Stage 3 ovarian cancer

Stage 3 ovarian cancer has spread outside the pelvis into the abdominal cavity or to lymph nodes. Treatment is surgery and chemotherapy.

The stage of a cancer tells the doctor how far it has grown and if it has spread. The tests and scans you have to diagnose your cancer will give some information about the stage.  But your doctor might not be able to tell you the exact stage until you have surgery.

Doctors use a simple 1 to 4 staging system for ovarian cancer. It is called the FIGO system after its authors - the International Federation of Gynaecological Oncologists.

What is stage 3?

Stage 3 ovarian cancer means the cancer has spread outside the pelvis to the lining of your abdominal cavity (peritoneum). It can also spread to the lymph nodes in the back of your abdomen.

There are three groups - 3A, 3B and 3C:

Stage 3A has 2 groups:

• Stage 3A1 means the cancer has spread to the lymph nodes in the back of your abdomen
• Stage 3A2 means that the doctor finds cancer cells in tissue samples they take from the lining of your abdomen (peritoneum). And it might also be in your lymph nodes

Stage 3B means there are cancer growths that are 2cm or smaller in size on the lining of your abdomen (peritoneum). And there might also be cancer in your lymph nodes. 

Stage 3C means there are cancer growths larger than 2cm on the lining of your abdomen (peritoneum). And there might also be cancer in your lymph nodes. 

Treating stage 3 ovarian cancer

Doctors usually class stage 3 ovarian cancer as advanced ovarian cancer. This means the cancer has spread away from the ovary.

The main treatments are surgery and chemotherapy. Treatment can cure some advanced cancers. But if treatment can’t cure you, the aim of treatment is to control the cancer for as long as possible.

The specialist doctors consider several factors when deciding whether you can have surgery. And whether you should have chemotherapy before or after the operation. These include:

• where the cancer has spread to
• whether the specialist surgeon (gynaecological oncologist) thinks they can remove all the cancer 
• your general health

You might have:

• chemotherapy after surgery (debulking surgery)
• chemotherapy before and after surgery – doctors sometimes call this interval debulking surgery (IDS)

Chemotherapy after surgery

You have debulking surgery as your first treatment if;

• you are well enough
• the specialist surgeon thinks they can remove all the cancer.

The surgeon removes as much of the cancer as possible. After you recover from surgery, you have chemotherapy. This is adjuvant chemotherapy.

Adjuvant chemotherapy aims to reduce the risk of the cancer coming back. If the surgeon couldn't remove all the cancer, then chemotherapy aims to shrink the cancer that is left behind. Some women may then have further surgery.

Chemotherapy before and after surgery

You might have chemotherapy as your first treatment if:

• your surgeon looks at your scans and decides it isn’t possible to remove all your cancer
• you aren’t well enough for surgery straight away

This is neoadjuvant chemotherapy or primary chemotherapy. The chemotherapy aims to shrink the cancer and make it easier to remove.

You have a scan halfway through the chemotherapy course. You then have surgery if the scan shows your cancer is shrinking. You may hear your specialist call this interval debulking surgery, or IDS. After the surgery, you have the rest of the course of chemotherapy.

Targeted cancer drug treatment

For some stage 3 cancers, you might have a type of targeted drug treatment called bevacizumab with chemotherapy.

If surgery isn't possible

It might not be possible to have surgery if your cancer has spread widely or you are not well enough.

You can have chemotherapy on its own to shrink the cancer as much as possible and to slow it down. You might have radiotherapy to relieve your symptoms. This depends on where in the body the cancer has spread.

You might have other types of treatment to help relieve your symptoms. For example, treatment for fluid in the abdomen (ascites) or for a blocked bowel.