Staging and grading of ovarian 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.

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Staging cancer of the ovary, fallopian tube or peritoneum

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps your doctors and nurses plan the best treatment for you.
If you are having surgery, your doctor will usually not know the exact stage until the cancer has been removed.

If you are not having surgery, doctors use tests and CT scan, to decide the stage of the cancer.

Doctors use FIGO staging for cancer of the ovary, fallopian tube cancer and primary peritoneal cancer. This system uses numbers and letters to describe the stages.

Side view ovarian with ureter

The diagram shows a side view cross-section of the organs and structures in the female abdomen and pelvis. This includes the womb, an ovary, a fallopian tube and the bladder.
Image: The diagram shows a side view of a female body from the level of the belly button down to the upper thigh. It shows the structures and organs in the abdomen and pelvis. There are 3 small openings into the pelvis between the legs. The opening closest to the back of the body leads up into a tube-shaped space. This is the back passage (rectum). The opening closest to the front of the body leads up into a rounded hollow organ. This is the bladder. The opening in the middle leads up into a slightly larger hollow organ with thick walls. This is the womb (uterus). The womb sits behind and over the bladder. At the top of the womb, a thin short tube is shown leaving the womb. This is a fallopian tube. It leads to a small solid oval organ. This is an ovary. Above the bladder and womb, a large space is shown. This space fills the front half of the body. Most of the space contains an irregular bundle of thick tubing. This is the bowel. A long flap of tissue is shown hanging down in the space in front of the bowel. This is the omentum. A thin lining is shown covering the walls of the space. The lining also covers the surfaces of the bowel, bladder and womb. This lining is the peritoneum. A fine tube is shown behind the bowel and womb. This is a ureter. It enters the top of the image towards the back of the body. It travels down behind the bowel and womb and connects to the top of the bladder through a small opening.

Lymph nodes in the abdomen and pelvis

The diagram shows the female abdomen and pelvis from the front. It shows a network of fine tubes and small oval shapes. These are the pelvic lymph nodes.
Image: The diagram shows the female abdomen and pelvis from the front. A narrow opening is shown between the legs. This leads into a narrow space shown inside the pelvis. This space is called the vagina. Above the vagina the space narrows until both sides almost touch. Then it opens again to form a hollow pear-shaped organ called the womb. The surfaces of the 2 sides are coloured red where they narrow between the vagina and the womb. The narrow area is the cervix. At either side of the upper end of the womb are 2 small solid oval shapes. These are the ovaries. They are connected to either side of the womb by narrow tubes called the fallopian tubes. A network of fine lines connecting small oval shapes is shown. This is the lymphatic system and lymph nodes. This network enters the image just above the tummy button. It splits into 2 main streams. These are shown over each ovary, down each side of the womb and into the area each side of the vagina at the top of the legs.

Stage 1

This is described as early cancer.

Stage 1a

The cancer is only within 1 ovary or 1 fallopian tube and does not affect the surface.

Stage 1b

The cancer is in both ovaries or both fallopian tubes.

Stage 1c

The cancer is in 1 or both ovaries or fallopian tubes, and 1 or more of the following has happened:

  • The surface (capsule) of the ovary or fallopian tube has broken. This may have caused cancer cells to leak into the tummy (abdomen) or pelvis (the lower area between the hips).
  • Cancer cells are on the surface of the ovaries or fallopian tubes.
  • Cancer cells are in the fluid in the tummy or pelvis.

Stage 2

The cancer is in 1 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. The peritoneum is the layer of tissue that covers the ovaries and fallopian tubes.

Stage 2a

Cancer is in the womb, fallopian tubes or ovaries.

Stage 2b

Cancer is in other structures in the pelvis, such as the bowel or bladder.

Stage 3

Cancer is in 1 or both ovaries or fallopian tubes or in the peritoneum. It has also spread to:

  • the lymph nodes in the pelvis or tummy (the retroperitoneal nodes)
  • parts of the peritoneum outside the pelvis.

Stage 3a1

The cancer has spread to the retroperitoneal nodes. This stage is further divided depending on whether the cancer is bigger or smaller than 1cm in diameter.

Stage 3a2

Very small amounts of cancer have spread to parts of the peritoneum outside the pelvis. Cancer may also be in the retroperitoneal nodes.

Stage 3b

The cancer is in parts of the peritoneum outside the pelvis. These areas are up to 2cm in diameter. Cancer may also be in the retroperitoneal nodes.

Stage 3c

Cancer is in parts of the peritoneum outside the pelvis. These areas are larger than 2cm in diameter. Cancer may also be in the retroperitoneal nodes. It may have spread to the capsule that surrounds the liver and spleen, but not inside these organs.

Stage 4

The cancer has spread to other parts of the body outside the tummy.

Stage 4a

The cancer has caused a build-up of fluid in the lining of the lungs (the pleura). This is called a pleural effusion.

Stage 4b

The cancer has spread to the inside of the liver or spleen. Or the cancer has spread to lymph nodes or organs outside the tummy, such as the lungs or armpits.

Further resources

The charity Target Ovarian Cancer have a which gives more information about the different stages and substages of ovarian cancer. It shows staging for cancers that start in the ovaries and fallopian tubes but not in the peritoneum.

Grading cancer of the ovary, fallopian tube or peritoneum

Grading describes how the cancer cells look under the microscope compared with normal cells. Knowing the grade helps your doctors plan your treatment.

Cancer of the ovary, fallopian tube or peritoneum is graded as:

  • Low grade or well differentiated (grade 1) – the cancer cells look very like 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 usually grow more quickly.

Most epithelial ovarian cancers are high grade serous cancers.

Doctors do not grade borderline tumours. This is because borderline tumours are made up of abnormal cells rather than cancer cells.

About our information

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.

  • 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 informationproductionteam@macmillan.org.uk

     

    Ovarian cancer: recognition and initial management. Clinical guideline [CG122] Published: 27 April 2011 Last updated: 02 October 2023 www.nice.org.uk/guidance/cg122 (accessed May 2024)

     

    Ovarian cancer: identifying and managing familial and genetic risk. NICE guideline [NG241]. Published: 21 March 2024 www.nice.org.uk/guidance/ng241 (accessed May 2024)

     

    A. González-Martín, P. Harter, A. Leary, D. Lorusso, R. E. Miller, B. Pothuri, I. Ray-Coquard, D. S. P. Tan, E. Bellet, A. Oaknin & J. A. Ledermann, on behalf of the ESMO Guidelines Committee. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Published August 17, 2023. www.annalsofoncology.org/article/S0923-7534(23)00797-4/fulltext (accessed May 2024)

Cancer Information Development team

Author

Dr Alexandra Taylor

Reviewer

Consultant Clinical Oncologist

Royal Marsden Hospital, London

Date reviewed

Reviewed: 01 March 2025
|
Next review: 01 March 2029
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

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