More About Ovarian Cancer

Ovarian Cancer: Introduction

What is cancer?

Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let's look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.

Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).

What is ovarian cancer?

Ovarian cancer is cancer that starts in your ovaries. Only women have ovaries, so only women get this kind of cancer.

Many types of tumors can start growing in the ovaries. Some are benign. This means that they’re not cancer. Benign tumors don’t spread. They can usually be treated by removing one ovary or part of the ovary. Ovarian cancer, however, is a malignant (cancerous) tumor. If a cancerous tumor isn’t treated, it can grow and spread to other parts of your body.

The ovary is made up of many layers of cells. Cancer can affect any one or all of these layers. These are the main types of ovarian cancer.

Epithelial ovarian cancer

This is by far the most common type of ovarian cancer. It starts in cells on the surface of the ovary. Many epithelial ovarian cancers start in fallopian tube or peritoneal (the lining of the inside of the belly) epithelial cells. Then they go to the surface of the ovary.

Germ cell ovarian cancer

This cancer starts in the cells that form eggs in the ovary. These rare tumors are most common in women in their teens and early twenties. There are different sub-types of germ cell tumors.

Stromal cell cancer

This cancer forms in the tissue that makes certain female hormones and holds the ovaries in place. This is a very rare form of ovarian cancer.

Understanding the ovaries

To understand where the tumor is, it may help to know more about your ovaries. A woman's reproductive system has two ovaries. These are the other structures in that system:

  • Vulva. This is the external female genitals. These are the parts outside your body.

  • Vagina. This is the passage that connects the uterus to the outside of your body. It's also called the birth canal.

  • Cervix. This is the lower part of your uterus that connects it to the vagina.

  • Uterus. This is the hallow, pear-shaped organ that holds a growing baby. It's also called the womb.

  • Two fallopian tubes. These are the tubes through which an egg travels from the ovaries to the uterus.

Your ovaries are responsible for hormone and egg production. They are located on either side of the uterus, in your pelvis. Each month, one of the ovaries releases an egg. After the egg leaves the ovary, it goes down the fallopian tube. If the egg connects with a sperm, it’s fertilized and burrows into the wall of the uterus. There it grows to become a baby. If the egg isn’t fertilized, it leaves the body through the vagina along with the menstrual flow. The ovaries also make the hormones that control the development of certain parts of your body. These include the breasts, body shape, and body hair. These hormones also control your menstrual cycle.

When a woman reaches menopause, her ovaries stop releasing eggs. They also stop making certain hormones.

Talk with your healthcare provider

If you have questions about ovarian cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.

 

Ovarian Cancer: Stages

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The stage of ovarian cancer (and fallopian tube cancer, which is often treated the same as ovarian cancer) is usually determined after surgery. This is done by looking at the removed tissue in the pathology lab. This is known as surgically staging the cancer.

Ovarian and fallopian tube cancer is staged using the AJCC and FIGO system. AJCC stands for American Joint Committee on Cancer. FIGO stands for International Federation of Gynecology and Obstetrics. These two staging systems are a lot alike. Both define cancers by Roman numerals 0 through IV. The lower the stage, the less the cancer has spread. The higher the stage, the more the cancer has spread.

What are the stages of ovarian cancer?

These are the stages of ovarian and fallopian tube cancer and their definitions. Be sure to ask your healthcare provider to explain your cancer’s stage to you. Gynecologic oncologists are specialists who have done extra training in the diagnosis and treatment of these types of cancer. It’s best to have ovarian cancer treated by one of these healthcare providers.

Stage I

Cancer is in one or both of the ovaries or fallopian tubes. It has not spread. Stage I is further divided into three stages.

Stage IA

Cancer is in a single ovary or fallopian tube. It has not spread onto the outer surface of the ovary or fallopian tube. Healthcare providers have not found cancer cells in nearby lymph nodes or in fluid or washings from the abdomen or pelvis.

Stage IB

Cancer is in both ovaries or fallopian tubes. It has not spread to their outer surfaces. Healthcare providers have not found cancer cells in nearby lymph nodes or in fluid or washings from the abdomen or pelvis.

Stage IC

The cancer is in one or both ovaries or fallopian tubes. Plus, at least one of these three facts is also true:

  • Cancer is on the outer surface of at least one of the ovaries or fallopian tubes.

  • The outer wall of a fluid-filled tumor, called a cystic tumor, has ruptured either before or during the surgery.

  • Cancer cells have been found in fluid or washings from the abdomen or pelvis.

Stage II

Cancer is in one or both ovaries or fallopian tubes. It has also grown onto or into other pelvic organs. These might include the uterus, fallopian tubes, bladder, colon, or rectum. The cancer has not spread to lymph nodes, the lining of the abdomen, or distant organs. Stage II is further divided into three stages.

Stage IIA

The cancer that started in the ovaries has spread onto or into the uterus or the fallopian tubes, or both. Or cancer that started in the fallopian tubes has spread onto or into the uterus or the ovaries, or both. Healthcare providers have not found cancer cells in nearby lymph nodes or in fluid or washings from the abdomen or pelvis.

Stage IIB

The cancer has spread onto or grown into other organs within the pelvis. These may include the bladder, colon, or rectum. Healthcare providers have not found cancer cells in nearby lymph nodes or in fluid or washings from the abdomen or pelvis.

Stage IIC

The cancer has spread to the uterus, bladder, colon, or other organs in the pelvis. Healthcare providers have also found cancer cells in fluid or washings from the abdomen or pelvis.

Stage III

The cancer is in one or both ovaries or fallopian tubes. Also, one or both of these things has happened:

  • Cancer has spread to the abdominal lining. This is called the peritoneum.

  • Cancer has spread to the lymph nodes.

Stage III is further divided into three stages.

Stage IIIA

Cancer is in one or both ovaries or fallopian tubes. Cancerous cells are also in the abdominal lining. But the cancer there is too small to be seen with the naked eye. The cancer may have also spread to the lymph nodes.

Stage IIIB

Cancer is in one or both ovaries or fallopian tubes. There are small, visible cancerous deposits, which are less than 2 centimeters (cm) across, in the abdomen. (Two cm is about 0.8 inch.) Deposits may be on the outside of the liver or the spleen. Cancer may have also spread to the lymph nodes.

Stage IIIC

Cancer is in one or both ovaries or fallopian tubes. Plus, one or both of these cases is true:

  • Cancer has spread to the lymph nodes.

  • Deposits of cancer (larger than 2 cm across) are in the abdomen. They may be on the outside of the liver or the spleen.

Stage IV

The cancer has spread outside the pelvic region to distant sites. These may include the inside of the liver or spleen, lungs, or other organs that aren’t in the abdomen.

Recurrent ovarian cancer

This is cancer that has returned or come back after treatment. The original stage that was assigned doesn’t change.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.