Not long ago, ovarian cancer was referred to as the “silent killer” because it’s difficult to diagnose and even more challenging to treat. More recently, it’s being referred to as “the disease that whispers”. In June 2007, the Society of Gynecologic Oncologists formed a consensus statement on ovarian cancer.

 

Ovarian cancer is a growth of abnormal cells that begins in the ovaries. Cancer that originates at another site (e.g. breast or colon) and spreads to the ovaries is not considered ovarian cancer.  Ovarian tumors can be benign (noncancerous) or malignant (cancerous).  Benign tumors do not metastasize (spread to other parts of the body).  Malignant cancer cells in the ovaries can metastasize in two ways: directly to other organs in the pelvis and abdomen (the most common way), through the bloodstream or lymph nodes to other parts of the body.

 

Despite an increase in the resources dedicated to the study of the disease, little remains known about ovarian cancer. Poor long-term survival rates are mostly due to the lack of a reliable method of detection, with less than a quarter of all ovarian cancer cases being detected at the critical early stages.

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Ovarian cancer is the fifth most common cancer among women, excluding non-melanoma skin cancers.  It ranks fifth in cancer deaths among women accounting for more deaths than any other cancer of the female reproductive system.

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About one in every 78 women will develop cancer of the ovary and one in every 100 women will die from it. The American Cancer Society estimates that there will be 19,710 cases of ovarian cancer diagnosed in 2023 with approximately 13,270 deaths.

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Stages of Ovarian Cancer

The stages of ovarian cancer are determined by how far the cancer has spread. The stage of ovarian cancer at diagnosis is the most important indicator of prognosis.

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Stage I – Cancer is limited to one or both ovaries.

• IA: Cancer is limited to one ovary and the tumor is confined to the inside of the ovary.             No ascites containing malignant cells is present, and the surface of the tumor has not ruptured.

• IB: Cancer is limited to both ovaries without any tumors on the ovaries’ outer surfaces. No ascites containing malignant cells is present, and the surface of the tumor has not ruptured.

• IC: The tumor is classified as either Stage IA or IB and one or more of the following conditions exist:

  • a tumor on the outer surface of one or both ovaries;

  • at least one ruptured tumor;

  • ascites or abdominal (peritoneal) washings containing malignant cells.

 

Stage II – The tumor involves one or both ovaries and extends to other pelvic structures.

• IIA: The cancer has extended to and/or involves the uterus and/or the fallopian tubes.

• IIB: The cancer has extended to the bladder or rectum.

• IIC: The tumor is classified as either Stage IIA or IIB and one or more of the following conditions exist:

  • a tumor on the outer surface of one or both ovaries;

  • at least one ruptured tumor;

  • ascites containing malignant cells or abdominal (peritoneal) washings containing malignant cells.

Stage III – The tumor involves one or both ovaries, and one or both of the following exist:

• The cancer has spread beyond the pelvis to the lining of the abdomen;

• The cancer has spread to the lymph nodes. The tumor is limited to the true pelvis but with histologically-proven malignant extension to the small bowel or omentum (peritoneum fold).

• IIIA: The tumor is in one or both of the ovaries. While surgeons cannot see cancer in the abdomen, and the cancer has not spread to the lymph nodes, biopsies checked under a microscope reveal tiny deposits of cancer in the abdominal (peritoneal) surfaces.

• 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 do not exceed two cm in diameter. The cancer has not spread to the lymph nodes.

• IIIC: The tumor is visible in one or both ovaries, and one or both of the following conditions exists:

  • the cancer has spread to lymph nodes;

  • the deposits of cancer exceed two cm in diameter and are found in the abdomen

Stage IV– Growth of the cancer involves one or both ovaries and distant metastases to the liver or lungs have occurred. Finding ovarian cancer cells in the excess fluid accumulated around the lungs (pleural fluid) also shows evidence of stage IV.

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For more specific information about ovarian cancer, see the American Cancer Society’s Detailed Guide.