Cancer develops when cells in the body grow and multiply too quickly and abnormally. 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

About 20,890 new ovarian cancer diagnoses occur in the U.S. every year. Most ovarian cancers are diagnosed at an advanced stage, which means stage 3 or 4. Stage 3 ovarian cancer is an advanced form of cancer that has spread around the abdomen or into nearby lymph nodes.

What Is Stage 3 Ovarian Cancer?

A cancer’s stage describes how far the cancer has spread and how advanced it is. Doctors use cancer staging information to recommend treatments and estimate the 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. This is commonly known by its 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: The size of the tumor (T), spread to lymph nodes (N), and whether the tumor has spread or metastasized (M) to other organs.

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 haven’t spread to distant organs outside the abdomen or into the liver. Stage 3 ovarian cancer (often written with Roman numerals: 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) as well as in the retroperitoneal lymph nodes, but not distant organs.
• Stage 3A2 — Cancer is in the peritoneum (lining of the abdomen) beyond the pelvis, may or may not be in retroperitoneal lymph nodes, but can only be seen under a microscope.
• Stage 3B — Macroscopic peritoneal metastases (visible deposits of cancer cells no bigger than 2 centimeters across) have spread outside the pelvis. Cancer may or may not be in retroperitoneal lymph nodes.
• Stage 3C — Cancer cells larger than 2 centimeters may appear on the surfaces of the liver or spleen. Ovarian cancer becomes stage 4 if the cancer spreads into the liver or spleen.

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 (not “serious”) 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 several factors. For instance, the type of cancer you have, how far your cancer has spread, whether all of your cancer can be removed, and your overall health. Stage 3 ovarian cancer can’t always be cured. In some cases, doctors use treatments to try to control cancer or reduce symptoms 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, a process called debulking.

Several possible surgical procedures 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 — Removal of 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 removing both ovaries, both fallopian tubes, the uterus, and the omentum. Removing all of these organs means that you will no longer be able to conceive 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 intestine 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 in place. People who keep one ovary and one 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 or induction 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 carboplatin and paclitaxel. These drugs may be given intravenously (through a vein). 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. Oncologists sometimes treat stage 3 and 4 ovarian cancers with neoadjuvant chemotherapy with interval debulking, including hyperthermic intraperitoneal chemotherapy. This involves an interval surgery after several chemotherapy sessions, often followed by biopsies.

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

Other Treatments for Stage 3 Ovarian Cancer

Doctors may give a targeted therapy drug called bevacizumab along with chemotherapy drugs. 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, including some that are used as first-line treatments alongside chemotherapy. These include poly (ADP-ribose) polymerase, or PARP, inhibitors. Doctors test tumors for specific genes to determine if PARP inhibitors like niraparib are a fit for first-line maintenance treatment.

A newer targeted therapy drug called mirvetuximab soravtansine-gynx was recently approved by the U.S. Food and Drug Administration (FDA). It’s approved to treat high-grade serous epithelial cancer when the tumor overproduces a specific protein called folate receptor alpha (FR-alpha) and has received one to three previous treatments.

Stage 3 ovarian cancer may cause several uncomfortable symptoms. Some people choose to have additional treatments, called supportive treatments, to help treat advanced ovarian cancer symptoms.

Outlook for Stage 3 Ovarian Cancer

Researchers report ovarian cancer survival 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.

Survival statistics are also based on the summary stage, meaning whether the cancer is local, regional, or distant. Stage 3 ovarian cancer is a regional stage, which means that cancer has spread from the ovary to nearby organs or lymph nodes, but it hasn’t yet spread to more distant organs of the body. Regional survival rates vary depending on the type of ovarian cancer:

• People who have epithelial ovarian cancer with regional spread are about 71 percent as likely to live for five years or more compared to people who don’t have ovarian cancer.
• People who have ovarian stromal tumors with regional spread are 88 percent as likely to live for five years or more.
• People who have germ cell tumors with regional spread are 94 percent as likely to live for five years or more.
• People who have fallopian tube cancer with regional spread are 66 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.

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