/ Updated July 10th, 2020

How Do I Know The Stage of My Ovarian Cancer? Staging Surgery Determines Spread

Creator: Dr. Amanda Nickles Fader
Published: 2020-05-25T11:42:03-04:00

Medical Source: Dr. Amanda Nickles Fader
Johns Hopkins Medicine

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The notion of “staging” your ovarian cancer is done through a surgery that determines what, if any, cancer has spread.

A staging procedure is one of the two main types of surgery that gynecologic oncologists perform for ovarian cancer (the other procedure is called debulking). Gynecologic oncologists recommend a staging procedure after a diagnosis of ovarian cancer when they have evidence that the cancer may be early or limited, which has to do with the location of the tumor. Based on where the cancer is found, it will be assigned a stage. "If it's remained in the ovary where it was initially found or developed, then the cancer is Stage 1," says Dr. Amanda Fader, vice chair of gynecologic surgical operations at Johns Hopkins University in Baltimore. "But if the cancer has started to spread to other organs or through the lymph nodes to other parts of the body, then it would be identified as Stage 2, 3, or 4."

The Stages of Ovarian Cancer

Stage 1: The cancer is confined to the ovaries or fallopian tubes
Stage 2: The tumor involves one or both ovaries with extension to other pelvic tissues (or is a primary peritoneal cancer)
Stage 3: The cancer has spread outside of the pelvic peritoneum including to the outside of the bowel, liver and spleen and/or it involves the lymph nodes
Stage 4: There are distant metastases (outside of the pelvis and abdomen) or metastases to the inside of the spleen or liver

When doctors have evidence before the surgery, such as from imaging tests, that the tumor may be limited to the ovary, they will usually recommend a staging procedure. During that operation doctors remove all or part of the ovary with the tumor and send itwhile the patient is still asleep on the operating tableto a pathologist who will examine the tissue and identify the type of tumor so doctors can decide how best to treat it.

If the tumor is determined to be benign, the surgery can end. Otherwise, more extensive surgery is usually performed. Prior to the surgery the patient and her doctor would have discussed the various possible findings, so that depending on the result of the ovarian biopsy, the surgeon knows what the patient's wishes are and how to proceed. "We would have made these decisions ahead of time through our preoperative counseling," explains Dr. Fader.

If the tumor is malignantovarian cancer"then we usually do a hysterectomy and remove the opposite ovary, too, in case it's involved with the cancer. We also remove the omentuman apron of fat in the abdomen. It has no known function, like the appendix, but can be involved in many ovarian cancer cases. And we'll do several biopsies around the abdomen and pelvis, including biopsies of the lymph nodes and peritoneum (the tissue lining of the abdomen)." These biopsies will determine whether the cancer has spread and if so, how far.

All of these tissue samples are sent to the pathology lap to be examined microscopically to determine the stage of a woman's ovarian cancer. Based on that information doctors can help formulate the best treatment plan, such as the most effective chemotherapy protocol, to proceed with after surgery. Your treatment may be influenced by the ongoing pandemic. Ask your doctor if your treatment protocol should be changed because of COVID-19.

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Dr. Amanda Nickles Fader is both the Vice Chair of Gynecologic Surgical Operations and the Director of the Center for Rare Gynecologic Cancers at The Johns Hopkins Hospital. Read More

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