Ovarian Cancer

Advanced and Recurrent Disease

Disease limited to one or both ovaries is stage I, local spread to organs in the pelvis is stage II, spread to the abdominal lining or lymph nodes is stage III and distant spread is stage IV. Your doctor also may determine the tumor’s grade, which indicates how abnormal the cells are.

From 70 to 80 percent of ovarian cancer patients are initially diagnosed with advanced disease, after their cancer has spread to other parts of the body. Researchers are trying to find ways to diagnose patients in earlier stages of the disease when it is localized to the ovaries.

Surgery remains the initial approach to treatment even for patients with advanced disease because doctors have found that ovarian cancer patients who have aggressive initial surgery fare better in the long run.

After surgery, staging and grading, your doctor may recommend intravenous chemotherapy, most commonly in the form of a two-drug combination, although single-agent and oral regimens are sometimes used. A newer chemotherapy technique, intraperitoneal chemotherapy, involves injecting the drugs into the abdominal cavity.

Many patients who receive a combination of surgery and chemotherapy go into remission, that is, experience a period when the signs and symptoms of cancer disappear. Unfortunately, most of these patients will have a relapse and return of cancer as well. Research suggests that from 70 to 90 percent of ovarian cancer patients will have a recurrence of their disease at some point in treatment.

Your doctor will monitor you for recurrence of cancer and re-start treatment when appropriate. Chemotherapy is the primary treatment for recurrent ovarian cancer, and there are a lot of options. In general, the longer it’s been since your initial treatment and the longer the treatment-free interval between the end of initial treatment and the recurrence of cancer, the better your chances of responding to chemotherapy re-treatment.

Although radiation therapy is rarely used for primary treatment of ovarian cancer, it is sometimes used to treat recurrences. Cancer cells can be killed by radiation, but ovarian cancer that spreads can involve a large area of the abdomen, from the liver to deep in the pelvis. Radiation given to the whole abdomen to treat recurrent ovarian cancer can be associated with damage to other organs in the abdomen, such as the kidney and liver. However, radiation therapy may be used to treat ovarian cancer that recurs outside the abdomen, especially in the lymph nodes. Ask your doctor what’s best for you.

Women who are diagnosed with ovarian cancer should know about an inherited condition known as familial breast-ovarian cancer syndrome. This common syndrome is responsible for 10 percent of ovarian cancers and 5 to 10 percent of all breast cancers. Women with one of these cancers face increased risk of developing the other.

What the Stages of Ovarian Cancer Mean

Stage I: Cancer is found in one or both ovaries and is contained there.

Stage IA: A cancerous tumor or tumors have developed in one ovary, confined to the inside of the ovary. No cancer exists on the outer surface of the ovary. Laboratory tests of washings from the abdomen and pelvis do not identify any cancer cells.

Stage IB: Cancer has developed within both ovaries but not on the outer surfaces. Laboratory tests of washings from the abdomen and pelvis do not identify any cancer cells.

Stage IC: Cancer is present in one or both ovaries and on the outer surface of at least one of the ovaries. In the case of cystic tumors (fluid-filled tumors), the outer wall of the tumor has ruptured. Laboratory tests of fluid or washings from the abdomen and pelvis identify cancer cells.

Stage II: Cancer is in one or both ovaries and involves other organs within the pelvis, such as the fallopian tubes, uterus, bladder, the colon or the rectum.

Stage IIA: Cancer has spread to the fallopian tubes or uterus or both. Laboratory tests of washings from the abdomen do not identify any cancer cells.

Stage IIB: Cancer has spread to other nearby pelvic organs, such as the bladder, the rectum or colon. Laboratory tests of washings from the abdomen do not identify any cancer cells.

Stage IIC: Cancer has spread to pelvic organs as described in stages IIA or IIB and laboratory tests of the washings from the abdomen identify cancer cells.

Stage III: Cancer involves one or both ovaries and has spread beyond the pelvis to the lining of the abdomen or to lymph nodes or to both the lining of the abdomen and lymph nodes.

Stage IIIA: Cancer is visible in the ovary or ovaries but not in the abdomen and has not spread to lymph nodes. However, biopsy tissue examined under a microscope shows tiny deposits of cancer in the lining of the upper abdomen.

Stage IIIB: Cancer is visible in one or both ovaries and deposits of cancer are large enough to be seen (but smaller than 3/4 inch in diameter) in the abdomen. Cancer has not spread to the lymph nodes.

Stage IIIC: Cancer is visible in one or both ovaries and has spread to lymph nodes and/or deposits of cancer larger than about 3/4 inch in diameter can be seen in the abdomen.

Stage IV: This stage represents the most advanced form of ovarian cancer. Cancer has spread to the lungs, inside the liver or to other organs outside of the abdominal cavity. Ovarian cancer cells found in the fluid surrounding the lungs also indicate stage IV disease.

Recurrent ovarian cancer: Cancer went into remission with treatment but returned.

Source: American Cancer Society, “How Is Ovarian Cancer Staged?” Available online at www.cancer.org.


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