Types & Stages of Ovarian Cancer

Author: Shannon Miller

March 14, 2011

According to the National Ovarian Cancer Coalition, there are more than 30 different types of ovarian cancer which are classified according to the type of cell from which they start.

Cancerous ovarian tumors can start from three common cell types:

  • Surface Epithelium – cells covering the lining of the ovaries
  • Germ Cells – cells that are destined to form eggs
  • Stromal Cells – Cells that release hormones and connect the different structures of the ovaries

Common Epithelial Tumors – Epithelial ovarian tumors develop from the cells that cover the outer surface of the ovary. Most epithelial ovarian tumors are benign (noncancerous). There are several types of benign epithelial tumors, including serous adenomas, mucinous adenomas, and Brenner tumors. Cancerous epithelial tumors are carcinomas – meaning they begin in the tissue that lines the ovaries. These are the most common and most dangerous of all types of ovarian cancers. Unfortunately, almost 70 percent of women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage.

There are some ovarian epithelial tumors whose appearance under the microscope does not clearly identify them as cancerous. These are called borderline tumors or tumors of low malignant potential (LMP tumors).

Epithelial ovarian carcinomas (EOCs) account for 85 to 90 percent of all cancers of the ovaries. We must continue research and expand our knowledge about this group of cancers in order to improve treatment and save lives.

Germ Cell Tumors – Ovarian germ cell tumors develop from the cells that produce the ova or eggs. Most germ cell tumors are benign (non-cancerous), although some are cancerous and may be life threatening. The most common germ cell malignancies are maturing teratomas, dysgerminomas, and endodermal sinus tumors. Germ cell malignancies occur most often in teenagers and women in their twenties. Today, 90 percent of patients with ovarian germ cell malignancies can be cured and their fertility preserved.

Stromal Tumors – Ovarian stromal tumors are a rare class of tumors that develop from connective tissue cells that hold the ovary together and those that produce the female hormones, estrogen and progesterone. The most common types are granulosa-theca tumors and Sertoli-Leydig cell tumors. These tumors are quite rare and are usually considered low-grade cancers, with approximately 70 percent presenting as Stage I disease (cancer is limited to one or both ovaries).

Primary Peritoneal Carcinoma

The removal of one’s ovaries eliminates the risk for ovarian cancer, but not the risk for a less common cancer called Primary Peritoneal Carcinoma. Primary Peritoneal Carcinoma is closely rated to epithelial ovarian cancer (most common type). It develops in cells from the peritoneum (abdominal lining) and looks the same under a microscope. It is similar in symptoms, spread and treatment.

Stages of Ovarian Cancer

Once diagnosed with ovarian cancer, the stage of a tumor can be determined during surgery, when the doctor can tell if the cancer has spread outside the ovaries. There are four stages of ovarian cancer – Stage I (early disease) to Stage IV (advanced disease). Your treatment plan and prognosis (the probable course and outcome of your disease) will be determined by the stage of cancer you have.

Following is a description of the various stages of ovarian cancer:

Stage I – Growth of the cancer is limited to the ovary or ovaries.

Stage IA – Growth is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites present containing malignant cells. The capsule is intact.

Stage IB – Growth is limited to both ovaries without any tumor on their outer surfaces. There are no ascites present containing malignant cells. The capsule is intact.

Stage IC – The tumor is classified as either Stage IA or IB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.

Stage II – Growth of the cancer involves one or both ovaries with pelvic extension.

Stage IIA – The cancer has extended to and/or involves the uterus or the fallopian tubes, or both.

Stage IIB – The cancer has extended to other pelvic organs.

Stage IIC – The tumor is classified as either Stage IIA or IIB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.

Stage III – Growth of the cancer involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.

Stage IIIA – During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal peritoneal surfaces.

Stage IIIB – The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.

Stage IIIC – The tumor is in one or both ovaries, and one or both of the following is present: (1) the cancer has spread to lymph nodes; and/or (2) the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.

Stage IV – This is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and distant metastases (spread of the cancer to organs located outside of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.

These statistics, and the information regarding tumor stage and grade, demonstrate that there is a critical need to establish an agenda for more research into the areas of basic and translational research, genetic susceptibility and prevention, diagnostic imaging, screening and diagnosis, and therapy. These could hold the most promise for future discoveries that will lead to improved prevention, detection, and treatment of ovarian cancer, particularly the common epithelial cancers.

About the National Ovarian Cancer Coalition

The mission of the NOCC is to raise awareness and promote education about ovarian cancer. The Coalition is committed to improving the survival rate and quality of life for women with ovarian cancer.

More than 20,000 women in the United States are diagnosed with ovarian cancer each year, and approximately 15,000 women die annually from the disease. Unfortunately, most cases are diagnosed in their later stages when the prognosis is poor. However, if diagnosed and treated early, when the cancer is confined to the ovary, the five-year survival rate is over 90 percent. That is why it is imperative that the early signs and symptoms of the disease are recognized, not only by women, but also by their families and the medical community.

There is currently no early detection test for ovarian cancer. Pap tests do not detect ovarian cancer. Until there is a test, the key to early diagnosis is awareness. And the key to awareness is knowing the subtle symptoms of ovarian cancer and urging women to take early action and live. Through national programs and local Chapter initiatives, the NOCC’s goal is to make more people aware of the early symptoms of ovarian cancer. In addition, the NOCC provides information to assist the newly diagnosed patient, to provide hope to survivors, and to support caregivers. Our programs are possible only with the help of our volunteers; committed men and women dedicated to the mission of the NOCC in communities across the country. We encourage you to join them. Together, we can make a difference in the lives of women affected by ovarian cancer. Together, we can break the silence.

Visit the National Ovarian Cancer Coalition on the web at http://www.ovarian.org/

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5 Responses to “ Types & Stages of Ovarian Cancer ”

  1. Courtney Mulligan Says:

    March 15th, 2011 at 11:06 am

    Hi Shannon,
    You have been a hero of mine since I was young and I’m so sorry to hear that you are going through this. Glad that you caught it so early and I look forward to your continued success. May God Bless you and and your family.


  2. DeAnn Says:

    April 7th, 2011 at 11:30 pm

    Did your OB/Gyn run the new OVA 1 test to help diagnose your ovarian cancer?

  3. Norma Says:

    July 10th, 2011 at 7:52 pm

    Hi Shannon,

    My Mom lives in Edmond and just told me tonight about your ovarian cancer. She was listening to your radio program today and also sees your photo in Pan’s salon every time she gets her hair done.

    Did you have a BRCA test to determine if your cancer may be due to Hereditary Breast and Ovarian Cancer (HBOC) syndrome? Positive results may impact your risk for other cancers and impact other family members.

    InformedDNA provides genetic counseling to individuals at risk for hereditary diseases and syndromes, including HBOC.

    Other national organizations dedicated to the prevention, early detection and/or treatment of ovarian cancer include:

    Facing Our Risk of Cancer Empowered (FORCE)
    FORCE was created for women whose family history and genetic status put them at high risk for breast and ovarian cancer, as well as entire families dealing with BRCA mutations. Its mission is to improve the lives of individuals and families affected by hereditary breast and ovarian cancer.


    Best wishes for success in educating women about the signs and symptoms of ovarian cancer.

  4. Shannon Miller Says:

    July 10th, 2011 at 10:02 pm

    So nice to hear from Edmond! I did not have BRCA testing done prior to my cancer diagnosis. I have no history of ovarian cancer in my family so had not really considered it. However, my cancer was a germ cell (immature teratoma) tumor thus no clear genetic link. Thank you for sharing this information. The more information and advice we can share the better! Love to Oklahoma!

  5. Ruthie Snyder Says:

    March 5th, 2012 at 5:32 pm

    Hi Shannon, I am a 17 1/2 year survivor of stage 3c Ovarian Cancer with metastasis to my diaphragm. There is hope for you and all other women and girls with this disease. God be with you and yours. Ruthie

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