Stages of ovarian cancer

According to WHO, for the year around the world, ovarian cancer is diagnosed in almost 250,000 women and shortens life to 140,000. This pathology is often detected at a late stage, therefore, clearly defining the stage of ovarian cancer, oncology can prescribe the most effective treatment and thereby prolong the life of hundreds of thousands of women.

Since the mid-1970s, the incidence of ovarian cancer among women under the age of 40 increased by 56%; within five years after diagnosis, an average of 40% of patients survive.

[1], [2], [3], [4]

Symptoms of ovarian cancer at an early stage

To date, fairly persistent symptoms of ovarian cancer have been identified at an early stage:

• an increase in the size of the abdomen, which has a permanent character (in contrast to the temporary bloating in meteorism);
• heaviness in the abdomen;
• feeling of pressure in the pelvic cavity;
• a feeling of rapid satiation and even an overcrowded stomach with a small amount of eaten;
• periodic pulling pain in the abdominal and pelvic areas;
• the need for urination increases, and the urge to it increases (often with a decrease in the single volume of excreted urine).

OCNA experts believe that the frequency of these symptoms in women over a sufficiently long period of time (from three weeks to 1.5-2 months) and their combination are a warning signal for women and should prompt them to go to the doctor immediately. And for doctors, these symptoms of ovarian cancer at an early stage make it possible in time - in the I-II stages - to conduct a comprehensive examination, make a diagnosis and quickly start therapy.

After all, all the mentioned signs are the result of accumulation of fluid in the abdominal cavity, that is ascites, more precisely, of malignant ascites. And all oncologists recognize that ascites is most often observed with two tumor localizations - actually in the abdominal cavity and ovaries.

By that time, the cancer, as a rule, already spreads beyond the ovaries, and some types of ovarian cancer can quickly spread to the surface of nearby organs. However, special attention to these symptoms can improve the chances of early diagnosis and successful treatment.

In addition, the symptoms of ovarian cancer at an early stage can manifest itself in the form of intestinal disorders such as nausea, diarrhea, and gas accumulation. And it is not surprising that they can be associated with other, less serious diseases.

The main stages of ovarian cancer

In the course of the survey, most specialists in the stage of ovarian cancer are identified by the Federation Internationale Gynecology and Obstetrics, developed according to the TNM classification standards for cancer of any location.

1 stage of ovarian cancer or stage I - the tumor is found only in the ovaries:

• IA - the cancer is limited to one ovary, malignant cells are not found on the surface of the ovary and in the abdominal cavity (according to the results of diagnostic peritoneal flushing);
• I-B - a tumor on two ovaries, the presence of fluid accumulation in the abdominal cavity (ascites or hydrocele), there are no malignant cells in the peritoneal washout;
• I-C-I-A or I-B, the tumor is located on the surface of the ovary or the outer membrane of the ovaries is burst, there is malignant ascites and the presence of malignant cells is detected in diagnostic flushing;

2 stage of ovarian cancer or stage II - a tumor can affect one or both ovaries with penetration into the pelvic organs:

• II-A - spread of the tumor to the outer membrane of the uterus or fallopian tubes;
• II-B - spread to other tissues in the pelvic region, there are no malignant cells in the ascitic fluid and peritoneal washout;
• II-C-II-A or II-B with malignant ascites and tumor cells in a peritoneal washout.

Stage 3 ovarian cancer or stage III tumor affects one or two ovaries with exit from the pelvis into the abdominal cavity, the presence of metastases in the retroperitoneal lymph nodes:

• III-A - microscopic metastases outside the small pelvis (in the abdominal cavity);
• III-B - metastasis (≥20 mm) is present in the abdominal cavity outside the small pelvis (with or without spreading to the abdominal region);
• III-С - metastases outside the small pelvis exceed 20 mm, there are metastases in the regional retroperitoneal lymph nodes.

4 stage of ovarian cancer or stage IV - distant metastases (except peritoneal):

• IV-A - tumor cells penetrate into the interstitial fluid of the pleural cavity;
• IV-B - the spread of metastases far beyond the abdominal cavity.

Early stage of ovarian cancer

The earlier a malignant disease of the ovaries is revealed, the chances of survival in patients are higher, as the treatment will be more effective. However, the first or early stage of ovarian cancer, when the tumor does not go beyond it, does not show pathological symptoms (as professionals say, the symptoms are vague). This explains the late diagnosis of the disease: only 18-22% of cases of oncology are detected at an early stage of development.

In 2007, the American National Ovarian Cancer Coalition (NOCC) and the National Ovarian Cancer Alliance (OCNA) stated that there are early signs of ovarian cancer, and this is confirmed by medical statistics over 10 years of observation (1997-2007). However, given that these symptoms are not certainly characteristic of ovarian cancer and are noted, for example, in gastrointestinal disorders, gynecologists and oncologists are not considered as the final diagnostic tool. But while the doctors have not developed a specific diagnostic approach for this disease, a key role in deciding how to diagnose ovarian cancer at an early stage will be the recognition of possible symptoms of the disease and attentive treatment of both the women themselves and the doctors they treat complaints about changes in health. And these changes are subsequently confirmed by the results of a survey of oncologists.

[5], [6], [7], [8], [9], [10]

Stages of ovarian cancer and survival

Ovarian cancer causes more deaths than any other oncology of the female reproductive system, although it accounts for only about 3% of all cancers in women. The shape and degree of development of the tumor process depends on the prognosis of its outcome, which is why the stages of ovarian cancer and the survival of patients with this diagnosis are so closely related.

According to 2012 data, in Ukraine, out of 100,000 women, malignant ovarian tumors are detected in almost 16 patients who have turned to a gynecologist, with only about 30% occurring in the early stages of ovarian cancer - the first and second.

Statistics World Cancer Research Fund International provides such data on the survival rate for ovarian cancer: 60% -70% of women survive in the first stage of the diagnosis in the first stage of ovarian cancer five years after diagnosis (in North America - more than 90%); at stage 2 - 4550% (in the West - 70-75%); at stage 3 - no more than 15% (in the USA and Canada - from 39 to 59%); at stage 4 - no more than 5-9% (in Western Europe and North America about 17%).

When the early stage of ovarian cancer is diagnosed, 9 out of 10 ill women after appropriate treatment will be able to live for five years or more: in North America, about 94% of patients live longer than five years after diagnosis at an early stage.

But if more advanced stages of ovarian cancer are detected, out of a hundred women, at best, only five survive.

How to diagnose ovarian cancer at an early stage?

Early diagnosis of ovarian cancer includes:

• regular examination on the gynecological chair;
• rectovaginal (vaginal-rectal) examination;
• palpation of the abdominal region;
• blood chemistry;
• a blood test for markers of human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP);
• cytological examination of a vaginal smear or scraping of the cervical canal;
• puncture of the posterior vaginal fornix and cytological examination (for abnormal cells) of the peritoneal flushing of the women in the abdominal cavity of the depressions between the rectum, bladder and uterus (the so-called Douglas space);
• abdominal puncture (paracentesis) to detect ascites;
• Ultrasound or CT scan of pelvic organs;

• transvaginal ultrasound (TVUS);
• endoscopy of the internal organs of the small pelvis (culdoscopy);
• X-ray of the abdominal and chest organs and contrast X-ray of the large intestine.

Is it possible to diagnose ovarian cancer at an early stage by the results of a blood test for the antigen of cancer cells - the CA-125 oncomarker - was finally determined. First, this glycoprotein synthesizes and normal cells; second, to detect cancer can only be in case of a significant excess of its rate, which is characteristic of progressive tumors.

Foreign experts in the field of oncology are guided by the CA-125 level indicators for monitoring the woman's response to the treatment of ovarian cancer and to detect its recurrence after the therapy. The CA-125 test is not used to diagnose ovarian cancer in the early stages.