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Staging and grading of ovarian cancer

In this article, I delve further into the types of ovarian cancer and their treatment. Before reading on, take a peek at my first article on ovarian cancer for relevant background information. I explain where the cancer is located, symptoms to look out for, who may be at risk of developing it, and the support available for anyone with this diagnosis. 

Staging and grading of ovarian cancers 

At this point, you might think – ‘I want to know how to treat ovarian cancer – why are you boring me with staging and grading?’. There’s a good reason, I promise! The treatment of ovarian cancer is determined based on the subtype of ovarian cancer, its location, and its size. These three characteristics are usefully grouped into stages and grades. You may also see these terms used in medical reports you receive about your diagnosis, so I hope this article will help make some sense of them.

Grading 

Grading refers to the first of the three characteristics above: the subtypes of ovarian cancer. This can give us more information about how aggressive the cancer is, and how likely it is to grow and spread. Cells are constantly growing and dividing to keep our organs and tissues functioning properly. Some cells are very specialised, carrying out a specific role in specific parts of the body: they are differentiated. Looking down a microscope at a sample of cells from an ovarian cancer, scientists can see if they look like the specialised, or differentiated, cells of the ovaries, or whether they are an abnormal type of cell (undifferentiated). They defined three grades of ovarian cancers based on this:

    • Grade 1. These cancers stem from differentiated cells, similar to the normal cells in the ovary. They are also known as low grade, tending to grow slower and not spread.
    • Grade 2. These cells are between grades 1 and 3 in terms of specialisation and spread.
    • Grade 3. These cells do not resemble normal ovarian cancer cells – they are undifferentiated. These types of cells tend to grow and spread faster.  

If the cancer cells look completely different to the above, they may have spread to the ovary from elsewhere in the body – known as metastatic cancer. (1)

Staging 

Staging describes the size and location of the tumour. The 4 stages of ovarian cancer are:

Stage 1: Cancer in the ovaries alone.

Stage 2: Cancer in the ovaries and pelvis.

Stage 3: Cancer that has spread to other areas of the abdomen (such as the lymph nodes, diaphragm, intestines, or liver).

Stage 4: Cancer that has spread to other organs outside of the abdomen.

Treatment options 

The main treatments for ovarian cancer are surgery, chemotherapy, radiotherapy and targeted therapy. These will be decided based on the stage and grade of the cancer, your overall health, and your own health beliefs and priorities. 

Surgery

The aim of surgery is usually to remove as much of the tumour as possible. 

In stage 1 or 2 ovarian cancer, surgeons may remove all the cancer from the ovaries and pelvis. This could involve removing one or both of the affected ovaries and Fallopian tubes (salpingo-oophorectomy), the womb and cervix (hysterectomy), the lymph nodes and surrounding tissue. The medical team will explain the implications of having these body parts removed, and ensure you understand the procedure before going ahead. 

If the cancer has spread beyond the ovaries and pelvis, it is stage 3 or 4. If you are healthy enough, a ‘debulking surgery’ may be performed to remove as much of the disease as possible. If it has spread to the bowel, a part of your bowel may need to be removed. The surgeon will try to remove as little as possible to preserve normal gut function. You can find useful diagrams explaining details of the various surgeries here. (2, 3)

Chemotherapy 

Chemotherapy is a cocktail of toxins injected into the body to kill the cancer cells. This is received through a drip in your arm, in hospital, over several hours. Some examples include carboplatin and paclitaxel. This medication does not specifically target the cancer cells, so normal healthy cells will be destroyed too. Therefore, patients often feel unwell with chemotherapy, but being in good health will help you recover quicker. 

Chemotherapy can be used alone or alongside surgery. It can be used before surgery to shrink the tumour and increase the chance of successful surgery. Alternatively, chemotherapy may be used after surgery if the surgeon was unable to remove all the tumour, or to reduce the chance of recurrence of the cancer. (1)

Radiotherapy

Radiotherapy uses high-energy beams to target and destroy cancer cells. It can be used alongside chemotherapy and surgery to help shrink the size of the tumour and ease symptoms such as bleeding and pain. It may also be used alone if the above are not suitable treatment options. The number of rounds of radiotherapy you can receive is limited due to its side effects. (1)

Targeted therapy 

Targeted and hormone therapies block specific processes used by the cancer cells to grow. These are rarely used, for example in cases where ovarian cancer has returned, and are usually used as symptom control rather than a curative treatment. (1, 3)

Symptom control

If the cancer is diagnosed at an advanced stage, or has returned, it may not be curable. This means it will not be possible to completely get rid of the cancer. It does not mean you will no longer receive life-prolonging treatment. The focus of treatment will be to shrink the cancer, stop it growing and spreading, and thus control your symptoms. You may also feel that this is the right decision if chemotherapy makes you feel very ill, or the trips to hospital for radiotherapy are tiring. The team looking after you will be specialised in managing symptoms and providing any support you may need in this situation. (1)

Will it affect my fertility?

Any treatment directly impacts your ovaries and uterus can affect your fertility. If preserving your fertility is important to you, discuss this with your doctor to reach the best treatment option based on your priorities. (4)

    • Surgery. Surgical treatment of ovarian cancer will not affect your fertility if one healthy ovary and fallopian tube can be preserved. If the cancer is diagnosed at a more advanced stage, and more of your reproductive system must be removed, your fertility will be affected. 
    • Chemotherapy effects on fertility depend on your age and type of chemotherapy received. It can cause some women to go through the menopause early, which may be irreversible. In some cases, hormonal treatment can help preserve your fertility. However, if you are still fertile, you will likely be advised to wait until after treatment has finished to have a baby, as many cancer drugs can be toxic to unborn babies. 
    • Radiotherapy targeting the ovaries or womb directly causes permanent infertility. If other parts of the pelvis are targeted, this can also affect fertility. However, the ovaries may be protected, or even moved to another part of the body (ovaries transposition) to preserve fertility.

For all the above, you will be given time, help and support to think about fertility preservation treatments if this is important to you. 

What help and support is available?

Your GP and doctors are there to help guide you through this journey and answer your questions. They will give you more information on other members of the medical team who can support you, for example cancer nurses and clinical nurse specialists. Various charities, including Macmillan Cancer Support, Cancer Research UK, Ovacome, Target Ovarian Cancer and Marie Curie, also provide services for ovarian cancer patients. For more information, see the NHS website. (3)

References 

  1. Ovarian cancer | Cancer Research UK [Internet]. Cancerresearchuk.org. 2021. Available from: https://www.cancerresearchuk.org/about-cancer/ovarian-cancer
  2. Types of ovarian cancer surgery [Internet]. Ovarian Cancer Action. 2022. Available from:https://ovarian.org.uk/ovarian-cancer/patient-hub/treatment/surgery/types-ovarian-cancer-surgery/
  3. Ovarian cancer [Internet]. nhs.uk. 2022. Available from: https://www.nhs.uk/conditions/ovarian-cancer/
  4. Fertility in women – Macmillan Cancer Support [Internet]. Macmillan.org.uk. 2019. Available from: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/fertility-in-women

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