Ovarian Epithelial Cancer Stage III

Stage 3 ovarian epithelial cancer has spread beyond the pelvis into the abdomen or nearby lymph nodes, but with modern treatment approaches combining surgery and chemotherapy, many patients can achieve long-term survival.

Table of contents

• What is stage 3 ovarian epithelial cancer?
• Understanding the substages
• Body parts affected
• Signs and symptoms
• Treatment approaches
• Long-term survival

What is stage 3 ovarian epithelial cancer?

Stage 3 ovarian epithelial cancer means the cancer has spread outside the pelvis. The cancer is in the lining of the abdominal cavity, which doctors call the peritoneum (the tissue that covers the organs in your abdomen). The cancer may also have spread to lymph nodes in the back of your abdomen^[1].

Epithelial ovarian cancer is the most common type of ovarian cancer, accounting for about 90% of all ovarian cancer diagnoses. It develops in the thin tissue that covers the outside of the ovaries. It can also form in the lining of the fallopian tubes or in the peritoneum^[5].

Most people with ovarian cancer are diagnosed at stage 3. About 60 percent of people with ovarian cancer have stage 3 disease when they receive their diagnosis. Nearly 70% of high-grade serous ovarian cancer cases, the most common and aggressive subtype, are stage 3 or 4 at diagnosis^[5][8].

Understanding the substages

Stage 3 ovarian epithelial cancer is divided into three groups based on where and how much the cancer has spread^[1]:

Stage 3A has two groups. Stage 3A1 means the cancer has spread to the lymph nodes in the back of your abdomen. If the cancer in the lymph nodes is smaller than 1 centimeter, it is called 3A1(i). If the cancer in the lymph nodes is larger than 1 centimeter, it is called 3A1(ii). Stage 3A2 means there are cancer cells in the peritoneum that can only be seen under a microscope. The cancer might also be in the lymph nodes^[1].

Stage 3B means there are cancer growths in the peritoneum that are 2 centimeters (about 3/4 inch) or smaller. The cancer might also be in the lymph nodes in the back of the abdomen^[1].

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

Body parts affected

• Ovaries
• Fallopian tubes
• Peritoneum (abdominal lining)
• Lymph nodes in the abdomen
• Surface of the liver
• Surface of the spleen

Signs and symptoms

Epithelial ovarian cancer rarely causes symptoms in its early stages. Symptoms become more noticeable as the disease progresses. As the cancer spreads into the peritoneum, fluid can accumulate in the abdomen^[5].

Common symptoms include abdominal pain, bloating, difficulty eating or feeling full quickly, nausea and vomiting, and pelvic pain^[5].

Less common symptoms include changes in bowel habits, a strong urge to urinate or urinating more frequently, and vaginal bleeding^[5].

Treatment approaches

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

Surgery

Surgery is often the first treatment for stage 3 cancer. A specialist surgeon called a gynecological oncologist will perform the operation. The surgeon will remove both ovaries, both fallopian tubes, and your womb (including the cervix). They will also check where the cancer has spread 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 or debulking surgery. 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^[3].

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. You might receive chemotherapy at different times during your treatment^[1]:

• After surgery, called adjuvant chemotherapy
• Before and after surgery, called neoadjuvant chemotherapy with interval cytoreductive surgery
• Into your abdomen during surgery, called hyperthermic intraperitoneal chemotherapy or HIPEC

The most common chemotherapy combination is carboplatin and paclitaxel. These drugs are usually given by intravenous infusion (into a vein)^[16].

Targeted cancer drugs

Some people may receive treatment with a targeted cancer drug. This will depend on your individual situation. You might have a targeted cancer drug with chemotherapy, on its own, or after chemotherapy^[1].

Bevacizumab (Avastin) is a targeted drug that may be used. It is a monoclonal antibody that targets a protein called vascular endothelial growth factor (VEGF), which helps tumors grow blood vessels^[13].

When surgery is not possible

It might not be possible to have surgery if your cancer has spread widely or you are not well enough. In these cases, you can have chemotherapy on its own to shrink the cancer as much as possible and to slow it down. You might also have other treatments to help relieve your symptoms, such as treatment for fluid in the abdomen or for a blocked bowel. Radiotherapy may be used to relieve symptoms like pain^[1].

Long-term survival

Long-term survival is not unusual in patients with epithelial ovarian cancer, even in those with advanced stage disease. About 31% of people who are initially diagnosed with stage 3 or 4 epithelial ovarian cancer are alive at least 5 years after diagnosis^[3].

Certain factors are associated with better long-term survival. These include younger age at diagnosis, early stage disease, low-grade tumors, and certain types of cancer other than high-grade serous cancer. However, long-term survivors also include women with high-risk cancer^[22].

Some people with advanced ovarian cancer can be considered cured. About 20% of those with late-stage ovarian cancer survive more than 12 years after treatment^[20].

Your individual prognosis depends on many factors, including your age, overall health, how well your cancer responds to treatment, and what treatment options are available to you. Your doctor can give you an estimate based on your individual situation^[3].