Ovarian cancer - stages and treatment

In our previous article, we have detailed what ovarian cancer is, it’s symptoms and causes. In this article, let’s go over the different stages of cancer, why it is diagnosed and what are the treatment options in each stage of cancer. 

After a woman is diagnosed with ovarian cancer, the next step for a gynaecologist or oncologist is to determine the stage of the cancer. There are 4 stages of cancer starting from I to IV. (1 to 4). Lower number being an earlier stage than the number following it. Staging is an important step in analysing the extent/spread of cancer in the body, how treatable it is and what could be the prognosis after treatment.

In women for whom surgery is an option, sample tissue for biopsy may be taken from different parts of the body such as pelvis, abdomen etc and examined under a microscope for the presence of cancer cells. If surgery is not an option in the person, imaging techniques such as an MRI may be taken along with tissue samples taken from reproductive organs through the vagina.

Determining the stage of ovarian cancer

Staging cancer has two standards:

FIGO – International Federation of Gynecology and Obstetrics System

AJCC – American Joint Committee on Cancer TNM Staging system. 

Both the standards are more or less the same but different hospitals follow different staging standards. 

Factors that are considered in determining the cancer stage:

1. Size or extent of tumour (Indicated with letter T) – Is the cancer still contained in the ovaries or is it spread to surrounding organs such as fallopian tubes or bladder or uterus.
2. Spread to nearby lymph nodes (indicated with letter N) – Has the cancer spread to nearby lymph nodes or around the aorta (the main artery that runs from heart to the pelvis). The lymph nodes around the aorta are called ‘para-aortic’ lymph nodes.
3. Cancer metastasis (indicated with letter M) – check if the cancer has spread to distant parts of the body such as lungs or liver or sometimes bones.

The following table has been taken from the website cancer.org and reproduced ‘as-is’. The table gives a detailed picture about the stages of cancer. 

Treatment of Ovarian cancer

If you have been diagnosed with ovarian cancer, treatment depends on the following factors:

1. Your ovarian cancer’s stage
2. The type of ovarian cancer
3. Your overall health
4. Your age

Local treatment options of ovarian cancer

If the cancer hasn’t spread to surrounding tissues or lymph nodes and is still in the starting/beginning stages, localised treatment may be done to remove the tumour from the body.

Surgery for ovarian cancer

When the cancer tumour is located in a single place, it is most often removed with a surgery. This can be a conventional surgery involving cutting the abdomen open or can be laparoscopic removal. Removal of ovaries or fallopian tubes may not be an option in case of women with starting stage of cancer.

Radiation therapy for ovarian cancer

High energy x-rays are focused on the tumours to destroy the cancer cells. Radiation therapy may be performed in combination with chemotherapy or just done by itself. Radiation therapy is done in case of local or metastasized cases.

Systematic treatment options for ovarian cancer

Usage of drugs to kill the cancer cells in the body is considered as systemic therapies. Drugs induced into the body either orally or through IV can reach almost any part of the body and start attacking the cancer cells. Different types of drug treatments include:

1. Chemotherapy for ovarian cancer – Chemotherapy may be performed either before or after the surgical removal of cancer tumour. Chemo drug can reach any part of the body and is usually used after the surgery to make sure that the leftovers of the tumour is taken care of.
2. Hormone therapy for ovarian cancer – This type of therapy involves using hormones or hormone blocking drugs to fight the growth of cancer cells. 
3. Targeted therapy for ovarian cancer – Targeted therapy involves usage of drugs that mainly target cancer cells and cause very little damage to normal cells around them.

Other treatment options for ovarian cancers

Other approaches of treating ovarian cancers depend on the type of cancer. As mentioned in our previous article, there are 3 main types of ovarian cancer.  Different approaches are used to treat invasive epithelial ovarian cancer and its stage, epithelial tumours of low malignant potential, germ cell tumours and stromal tumours. 

In most cases, your doctor will try to help you understand the type of cancer, its stage and the type of treatment he/she is willing to follow to get rid of the cancer cells in your body. Don’t hesitate to ask any questions that you may have before proceeding with the procedure and let those questions include post treatment complications and recurrence of cancer.