Ovarian Cancer Stage & Grade : Two Critical Factors

ovarian cancer metastases
Ovarian cancer spreads mainly within the abdominal cavity and not to other parts of the body. Photo © A.D.A.M.

If you are diagnosed with ovarian cancer, the two most important things you must know about are the stage and grade of your cancer.


Ovarian cancers are categorized by "stages", depending upon how far they have spread beyond the ovary. This is determined by biopsies that the surgeon takes during initial surgery, as well as “washings” or “cytology” (looks for free floating microscopic cancer cells inside your abdomen).

Biopsies are taken from multiple areas including the lymph nodes (part of your immune system), the omentum (a fatty carpet that is attached to your intestine which acts as a “band-aid” in case of infection in your abdomen), and various areas of peritoneum (similar to skin lining the inside of your abdomen).

Based on whether or not cancer cells are found in each of these areas, a stage is assigned. The lower the stage number, the better the situation. But, don’t get discouraged. There is significant hope for a cure, or at least years of good quality life in remission, even with higher stage cancers.

Stage I: Ovarian cancer that is confined to one or both ovaries.
Stage II: Ovarian cancer that has spread to pelvic organs (e.g., uterus, fallopian tubes), but has not spread to abdominal organs.
Stage III: Ovarian cancer that has spread to abdominal organs or the lymphatic system (e.g., pelvic or abdominal lymph nodes, on the liver, on the bowel).

Stage IV: Ovarian cancer that has spread outside to distant sites (e.g., lung, inside the liver, brain, lymph nodes in the neck).
Recurrent: Ovarian cancer that has recurred (come back) even though the patient has completed treatment.

There are sub-stages to the above which you can learn more about by visiting FIGO Staging System.


Biopsies that are taken from the ovary are also “graded” for how abnormal or ugly they look when viewed through a microscope. Ovarian cancers are given a grade from 1 through 3. Other cancers use different numbering systems, so don't get confused by someone else's advice if they have or had a different cancer type.
Grade 1 represents cells that are more normal looking and therefore usually better behaved.
Grade 3 cells look very abnormal, almost unrecognizable, which usually means the cancer is more aggressive.
Grade 2 is in between.

Borderline Ovarian Cancer

There is also an epithelial ovarian tumor which is called “borderline” or “low malignant potential” or “LMP” cancer. These are technically cancers, and are sometimes assigned a stage if it appears that spread has occurred or if it is unclear during surgery whether or not a higher grade cancer is present.

Most of these are early stage and usually do not grow back, or grow back very slowly (many years). An entire book can be devoted to the management of these tumors, and is beyond the scope of this overview.
Usually they can be managed much more conservatively, preserving one or both ovaries. Chemotherapy is usually not required, even if there is some spread.

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