Ovarian Cancer Stage III

Stage 3 ovarian cancer has spread beyond the pelvis into the abdominal cavity or to nearby lymph nodes. While this is an advanced form of the disease, treatment combining surgery and chemotherapy can be effective, and many people continue to live full lives after diagnosis.

Table of contents

• What is Stage 3 Ovarian Cancer?
• Understanding the Substages
• Treatment Options
• Surgery
• Chemotherapy
• Targeted Cancer Drugs
• When Surgery Is Not Possible

What is Stage 3 Ovarian Cancer?

Stage 3 ovarian cancer means the cancer has spread outside the pelvis into the abdominal cavity or to lymph nodes (small glands that help fight infection and remove waste from the body)^[1]. The cancer may be present in the lining of your abdominal cavity, called the peritoneum, or in the lymph nodes in the back of your abdomen^[1].

At this stage, the cancer may also appear on the surface of organs like your liver or spleen, though it has not spread inside these organs^[2]. By the time of diagnosis, about 60 percent of ovarian cancer cases are at stage 3^[6].

The staging system used by doctors applies not only to ovarian cancer but also to cancer of the fallopian tubes and primary peritoneal cancer, because these cancers develop from similar types of tissue^[3].

Understanding the Substages

Stage 3 ovarian cancer is divided into three groups — 3A, 3B, and 3C — based on how far the cancer has spread and the size of any growths^[1].

Stage 3A has two groups. Stage 3A1 means the cancer has spread to the lymph nodes in the back of your abdomen, called retroperitoneal lymph nodes^[1]. This is further split into two categories: 3A1(i) means the cancer in the lymph nodes is smaller than 1 centimeter, while 3A1(ii) means it is larger than 1 centimeter^[1]. Stage 3A2 means that there are cancer cells in the peritoneum, and it might also be in your lymph nodes^[1].

Stage 3B means there are cancer growths in the peritoneum that are 2 centimeters or smaller. There might also be cancer in the retroperitoneal lymph nodes^[1].

Stage 3C means there are cancer growths in the peritoneum larger than 2 centimeters. There might also be cancer in your lymph nodes or on the surface of your spleen or liver^[1].

Treatment Options

Treatment for stage 3 ovarian cancer typically includes surgery, chemotherapy, and sometimes targeted cancer drugs^[1]. Your healthcare team will consider several factors when deciding what treatment you need, including where the cancer has spread, whether the specialist surgeon thinks they can remove all the cancer, and your general health^[1].

Surgery

Surgery is often the first treatment given for stage 3 ovarian cancer^[1]. A specialist surgeon called a gynaecological oncologist will remove both ovaries, both fallopian tubes, and your womb (including the cervix)^[1]. They will also check where the cancer has spread to in your pelvis and whether it is in your lymph nodes^[1].

The surgeon will aim to remove as much of the cancer as possible. This is called cytoreductive surgery, and you may also hear it referred to as debulking surgery^[1]. During this procedure, the surgeon may also remove all or parts of other organs where cancer has spread, such as the intestines, liver, or bladder^[2].

Surgery serves two main purposes. First, it helps doctors see exactly how far the cancer has spread and where tumors are located. Second, it removes as much cancer as possible, which can improve treatment outcomes^[12].

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. For stage 3 ovarian cancer, chemotherapy is usually given as a combination of two or more drugs^[14]. The most commonly used combination includes a platinum drug, such as carboplatin or cisplatin, combined with a taxane drug, such as paclitaxel or docetaxel^[14].

The timing of chemotherapy can vary depending on your individual case^[1]. You might have chemotherapy after surgery, which is called adjuvant chemotherapy with cytoreductive surgery^[1]. Some people receive chemotherapy before and after surgery, known as neoadjuvant chemotherapy with interval cytoreductive surgery^[1]. In some cases, chemotherapy may be given directly into your abdomen during surgery, a treatment called hyperthermic intraperitoneal chemotherapy or HIPEC^[1].

If your body cannot handle surgery as a first treatment, you may begin with chemotherapy, then have surgery, and receive more chemotherapy afterward^[2].

Targeted Cancer Drugs

Some people may receive treatment with a targeted cancer drug, depending on their situation^[1]. These drugs work differently from chemotherapy by targeting specific features of cancer cells.

You might have a targeted cancer drug given together with chemotherapy, on its own, or after chemotherapy^[1]. One example is bevacizumab (Avastin), which may be taken with chemotherapy at first, then by itself for up to a year^[2].

When Surgery Is Not Possible

It might not be possible to have surgery if your cancer has spread widely or if you are not well enough for the procedure^[1]. In these cases, you can have chemotherapy on its own to shrink the cancer as much as possible and to slow it down^[1].

You might have other treatments to help relieve your symptoms. This could include treatment for fluid buildup in the abdomen, called ascites, or for a blocked bowel. Radiotherapy (treatment using radiation) may be used to relieve symptoms like pain^[1].