Ovarian Cancer
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The term “ovarian cancer” includes various cancer subtypes. The various forms (or subtypes) of ovarian cancer are identified by their locations on the ovary and distinguishable by their different characteristics (expressions). Approximately 90% of all ovarian cancers are found in the epithelium.
Gynecological Anatomy related to Ovarian Cancer
The Epithelium
Most ovarian cancer is found in the epithelium, which is the layer of tissue that surrounds (encapsulates) the ovary. Collectively, these are referred to as epithelial ovarian cancers. There are various subtypes of epithelial ovarian cancers including serous cell and endometrioid (endometrial).
The Peritoneum
The peritoneum is bodily tissue that is separate and distinct from the ovaries. It is a membrane that surrounds, protects and helps support the abdominal organs including all of the female reproductive organs. The location of the peritoneum identifies another subtype of ovarian cancer referred to as “peritoneal ovarian cancer.” A small percentage (~10%) of ovarian cancer cases originate in the peritoneum.
Subtypes of Ovarian Cancer
Peritoneal Ovarian Cancers
Peritoneal ovarian cancer originates outside of the ovaries, in one or more areas of the peritoneum tissue- a membrane that surrounds, protects and helps support the abdominal organs including, for women, the uterus and all of the other female reproductive organs. Primary peritoneal ovarian cancer can spread to other locations in the abdomen including, in some cases, the ovaries. The peritoneum consists of epithelial cells and, in this way, is similar to the epithelium tissue that encapsulates the ovaries. Due to this similarity, treatment of epithelial and peritoneal cancers is often similar.
However, peritoneal cancer can be confined to the peritoneum and not affect the ovaries. It can develop in women who have had their ovaries removed. “Primary” peritoneal cancer can occur anywhere in the peritoneum and not implicate the ovaries. In other cases, peritoneal cancer cells can be present in both the peritoneum and one or both ovaries.
The serous cell lining (outer surface) of the ovaries and the serous cell composition of the peritoneum interact which enables cancer cells to migrate between the two anatomical structures. When cancer cells are present in both the ovary(ies) and the peritoneum, the diagnosis is peritoneal ovarian cancer.
Epithelial Ovarian Cancers
The most common types of ovarian cancer are the referred to collectively as the epithelial cancers, all of which are found in the epithelium - the layer of tissue that surrounds the ovary. Epithelial Ovarian include the following subtypes:
- Serous cell epithelial ovarian cancer
- This is the most common subtype of all epithelial ovarian cancer, accounting for approximately 60% of newly diagnosed cases of ovarian cancer. When diagnosed, serous cell epithelial ovarian cancer is commonly classified as either low-grade or high-grade depending upon the nuclei and mitotic characteristics of the cells.
- Endometrioid (endometrial) ovarian cancer
- This subtype is identified by its relationship to the endometrium, which is the membrane that is the interior lining of the uterus. Endometrioid (endometrial) ovarian cancer can often develop in conjunction with other cancers or diseases or abnormalities affecting the endometrium such as endometriosis
- Mucinous, Clear Cell and Unclassified/Undifferentiated
- These three are less common (rare) subtypes of ovarian cancer. Though distinguishable for diagnostic purposes, the prescribed treatment for each is similar.
Ovarian Cancer Staging
Staging of cancer provides doctors with diagnostic information that helps guide consideration of treatment options. Staging protocol generally accounts for the severity of the cancer diagnosis. The first step is diagnosis of the ovarian cancer subtype - serous cell, endometrioid (endometrial), peritoneal, etc. Then next step is “staging” to understand its severity and help narrow potential treatment options.
The National Ovarian Cancer Coalition (NOCC)
NOCC provides the following staging protocol that guides doctors and patients:
Stage I
- Stage I
- Growth of the cancer is limited to the ovary or ovaries.
- Stage IA
- Growth is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites present containing malignant cells. The capsule is intact.
- Stage IB
- Growth is limited to both ovaries without any tumor on their outer surfaces. There are no ascites present containing malignant cells. The capsule is intact.
- Stage IC
- The tumor is classified as either Stage IA or IB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.
Stage II
- Stage II
- Growth of the cancer involves one or both ovaries with pelvic extension.
- Stage IIA
- The cancer has extended to and/or involves the uterus or the fallopian tubes, or both.
- Stage IIB
- The cancer has extended to other pelvic organs.
- Stage IIC
- The tumor is classified as either Stage IIA or IIB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.
Stage III
- Stage III
- Growth of the cancer involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.
- Stage IIIA
- During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal peritoneal surfaces.
- Stage IIIB
- The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.
- Stage IIIC
- The tumor is in one or both ovaries, and one or both of the following is present: (1) the cancer has spread to lymph nodes; and/or (2) the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.
Stage IV
- Stage IV
- This is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and distant metastases (spread of the cancer to organs located outside of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.
