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Stage 3 Ovarian Cancer Explained

Posted on July 07, 2021
Medically reviewed by
Howard Goodman, M.D.
Article written by
Maureen McNulty

Cancer develops when cells in the body grow and multiply too quickly. Ovarian cancer includes a group of cancers that develop from multiple different tissues:

  • Ovaries — Organs that make egg cells and produce hormones
  • Fallopian tubes — Tubes that carry egg cells from the ovaries to the uterus
  • Peritoneum — The lining of the abdomen and abdominal organs

The American Cancer Society estimates that about 21,410 women will receive a new diagnosis of ovarian cancer in 2021. About 60 percent of people with ovarian cancer have stage 3 disease when they are diagnosed. Stage 3 ovarian cancer is an advanced form of cancer that has spread around the abdomen.

What Is Stage 3 Ovarian Cancer?

A cancer’s stage describes how far a person’s cancer has spread and how advanced it is. Doctors use cancer staging information to recommend treatments and estimate outlook. There are two staging systems used to determine the stages of ovarian cancer. One is called the International Federation of Gynecology and Obstetrics staging system, commonly known by the acronym “FIGO.” The other is called TNM staging, created by the American Joint Committee on Cancer (AJCC). The AJCC’s staging system uses the letters T, N, and M to describe different characteristics of the cancer.

At stage 3, ovarian cancer has spread to other tissues in the abdomen. Cancer cells may or may not have spread to nearby lymph nodes (glands that fight infection and remove waste). They have not spread to distant organs outside the abdomen nor into the liver. Stage 3 ovarian cancer, also called stage III ovarian cancer, has several substages:

  • Stage 3A1 — Cancer cells are in the ovaries, fallopian tubes, or peritoneum (the membrane that lines the cavity of the abdomen), and cancer has spread to nearby lymph nodes.
  • Stage 3A2 — Microscopic groups of cancer cells are growing in the abdomen.
  • Stage 3B — Cancer cells have formed small tumors — no more than 2 centimeters in diameter — in tissues or organs in the abdomen.
  • Stage 3C — Cancer cells have formed medium or large tumors in the abdomen.

In addition to assigning a stage, doctors also determine the type of ovarian cancer. Stage 3 ovarian cancer is most often high-grade serous cancer. “Serous” refers to a thin membrane — such as the peritoneum — with cells that secrete a lubricating serous fluid.

Stage 3 Ovarian Cancer Treatments

Stage 3 ovarian cancer is often treated with surgery, chemotherapy, or both. When recommending treatment options, your doctor will consider what type of cancer you have, how far your cancer has spread, whether all of your cancer can be removed, and whether you have other health problems. Stage 3 ovarian cancer can’t always be cured. In some cases, doctors use treatments to try to control cancer rather than to make it disappear completely.

Surgery for Stage 3 Ovarian Cancer

Treatment for stage 3 ovarian cancer often includes surgery. There are two main purposes of surgery. One is to help stage the tumor. During surgery, doctors can easily see how far the cancer has spread and where tumors are located. The second purpose of surgery is to remove as much of the cancer as possible, called debulking.

There are several possible surgical procedures that can help treat ovarian cancer. Doctors may recommend some or all of these options:

  • Oophorectomy — Removal of the ovaries
  • Salpingectomy — Removal of the fallopian tubes (when combined with removal of the ovaries, the procedure is called a salpingo-oophorectomy)
  • Hysterectomy — Removal of the uterus
  • Omentectomy — Removal of the omentum (fat that covers certain abdominal organs)
  • Biopsy — Taking a small sample from the lymph nodes or other organs to see if the cells are cancerous

There are three main types of ovarian cancer: epithelial cancer, stromal cancer, and germ cell tumors. Each may be treated slightly differently. Doctors usually treat stage 3 epithelial ovarian cancer by taking out both ovaries, both fallopian tubes, the uterus, and the omentum. Removing all of these organs means that a woman will no longer be able to have children. If cancer has spread to other nearby organs, such as the liver or bladder, the surgeon may also remove parts of them. If a piece of the intestines needs to be taken out, the surgeon can usually sew the ends back together. However, on occasion, the surgeon may need to create an opening in the abdomen where waste can leave the body. This is called an ileostomy or colostomy.

Ovarian stromal or germ cell tumors may occur only on one side of the body (in one ovary or one fallopian tube). In these cases, doctors may be able to remove only the cancerous ovary and leave the other one in place. Women who keep one ovary and fallopian tube in addition to their uterus can usually still have biological children in the future.

Chemotherapy for Stage 3 Ovarian Cancer

Doctors may use chemotherapy for several different purposes when treating stage 3 ovarian cancer. People with ovarian cancer may receive chemotherapy:

  • Before surgery, to shrink the cancer and make it easier to take out (called neoadjuvant chemotherapy)
  • After surgery, to shrink any remaining tumors and help keep the cancer from returning (called adjuvant chemotherapy)
  • Instead of surgery, if a person has inoperable ovarian cancer or has other health problems that make surgery risky

Chemotherapy for epithelial ovarian cancer often includes the medications Paraplatin (carboplatin) and Taxol (paclitaxel). These drugs may be given intravenously (through an IV). Alternatively, some people receive intraperitoneal chemotherapy, where the drugs are delivered straight into the abdomen. Doctors usually give chemotherapy in three-week cycles. During each cycle, a person receives one round of chemotherapy and then has a rest period.

If you have chemotherapy after surgery, you will most likely go through six cycles. If you receive chemotherapy as a first treatment, you may undergo just three cycles. Then, if imaging tests show that the chemotherapy is working and the cancer is shrinking, you may undergo surgery, followed by additional cycles of chemotherapy.

People with germ cell or stromal tumors usually receive different chemotherapy drugs. Most often, doctors recommend a combination of three chemotherapies: Blenoxane (bleomycin), VP-16 (etoposide), and Platinol (cisplatin). People with stromal ovarian cancer may also take hormone treatments such as Lupron (leuprolide) or Zoladex (goserelin).

Other Treatments for Stage 3 Ovarian Cancer

Doctors may give a targeted therapy drug along with chemotherapy drugs. Avastin (bevacizumab) is approved by the U.S. Food and Drug Administration to treat stage 3 or stage 4 ovarian tumors. Bevacizumab prevents tumors from creating their own blood supply. It helps starve and kill cancer cells. Other targeted therapies help treat advanced-stage epithelial ovarian cancer after other treatments have been tried. These include poly (ADP-ribose) polymerase, or PARP, inhibitors.

Stage 3 ovarian cancer may cause several uncomfortable symptoms. Some people choose to have additional treatments, such as radiation therapy, to help treat these symptoms.

Outlook for Stage 3 Ovarian Cancer

Researchers report ovarian cancer survival rates based on a five-year relative survival rate. These rates change based on a person’s age, overall health, cancer stage, ovarian cancer subtype, and treatment plan. Stage 3 ovarian cancer is a “regional” stage, which means that cancer has spread from the ovary to nearby organs or lymph nodes. However, it has not yet spread to more distant parts of the body. Regional survival rates vary depending on the type of ovarian cancer:

  • People with epithelial ovarian cancer are about 75 percent as likely to live for five years or more compared to people who don’t have ovarian cancer.
  • People with ovarian stromal tumors are 89 percent as likely to live for five years or more.
  • People with germ cell tumors are 94 percent as likely to live for five years or more.
  • People with fallopian tube cancer are 53 percent as likely to live for five years or more.

These numbers are calculated based on people who were diagnosed five to 10 years ago. Treatments are constantly improving, so people diagnosed today may have a better outlook than those who were diagnosed a decade ago.

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer and their loved ones. On MyOvarianCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Are you living with stage 3 ovarian cancer? Share your experiences in the comments below, or start a conversation by posting on MyOvarianCancerTeam.

All updates must be accompanied by text or a picture.
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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