Surgical Staging

Surgical staging is done with an exploratory laparotomy. An incision is made in the abdominal wall to gain access to the abdominal and pelvic cavities. The areas can be examined for the presence of tumors. For ovarian cancer, this may include surgical removal of tumors, tissue, or organs in advance of other staging tests.

Staging Tests

Tests that may help determine ovarian cancer stage:

• Blood tests to look for abnormal numbers of certain blood cells, proteins, indications of cancer, and abnormal cells. The tests may also show changes in kidney or liver function.
• Imaging tests—To help determine how deep the tumor has moved into the layers of the pelvis, abdomen, or beyond the primary site. They may also help to determine if there are any metastatic growths in other areas of the body. Some tests use contrast material to highlight structures so images are more clear and detailed. Imaging tests may include:
  • Chest x-rays
  • MRI scan
  • CT scan
  • Barium enema
• Other tests may include:
  • Colonoscopy —A thin, lighted tube with a tiny camera attached is inserted into the rectum and passed into the colon. The inside of the colon and rectum are examined for the presence of polyps or cancer. Any suspicious tissue can be removed during this procedure.
  • Peritoneal wash—The peritoneum, a fluid-filled membrane that surrounds and supports the abdominal cavity, is washed with a saline solution. Cells in the wash are collected and examined for the presence of cancer.
• Tissue evaluation—Cancer tissue from the biopsy will be closely examined to look for characteristics that can help with prognosis and treatment selection.

Stages of Ovarian Cancer

Ovarian cancer is staged from 1-4:

• Stage 1A —Cancer is in ONE ovary OR fallopian tube.
• Stage I1 —Cancer is in BOTH ovaries OR fallopian tubes.
• Stage 1C —Cancer is found in ONE or BOTH ovaries OR fallopian tubes WITH:
  • Cancer on the outside of ONE or BOTH ovaries OR fallopian tubes.
  • OR
  • The capsule surround the ovary has ruptured. This can occur before or during surgery.
  • OR
  • Cancer cells are in the fluid of the peritoneum and/or peritoneal cavity.
• Stage 2 —Cancer is in ONE or BOTH ovaries OR fallopian tubes and has spread to nearby pelvic or abdominal organs.
  • Stage 2A —Cancer has spread FROM the ovaries AND/OR fallopian tubes TO the uterus.
  • Stage 2B —Cancer has spread TO nearby pelvic organs, including the bladder, rectum, or colon.
• Stage 3 —Cancer is in ONE or BOTH ovaries OR fallopian tubes WITH spread from the pelvis TO the abdomen AND/OR lymph nodes.
  • Stage 3A —Cancer is in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum OR cancer cells are found ON the peritoneal layer OR IN the pelvic lymph nodes.
  • Stage 3B —Cancer is outside of the pelvis and in the peritoneum. Tumor is 2 centimeters (cm) or less. Cancer may be in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum.
  • Stage 3C —Cancer is outside of the pelvis and in the peritoneum. Tumor is more than 2 centimeters (cm). Cancer may be in the lymph nodes in and around the back of the abdomen, or ON the surface of abdominal organs like the liver or spleen.
• Stage 4A —Cancer is contained to the pelvis and abdomen, but cancer cells are in the pleural fluid that surround the lungs.
• Stage 4B —Cancer has spread to other parts of the body. The most common sites for metastatic ovarian cancer are the lymph nodes in other parts of the body, lungs, liver, and bones.

Grouping of Ovarian Cancer

To help streamline treatment planning, stage 1 cancer is considered early stage cancer, while stages 2-4 are considered advanced stage cancer.