

Content

Stage 1
Stage 2
Stage 3
Stage 4
Chemotherapy
Important questions to ask
Support for you
Glossary

Ovacome is a national charity providing support to anyone affected by ovarian cancer. We give information about symptoms, diagnosis, treatment options and research, for the different types of ovarian cancer. Ovacome runs a telephone and email support line and works to raise awareness and give a voice to all those affected by ovarian cancer.

This page describes how ovarian cancer is classified into four stages when diagnosed and what treatment can be offered for each stage. There is a glossary to explain words you may not be familiar with.

Ovarian cancer stages refer to how far the cancer has spread at the time it is diagnosed. Your team may determine this based on scans or after surgery when your surgeon has seen the cancer. Laboratory reports will confirm the stage and what type of ovarian cancer you have. The system of staging also applies to fallopian tube and primary peritoneal cancers.

Stage 1 ovarian cancer

This is the earliest stage and means that the cancer affects only one or both of the ovaries, or one or both fallopian tubes. At this stage the cancer may cause few symptoms and most people are not aware that anything is wrong.

About 20 per cent (one in five) of people have their cancer found at this early stage.

Even if a cancer appears to affect only the ovary, it is still possible that it has spread. To be certain that a cancer is at stage 1 samples from other areas of the body are taken during surgery and examined under the microscope.

If cancer is confirmed as stage 1, the outlook is good. This is particularly the case if the cancer is confined to one ovary, stage 1a, or both ovaries, stage 1b, when surgery alone may be enough to treat it.

Stage 1c is when the cancer is limited to one or both ovaries, or fallopian tubes. But at this stage cancer cells may have leaked into the abdomen during initial investigative surgery (stage 1c1); the ovary may have ruptured before surgery or there may be a tumour on the ovary or fallopian tube surface (stage 1c 2); or there may be cancer cells present in abdominal fluids (stage 1c 3). Stage 1c ovarian cancer usually requires chemotherapy.

You can find more information about stage 1 ovarian cancer here.

Stage 2 ovarian cancer

This is when the cancer has spread outside the ovary into the pelvis or has gone into the uterus (womb). Primary peritoneal cancer is classified as stage 2.

Ovarian cancer at stage 2 is only found in a small number of people with the disease. This is because the lining of the pelvis and abdomen are not separated, so the cancer usually spreads to the abdomen at the same time as the pelvis.

Ovarian cancer is classified as stage 2a when it has spread to the uterus (womb) or fallopian tubes. Stage 2b is when the tumour has spread into other pelvic tissues.

If you have stage 2 ovarian cancer you are likely to be offered chemotherapy as well as surgery.

You can find more information about stage 2 ovarian cancer here.

Stage 3 ovarian cancer

This is the most common stage at which ovarian cancer is diagnosed. At this stage the cancer may have spread beyond the pelvis to the lymph nodes in the peritoneum (the lining of the abdominal cavity).

Stage 3a1 is when the cancer has spread only to the peritoneal lymph nodes, these are nodes in the abdominal area. Stage 3a1(i) means the disease in the lymph nodes measures up to 10 millimetres in diameter, 3a1(ii) means that cancer in the lymph nodes measures more than 10mm. Stage 3a2 is when microscopic disease has spread beyond the pelvis with or without affecting the peritoneal nodes.

Stage 3b means visible disease has spread beyond the pelvis and measures less than two centimetres with or without affecting the peritoneal nodes.

Stage 3c is visible disease beyond the pelvis measuring more than 2cms, with or without involving the peritoneal nodes, including the surface of the liver and the spleen but not within these organs.

At stage 3 the tumour on the lining of the abdomen (peritoneum) may release fluid which collects inside the abdomen. This collection of fluid is called ascites.

You can find more information about stage 3 ovarian cancer here.

Stage 4 ovarian cancer

Stage 4 ovarian cancer has spread beyond the abdomen to more distant organs.

Stage 4a is when the cancer causes a build-up of fluid between the lining of the lungs and the chest wall, called a pleural effusion. This can result in breathlessness. Tests show this fluid contains cancer cells.

Stage 4b is when the cancer has spread within other more distant organs including lymph nodes outside the abdominal cavity.

If you have stage 3 or stage 4 ovarian cancer you may be offered surgery and chemotherapy. You may be offered some chemotherapy before surgery and the rest of the course afterwards. In some cases chemotherapy alone may be the best treatment.

You can find more information about stage 4 ovarian cancer here.

Chemotherapy

Chemotherapy is a drug treatment which kills cancer cells. The commonest given for ovarian cancer is called Carboplatin. It is given through a drip into a vein once every three weeks for six cycles. Paclitaxel (Taxol), another drug given into veins, may also be used in addition. For some rarer ovarian cancers other types of drugs are used as well.

Chemotherapy is normally given as outpatient treatment. It can have side effects which may include tiredness, nausea, hair loss and a reduction in the immune system. These often resolve when treatment is completed.

Important questions to ask

Will I be referred quickly to a medical team that specialises in diagnosing and treating gynaecological cancers?

Will medical professionals discuss the surgery and chemotherapy with me before my treatment?

Will the surgery be done by a gynaecologist trained in managing gynaecological cancers?

Will my chemotherapy be carried out by staff with a special interest in gynaecological cancers?

Can I see a specialist nurse or counsellor and a symptom-control team?

Can I and my family get information on support services?

Will I get information on any ongoing clinical trials?

Glossary

Ascites

Fluid caused by cancer that collects in the abdomen.

Chemotherapy

Treating cancer using cytotoxic drugs that kill cancer cells.

Gynaecology

The study of diseases of women.

Lymph nodes/glands

Small pearl-like glands connected to the lymph system which act as filters to bacteria or cancer cells.

Lymph system

A system of tubes and lymph nodes which carry tissue fluid (lymph) around the body.

Peritoneum

The lining of the abdominal cavity.

Pleural effusion

Fluid that collects between the lining of the lungs (pleura) and the chest wall.

Support for you

Ovacome is the UK 's national ovarian cancer support charity. We've been providing emotional support and personalised, expert information since 1996. Contact our support line by phone, email or text if you have questions about a diagnosis, or if you just want to talk things through.

We support anyone affected by ovarian cancer, including family members, carers, those with an inherited risk, and health professionals working in the field.

We run support groups and events, both in person and online, providing an opportunity to connect with others. Find out more about our groups and events here.

If you would like more information on the sources and references for this page, or if you would like to discuss anything about ovarian cancer, please phone our support line on 0800 008 7054 Monday to Friday between 10am and 5pm.

Booklet text reviewed by Professor Sean Kehoe MD DCH FRCOG. Professor of Gynaecological cancer and lead clinician, Oxford Gynaecological Centre, Churchill Hospital, Oxford; Senior Research Fellow, St Peters College, Oxford; Member of the International Federation of Obstetrics and Gynaecology (FIGO) Gynaecological cancer committee.

Disclaimer: Ovacome provides information and support. We make every effort to ensure the accuracy and reliability of the information at the time of printing. The information we give is not a substitute for professional medical care. If you suspect you have cancer you should consult your doctor as quickly as possible. Ovacome cannot accept liability for any inaccuracy in linked sources. Rights reserved.

V.3.1. Date last updated February 2022, due for review February 2025

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