Shortly after a woman is diagnosed with ovarian cancer it is important to stage the cancer. Staging is used to help determine the treatment used to fight her ovarian cancer. An exploratory laparotomy is used to determine the stage of the disease (how far the cancer has spread). A gynecologic oncologist usually performs the exploratory laparotomy by making an incision through the abdomen to expose the ovaries.
During the surgery, if cancer is seen, the doctor will remove as much of the cancer as possible. If only one ovary is involved a unilateral oophorectomy is performed (removal of one ovary). Typically the doctor will remove both ovaries unless the patient is young and in the childbearing years and has expressed a desire to maintain fertility. A biopsy of the surrounding tissue including lymph nodes, and then the abdominal cavity is “washed” with a fluid that is collected and examined for cancer cells (peritoneal lavage).
The staging occurs after the surgery, when a doctor will review the histopathology report from the samples taken during the surgery. The doctor may also consult with other tests performed on the patient such as ultrasound imagery, blood tests, and any other tests that were performed.
The staging will help to formulate projections for survival, recurrence of the disease or relapse of the disease. Staging also, as previously stated, help the doctor and patient to choose the most appropriate treatment methods.
The staging system includes four stages (I, II, III, IV) and recurrent cancer, which is cancer that has come back after the patient has been treated for cancer already.
The International Federation of Gynecology and Obstetrics developed staging scheme. Doctors also use a TNM system which is a classification system developed by the American Joint Committee on Cancer (AJCC) where T stands for Tumor size, N stands for Node involvement, and M stands for Metastasis status.
Typically the lower the stage the more favorable the prognosis.
The tumor is classified according to these categories:
- T1 tumors are limited to one or both ovaries but have not spread further than the ovaries.
T1a tumors are limited to one ovary with the outer wall of the tumor being intact. There is no evidence of tumor on the outer wall of the ovary. No cancer cells are detected in the peritoneal lavage.
T1b tumors are limited to both of the ovaries and the capsule is intact with no cancer detected on the ovarian surface and no cancer in the peritoneal lavage.
T1c tumors are limited to one or both ovaries with either a ruptured capsule, tumor on the ovarian surface, or cancer cells in the peritoneal lavage.
T2 tumors involve just one or both ovaries with spread of cancer to the pelvis.
T2a tumors have spread or attached to the uterus and or fallopian tubes with no cancer cells in the peritoneal lavage.
T2b tumors have spread to other pelvic tissues with no cancer cells in the peritoneal lavage.
T2c tumors have spread to the pelvic tissues with cancer cells in the peritoneal lavage.
T3 tumors are involved in one or both of the ovaries have confirmed microscopically peritoneal metastasis outside of the pelvis and or have metastasis to a nearby lymph node.
T3a tumors have peritoneal metastasis beyond the pelvis
T3b tumors are macroscopic (visible to the naked eye) peritoneal metastasis beyond the pelvis, with 2 cm or less in dimension.
T3c tumors with peritoneal metastasis beyond the pelvis, with more than a 2 cm in dimension.