Staging is the process of classifying a tumor according to the extent to which it has spread in the body at the time of diagnosis.
Ovarian cancer staging:
- Stage 1: Limited to one or both ovaries
- Stage 2: Limited to the pelvis
- Stage 3: Disease outside of the pelvis, but limited to the abdomen, or lymph node involvement, but not including the inside of the liver
- Stage 4: Disease spread to the liver or outside of the abdomen
Complete staging of an ovarian cancer includes hysterectomy, removal of the ovaries, tubes, pelvic and aortic lymph node biopsies or dissection, biopsies of the omentum (a large fatty structure that provides support for abdominal organs), and peritoneal (lining tissue of the abdomen) biopsies.
Ovarian cancer staging is determined surgically, unless it is stage 4 (metastasis outside of the abdomen, or metastasis to the liver -- not on the surface of the liver). If it is stage 4, or very advanced stage 3, then often this is proven with biopsy, and chemotherapy may start neoadjuvantly (before surgery). If the disease is not obviously stage 4, then aggressive surgical staging and debulking (see next section) often is considered. This decision is based on the health of the patient, as well as the judgment of the surgeon as to the chance of achieving an optimal debulking (see treatment below).