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Ovarian Cancer Stages: What to Expect

An ovarian cancer diagnosis is daunting, and it's natural to feel scared and overwhelmed. One of the tricks for dealing with all the information is to focus on what you need to know right then. After the diagnosis, the next key point of interest is the stage of the disease, which is a way of stating to what extent the cancer has spread.

Ovarian cancer stages are organized and defined differently than those of other types of cancer. Most cancers are staged by tumor size, growth rate, and lymph node involvement for stages I through III; stage IV indicates that the cancer has spread beyond its point of origin. In ovarian cancer, however, stages II through IV all indicate the extent to which the cancer has spread beyond the ovaries, and only stage I has the cancer remaining at its point of origin.

The International Federation of Gynecologists and Oncologists (FIGO) developed a standard for staging ovarian cancer and updated it in 2014. This system includes letters along with the Roman numeral stages to further differentiate and define how the cancer has spread.

Staging is determined from surgery results. The surgeon's observations of the abdominal organs during the procedure, along with the pathology report from the tumor and any other biopsies taken during the surgery, are evaluated in determining the stage. The information gathered is sorted into three categories and quantified: T for the size and growth of the primary tumor, N for the existence and placement of lymph node involvement, and M for the extent that the cancer has spread (or metastasized). The scores for the T, N, and M indicators determine the cancer stage.

Let's break down each of the ovarian cancer stages:

Stage I

Stage I ovarian cancer has not spread beyond the ovaries and fallopian tubes. There is no lymph node involvement or distant metastasis.

Stage II

At stage II, the cancer has spread to other organs in the pelvis, such as the sigmoid colon, rectum, bladder, or uterus. There is still no lymph node involvement or distant metastasis.

Stage III

At this stage, the tumors are larger and often visible to the surgeon without magnification. The lymph nodes at the back of the abdomen may be positive for cancer. Additionally, it may have spread to the abdominal wall and even the outside of the liver or spleen, but not inside those organs. This is still considered to be negative for distant metastasis.

Stage IV

Stage IV, or metastatic, ovarian cancer has spread to organs outside the abdomen. It may have reached the inside of the liver or spleen. The cancer may be found in the lungs, the fluid around the lungs, the brain, the skin, and other areas.


Cancer staging guides the treatment plan. There are three types of treatment for ovarian cancer: surgery, chemotherapy, and radiation. Patients may receive one, two, or all three of these treatments in succession, depending on the stage of their cancer and the areas to which it has spread. Surgery is typically the first course of action. Chemotherapy destroys cancer cells throughout the body, and radiation therapy focuses high-energy X-rays on problem areas in order to reduce tumor size or eliminate the remaining cancer cells in that specific spot.

Research continues to evaluate and improve treatment protocols for ovarian cancer with an eye toward increasing effectiveness while minimizing side effects. In addition to identifying the cancer's stage, the diagnostic process also looks at the pathology of the cells collected. Armed with this information, your team can then prepare for the next step: a plan to treat the cancer.

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