Part 3: Treatment planning
NCCN Guidelines for Patients
: Ovarian cancer
After initial tests suggest that you have ovarian cancer,
your doctors must confirm the diagnosis and plan
treatment. To plan treatment, your doctors need to find
out how far the cancer has spread in your body (cancer
stage) and how fast it may grow (cancer grade). But, it is
important to note that the only way to confirm if you have
ovarian cancer is to remove a sample of tissue from your
body and test it for cancer cells.
The removal of a tissue or fluid sample from your body
to test for disease is called a biopsy. Your doctor will take
a biopsy of the tumor and nearby tissue to confirm if you
have ovarian cancer and to find out how far the cancer has
spread. Biopsies are usually done during surgery to remove
ovarian cancer. If possible, this should be performed by
a gynecologic oncologist. Some biopsies can be done in
about 30 minutes, but others can take longer. The biopsy
samples will be sent to a lab so a pathologist can examine
them with a microscope to look for cancer cells. It may take
several days to get the test results of the biopsy back from
For certain situations, a biopsy such as FNA (
spiration) or paracentesis may be done before surgery. An
FNA biopsy uses a very thin needle that is inserted through
your skin to remove a small sample of tissue from the tumor.
For paracentesis, a thin needle is inserted through your
abdomen to remove a sample of fluid from the area inside
your belly. Before either biopsy, your doctor will numb the
area to make the procedure as painless as possible.
Cancer staging and grading
Cancer staging is a description of the extent of the
cancer. Cancer stages are defined by the growth of the
primary tumor and its spread to other parts of the body.
Generally, ovarian cancer is staged twice. The first,
called the clinical stage, is based on tests before surgery.
The second, called the pathologic stage, is based on
tests of tissue removed during surgery. The clinical stage
gives your doctor an idea of how far the cancer may
have spread. But, the pathologic stage is more important
because it is based on results of tissue removed from
your body and tested for cancer cells.
Ovarian cancer is also grouped into grades—1, 2, and
3. The cancer grade is based on how the cancer cells
look compared to normal cells when viewed with a
microscope. This helps your doctor decide if the cancer
is likely to grow fast or slow and if it is likely to spread.
Grade 1 (low grade) cancer cells look similar to normal
cells. Grade 2 cancer cells look more different from
normal cells than Grade 1. Grade 3 (high grade) cancer
cells look very different from normal cells. Grade 1
cancers are considered less aggressive because they
grow slowly and are less likely to spread. Grade 3
cancers are considered more aggressive because they
grow faster and are more likely to spread. Testing cancer
cells from tissue removed during surgery is the only way
to grade the cancer.