What AJCC Staging Means for Ovarian Cancer

After the initial diagnosis of ovarian cancer, staging is performed. Staging describes how much cancer is in the body and where it has spread, if at all. This helps your doctors and treatment team figure out a course of treatment and how to best approach your care.

The stage of your ovarian cancer can also give you and your care team an idea about your prognosis, or the projected outcome of your cancer. However, it is important to remember that each person is different, and a prognosis is not a definitive indication of how your treatment will go.

The stages of ovarian cancer range from Stage I to Stage IV, with higher stages reflecting more advanced cancer. Stage IV is the most advanced. Surgery and imaging tests help doctors classify the stage and provide information on where the cancer is and how big the tumors are.1

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The 2 systems used to stage ovarian cancer are the International Federation of Gynecology and Obstetrics (FIGO) system and the American Joint Committee on Cancer (AJCC) system.1

What does T, N, and M mean?

The staging system uses the letters T, N, and M to describe ovarian cancer:2

  • T refers to the tumor and its size
  • N refers to whether nearby lymph nodes have cancer
  • M refers to any metastases (cancer spread to other distant areas of the body)

T, N, and M are then paired with a number. The higher the number the more advanced the cancer usually is.2

What are the stages?

Ovarian cancer is given a classification from Stage 1 to Stage IV.

Stage I ovarian cancer

This is generally considered early-stage ovarian cancer. There are 3 sub-stages:1,2

  • Stage IA (T1a, N0, M0)
    • Cancer is in 1 ovary or fallopian tube and is confined to the inside of the ovary or fallopian tube with no cancer on the outer surface of the ovary or fallopian tube. No cancer cells are found in the fluid or washings from the abdomen and pelvis (T1a)
    • Cancer is not in any nearby lymph nodes (N0), and there is no spread to distant sites of the body (M0)
  • Stage IB (T1b, N0, M0)
    • Cancer is inside both ovaries or fallopian tubes but not on the outside surfaces, and no cancer cells are in the fluid or washings from the abdomen or pelvis (T1b)
    • There is no cancer in nearby lymph nodes (N0) and no distant spread (M0)
  • Stage IC (T1c, N0, M0)
    • Cancer is inside 1 ovary or fallopian tube, or inside both ovaries or fallopian tubes, and any of the following are also present:
      • The capsule/tissue surrounding the tumor broke during surgery, potentially letting cancer out. This is stage IC1
      • Cancer is on the outside surface of at least 1 ovary or fallopian tube OR the capsule burst before surgery. This is Stage IC2
      • Cancer cells are in the fluid (ascites) or washings from the abdomen or pelvis. This is Stage IC3
    • There is no spread to nearby lymph nodes (N0) or distant sites of the body (M0)

Stage II ovarian cancer

Stage II ovarian cancer has 2 sub-stages:1,2

  • Stage IIA (T2a, N0, M0)
    • Cancer has spread to the uterus or fallopian tubes, or the ovaries (if it started in the fallopian tubes) (T2a)
    • There is no spread to lymph nodes (N0) or distant sites of the body (M0)
  • Stage IIB (T2b, N0, M0)
    • The cancer is on the outer surface of or has grown into nearby organs in the pelvis, like the bladder, rectum, or sigmoid colon (T2b)
    • It has not spread to lymph nodes (N0) or distant sites of the body (M0)

Stage III ovarian cancer

There are several sub-stages to this stage:1,2

  • Stage IIIA1 (T1 or T2, N1, M0)
    • The cancer is in 1 or both ovaries or fallopian tubes, OR there is primary peritoneal cancer (T1) and it may have spread into nearby pelvic organs (T2)
    • It has spread to retroperitoneal lymph nodes (pelvic and/or para-aortic) (N1) but not distant sites in the body (M0)
  • Stage IIIA2 (T3a, N0 or N1, M0)
    • The cancer is in 1 or both ovaries or fallopian tubes, OR there is primary peritoneal cancer and it has spread into organs outside the pelvis
    • During surgery, no cancer is visible in the abdomen, but small deposits of cancer are found in the abdominal lining in the lab (T3a)
    • The cancer might or might not be in the retroperitoneal lymph nodes (N0 or N1), and there is no distant spread (M0)
  • Stage IIIB (T3b, N0 or N1, M0)
    • There is cancer in 1 or both ovaries or fallopian tubes, OR there is primary peritoneal cancer that has spread into organs outside the pelvis
    • The cancer is visible during surgery but the tumor(s) are no bigger than 2 cm across (T3b)
    • There may or may not be cancer in the retroperitoneal lymph nodes (N0 or N1), and there is no distant spread (M0)
  • Stage IIIC (T3c, N0 or N1, M0)
    • The cancer is in 1 or both ovaries or fallopian tubes, OR there is primary peritoneal cancer that has spread into organs outside the pelvis
    • The visible cancer is larger than 2 cm and may be on the outside of the liver or spleen (T3c)
    • It may or may not have spread to the retroperitoneal lymph nodes (N0 or N1) and there is no distant spread (M0)

Stage IV ovarian cancer

Stage IV ovarian cancer is the most advanced stage of cancer. There are 2 sub-stages of this stage:1,2

  • Stage IVA (any T, any N, M1a)
    • Cancer cells are found in the fluid around the lungs. This is called a malignant pleural effusion
    • No other areas of cancer spread are present, like the liver, spleen, intestine, or lymph nodes outside the abdomen (M1a)
  • Stage IVB (any T, any N, M1b)
    • Cancer has spread to the inside of the spleen or liver, lymph nodes other than the retroperitoneal nodes, and/or to other organs outside of the peritoneal cavity, like the bones (M1b)

Sometimes you will also see the following AJCC stages:1

  • TX – The main tumor cannot be properly assessed because of a lack of information
  • T0 – There is no evidence of a primary tumor
  • NX – The regional lymph nodes cannot be assessed because there is not enough information

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Written by: Jaime Rochelle Herndon | Last reviewed: May 2021