Staging and grading of ovarian, fallopian tube or peritoneum cancer
The stage and grade of ovarian cancer, fallopian tube cancer and primary peritoneal cancer describes its size, whether it has spread and how quickly it may grow.
The stage of a cancer describes the size and position of the cancer and whether it has spread. Knowing the stage helps your doctors plan the best treatment for you.
Your doctor will not usually know the exact stage of the cancer until it has been removed with surgery. If you have not had surgery, they can use the results of your tests to decide the stage of the cancer.
These diagrams of the organs close to the ovaries may help you to understand the staging information.
This is early cancer.
- Stage 1a
The cancer is only in one ovary or fallopian tube.
- Stage 1b
The cancer is in both ovaries or fallopian tubes.
- Stage 1c
The cancer is in one or both ovaries or fallopian tubes with any of the following:
-The tissue surrounding the ovary (capsule) or fallopian tube has broken, which may have let cancer cells leak into the abdomen or pelvis.
-There are cancer cells on the surface of the ovaries or fallopian tubes.
-There are cancer cells in the fluid in the abdomen or pelvis.
The cancer is in one or both ovaries or fallopian tubes and has grown into nearby areas inside the pelvis.
Or the cancer has started in the peritoneum but only affects areas inside the pelvis.
- Stage 2a
There is cancer on the womb, fallopian tubes or ovaries.
- Stage 2b
There is cancer on other structures in the pelvis, such as the bowel or bladder.
The cancer is in one or both ovaries or fallopian tubes or started in the peritoneum. And it has spread to the peritoneum outside the pelvis and the lymph nodes in the abdomen and/or pelvis.
- Stage 3a1
The cancer has spread to the lymph nodes in the abdomen and/or pelvis.
- Stage 3a2
Very tiny amounts of cancer have spread to the peritoneum outside the pelvis. There may also be cancer in the lymph nodes in the abdomen and/or pelvis.
- Stage 3b
There are areas of cancer on the peritoneum outside the pelvis. These areas are less than 2cm. There may also be cancer in the lymph nodes in the abdomen and/or pelvis.
- Stage 3c
There are areas of cancer on the peritoneum outside the pelvis that are larger than 2cm. There may also be cancer in the lymph nodes in the abdomen and/or pelvis. There may be cancer cells on the surface of the liver and spleen but not inside these organs.
The cancer has spread outside the abdomen.
- Stage 4a
The cancer has caused a build up of fluid in the lining of the lungs (called the pleura). This is called a pleural effusion.
- Stage 4b
The cancer has spread to the inside of the liver or spleen, or to lymph nodes or organs outside the abdomen.
Grading describes how the cancer cells look under the microscope compared with normal cells. Knowing the grade helps your doctor plan your treatment.
This is how ovarian, fallopian tube and primary peritoneal cancers are graded:
Borderline tumours are made up of abnormal cells rather than cancer cells.
- Low-grade or well-differentiated (grade 1) – The cancer cells look similar to normal cells. They usually grow slowly and are less likely to spread.
- Moderate or intermediate-grade (grade 2) – The cancer cells look more abnormal. They are slightly faster-growing.
- High-grade or poorly-differentiated (grade 3) – The cancer cells look very different from normal cells. They may grow more quickly.
Ovarian cancer references
Below is a sample of the sources used in our ovarian cancer information. If you would like more information about the sources we use, please contact us at email@example.com
Fotopoulou C, et al. British Gynaecological Cancer Society (BGCS) epithelial ovarian/ fallopian tube/ primary peritoneal cancer guidelines: recommendations for practice. European Journal of Obstetrics, gynecology, and reproductive biology. 2017. 213: 123-139.
National Institute for Health and Care Excellence. Ovarian cancer: recognition and initial management. Clinical guideline (CG122). April 2011. Available from: www.nice.org.uk/Guidance/CG122 (accessed June 2017).
Germ cell ovarian cancer references
Below is a sample of the sources used in our germ cell ovarian cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Royal College of Obstetricians and Gynaecologists. Management of female malignant ovarian germ cell tumours. Scientific impact paper no.52. Nov 2016. Available from: www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_52.pdf (accessed June 2017)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor David Luesley, Professor of Gynaecological Oncology.
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