Stages of ovarian cancer

According to WHO, ovarian cancer is diagnosed in almost 250,000 women worldwide each year and shortens the lives of 140,000. This pathology is often detected at a late stage, so by clearly defining the stages of ovarian cancer, oncologists can prescribe the most effective treatment and thereby prolong the lives of hundreds of thousands of women.

Since the mid-1970s, the incidence of ovarian cancer among women under 40 has increased by 56%, with an average of 40% of patients surviving five years after diagnosis.

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Symptoms of early ovarian cancer

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

• an increase in the size of the abdomen, which is permanent (as opposed to temporary bloating with flatulence);
• heaviness in the abdominal area;
• a feeling of pressure in the pelvic cavity;
• a feeling of rapid satiety and even a full stomach even after eating a small amount;
• periodic pulling pains in the abdominal and pelvic areas;
• the need to urinate increases, and the urge to do so becomes more frequent (often with a decrease in the one-time volume of urine excreted).

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

After all, all the above-mentioned symptoms are the result of fluid accumulation in the abdominal cavity, that is, ascites, or more precisely, malignant ascites. And all oncologists admit that ascites is most often observed in two tumor localizations - in the abdominal cavity itself and in the ovaries.

By then, the cancer has usually spread beyond the ovaries, and some ovarian cancers can spread quickly to the surface of nearby organs. However, paying close attention to these symptoms can improve the chances of early diagnosis and successful treatment.

In addition, early stage ovarian cancer symptoms may manifest as intestinal disorders such as nausea, diarrhea, gas accumulation. And it is not surprising that they can be associated with other, less serious diseases.

Main stages of ovarian cancer

During the examination, most specialists determine the stage of ovarian cancer according to the classification of the Federation Internationale Gynecologie and Obstetrics (International Federation of Gynecology and Obstetrics), developed in accordance with the standards of the TNM classification of cancer of any localization.

Stage 1 ovarian cancer or stage I – the tumor is only in the ovaries:

• IA – 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 lavage);
• I-B – a tumor on both ovaries, the presence of fluid accumulation in the abdominal cavity (ascites or abdominal dropsy), no malignant cells in the peritoneal lavage;
• I-C – I-A or I-B, in which case the tumor is located on the surface of the ovary or the outer shell of the ovaries has ruptured, there is malignant ascites and the presence of malignant cells is detected in the diagnostic washing;

Stage 2 ovarian cancer or stage II – the tumor can affect one or both ovaries with penetration into the pelvic organs:

• II-A – tumor spread to the outer lining of the uterus or fallopian tubes;
• II-B – spread to other tissues in the pelvic area, no malignant cells in ascitic fluid and peritoneal lavage;
• II-C – II-A or II-B with malignant ascites and tumor cells in peritoneal lavage.

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

• III-A – microscopic metastases were detected outside the pelvis (in the abdominal cavity);
• III-B – metastases (≥20 mm) are present in the abdominal cavity outside the pelvis (with or without spread to the abdominal region);
• III-C – metastases outside the pelvis exceed 20 mm, there are metastases in the regional retroperitoneal lymph nodes.

Stage 4 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 ovarian cancer

The earlier a malignant ovarian disease is detected, the higher the chances of survival for patients, as the treatment will be more effective. However, the first or early stage of ovarian cancer, when the tumor does not extend beyond their boundaries, does not manifest itself with pathognostic symptoms (as professionals say, the symptoms are vague). This explains the too late diagnosis of the disease: only in 18-22% of cases is oncopathology 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 symptoms of ovarian cancer at an early stage, and this is confirmed by medical statistics for 10 years of observations (1997-2007). However, given that these symptoms are not absolutely characteristic of ovarian cancer and are noted, for example, in gastrointestinal disorders, gynecologists and oncologists do not consider them as a final diagnostic tool. But until doctors have developed a specific diagnostic approach for this disease, the key role in solving the issue of how to diagnose ovarian cancer at an early stage will be played by awareness of possible symptoms of the disease and careful attention to them by both the women themselves and the doctors to whom they turn with complaints of changes in their well-being. And these changes are subsequently confirmed by the results of examination by oncologists.

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Ovarian Cancer Stages 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 cancer cases in women. The prognosis of its outcome depends on the form and degree of development of the tumor process, which is why the stages of ovarian cancer and the survival of patients with this diagnosis are so closely related.

According to data for 2012, in Ukraine, out of 100 thousand women, malignant ovarian tumors are detected in almost 16 patients who consult a gynecologist, while only about 30% are in the early stages of ovarian cancer - the first and second.

Statistics from the World Cancer Research Fund International provide the following data on ovarian cancer survival: within five years after diagnosis, 60-70% of women survive stage 1 ovarian cancer (in North America, over 90%); 45-50% survive stage 2 (70-75% in the West); no more than 15% survive stage 3 (39 to 59% in the USA and Canada); and no more than 5-9% survive stage 4 (about 17% in Western Europe and North America).

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

But if ovarian cancer is detected in later stages, at best only five out of a hundred women survive.

How to diagnose ovarian cancer at an early stage?

Early diagnosis of ovarian cancer includes:

• routine examination on a gynecological chair;
• rectovaginal (vaginal-rectal) examination;
• palpation of the abdominal area;
• biochemical blood test;
• 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 swab of the depressions in the abdominal cavity of women between the rectum, bladder and uterus (the so-called Douglas pouch);
• abdominal puncture (paracentesis) to detect ascites;
• Ultrasound or CT scan of the pelvic organs;

• transvaginal ultrasound (TVUS);
• endoscopy of the internal pelvic organs (culdoscopy);
• X-ray of the abdominal and chest organs and contrast X-ray of the colon.

It has finally become clear whether it is possible to diagnose ovarian cancer at an early stage based on the results of a blood test for the cancer cell antigen – the CA-125 tumor marker. Firstly, this glycoprotein is also synthesized by normal cells; secondly, cancer can only be detected if its norm is significantly exceeded, which is typical for progressive tumors.

Foreign oncology specialists rely on CA-125 levels to monitor a woman's body's response to ovarian cancer treatment and to detect its recurrence after therapy. The CA-125 test is not used to diagnose ovarian cancer at early stages.