Information & support Download resources The stages of ovarian cancer . Download fact sheet . The stage of ovarian cancer means how far the cancer has spread at the time it is diagnosed. This may be 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 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 women are not aware that anything is wrong. . Diagram of the female reproductive system . About 20 per cent (one in five) of women 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 contained within 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. . Stage 2 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 women 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. . Stage 3 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. . Stage 4 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. 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. . 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? If you would like more information on the sources and references for this fact sheet, please call us on 0800 008 7054. If you would like to discuss anything about ovarian cancer, please phone our supportline on 0800 008 7054 Monday to Friday between 10am and 5pm. . Written by Professor Sean Kehoe, Lawson Tait Professor of Gynaecological Cancer, University of Birmingham . Disclaimer Ovacome fact sheets provide 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. v.2 Date last reviewed May 2018 Date for review May 2020 . 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.