Grades of Ovarian Cancer
The behavior of cancers refers to how quickly or slowly they grow. This is called the grade of cancer, and it is judged by the appearance of the cells under the microscope.
The more the cancer cells look like a normal cell, the more they will behave like a normal cell. A low grade cancer tends to grow more slowly and is less likely to spread than a high grade one. The more normal a cancer cell looks, the lower its grade.
Based on the appearance of cancer cells under the microscope, tumors are grade by four degrees of severity: Grades 1, 2, 3, and 4.
The cells of Grade 1 tumors resemble normal cells, and tend to grow and multiply slowly. Grade 1 tumors are usually the least aggressive.
The more abnormal or less well developed a cancer cell is, the higher its grade.
The cells of Grade 3 or Grade 4 (higher grade) tumors do not look like normal cells. Grade 3 and 4 tumours tend to grow rapidly and spread faster than tumours with a lower grade.
For more information about tumor grades, visit the National Cancer Institute's website.
Stages of Ovarian Cancer
The stage of ovarian cancer is the extent of the cancer within the body. If the cancer has spread, the stage describes how far it has spread from the ovaries to other parts of the body.
At every stage of the disease, there are survivors leading full and productive lives after treatment. Studies indicate that patient survival is related to the volume of disease left at the completion of the primary (first) surgical procedure. The best results occur when surgery is performed by a Gynecological Oncologist.
In Stage 1, the ovarian tumour has grown only in the ovaries.
- Surgery alone is adequate for Stage 1A and B (cancer in one or both ovaries)
- Many, but not all, women with Stage IC (tumour on the surface of one or both ovaries) require use of treatment i.e., chemotherapy or radiation in addition to surgery
- Grade III tumors require use of treatment i.e., chemotherapy or radiation in addition to surgery (secondary treatments given after primary treatment, such as chemotherapy after surgery)
- Patients with clear cell carcinoma require use of treatment i.e., chemotherapy or radiation in addition to surgery
Tumour has spread beyond the ovaries to the uterus, fallopian tubes and/or other pelvic tissues.
- Surgery plus post-operative chemotherapy is recommended for all women with Stage II disease
- If, following surgery, there is minimal disease remaining, a combination of chemotherapy drugs are recommended
- Whole pelvic and abdominal radiation may be given in combination with chemotherapy for those at high risk of relapse
Stage III and IV
Malignant cells have grown and spread. Aggressive surgery should be performed by a Gynecological Oncologist, including:
- Total abdominal hysterectomy, and
- Bilateral salpingo-oophorectomy with omentectomy, and
- Debulking as much gross tumor as is possible
- All Stage III and Stage IV patients are treated with combination chemotherapy
Policies and guidelines governing the use of chemotherapeutic agents for ovarian cancer may differ across Canada and each institution's guidelines should be taken into consideration when treatment is recommended.