The prevalence of the process

Most ovarian tumors first grow in the pelvis. If they grow through the ovary, they can grow into the fallopian tubes, into the uterus, as well as into the bladder and intestines. Cancer can spread throughout the abdomen and spread into small metastases (peritoneal carcinomatosis). At the same time, it also grows into a large omentum. Often there is a lot of fluid in the abdominal cavity (ascites).

Further spread of ovarian cancer occurs through the lymphatic pathways, while metastases are found in the lymph nodes. The pelvic lymph nodes and lymph nodes around the aorta are often affected, but other lymph nodes may also be affected.

In ovarian cancer, metastases can also occur in the lungs and liver. But this is rather in rare cases. The spread of the tumor in the body is an important criterion in choosing the best treatment for the patient. For a more accurate description, depending on the prevalence of the process, tumors are divided into stages.

Classification is carried out according to certain standards, for which, first of all, three aspects are decisive:

• Tumor size (T)
• Involvement of lymph nodes (N)
• Presence of distant metastases (M)

Therefore, the term TNM classification is also used. The numbers after the letter give an accurate idea of the size and extent of the tumor (T1-4), the number and location of affected lymph nodes (N0-3) and the presence or absence of distant metastases (M0 and M1). T1 N0 M0 would mean in this case that we are talking about a small tumor without the presence of affected lymph nodes and distant metastases. An accurate assessment of the TNM stage is possible only after surgical removal of the tumor.

Along with the TNM system for cancers of the female organs, there is a further classification of stages, the so-called FIGO classification. It also takes into account the local spread of the tumor, the involvement of neighboring organs and lymph nodes in the process, as well as metastases to distant organs.

In the FIGO classification, 4 stages are distinguished:

• FIGO stage I: The tumor affects one or both ovaries
• FIGO stage II: tumor spread within the pelvis
• FIGO stage III: Tumor has spread to the abdomen or lymph nodes
• FIGO stage IV: the tumor has grown beyond the abdominal cavity

The next important criterion for treatment planning is the structure of the cancerous tissue (Grading). This is determined during microscopy, during a biopsy of tissues taken for examination, and gives an idea of the degree of malignancy of tumor cells.