Ovarian Cancer

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Grades of Ovarian Cancer: Measuring Its Aggressiveness

Dr. Emese Zsiros Roswell Park Comprehensive Cancer Center

In cancer, you often hear the words “stage” and “grade.” In ovarian cancer, oncologists are able to make these distinctions only after examining cells removed through the surgery that’s a first part of treatment.

Grades of Ovarian Cancer

Ovarian cancer can be divided into three grades of aggressiveness. Grade is not determined by the size or stage of the tumor, but rather by the behavior of the cells in the tumor. “Grade” refers to how likely the cancer is to spread, unlike “stage,” which refers to how far it has already spread.

Cells in the body become specialized for their function and place in the body. Well-differentiated cells show that they are specialized for their assigned function and are healthy.

Grade three cells are the most aggressive form of ovarian cancer and are poorly differentiated. They have a large nucleus, or cell center. They divide very quickly and no longer look like normal, healthy cells. This type of cancer is most likely to spread.

Grade two cells are mildly aggressive.

Grade one cells are the least aggressive cancer because they look most like normal ovarian tissue and are well-differentiated. Grade one ovarian cancer is less likely to spread.

In addition, doctors use two preliminary grades, “GX” and “GB.” When the grade cannot be determined, that’s “GX,” and “GB” refers to tissue that is borderline cancerous, commonly called “low malignant potential”.

Ovarian cancer can also be classified in four different stages, regardless of grade:

Stage one: The cancer is found only in one or both ovaries.

Stage two: The cancer has spread to other areas of the pelvis.

Stage three: The cancer has spread to the abdomen and other body parts in the abdominal region.

Stage four: The cancer spreads to regions beyond the abdomen.

Doctors generally determine the stage of the cancer during surgery, where they can see if the cancer has spread outside the ovaries.

Detecting ovarian cancer can be difficult. Ovarian cancer screenings aren’t especially reliable and sometimes can be harmful. If a woman knows she has BRCA1 or BRCA2 genes, which raise the risk of breast and ovarian cancer, or has a family history, then the scan could be a good idea. Some women with the gene opt to have their ovaries removed prophylatically before they reach the age when they’re most likely to develop ovarian cancer.

The BRCA gene test is recommended for women with a family history of breast or ovarian cancer and for women who have already been diagnosed with either. If women are found to have inherited BRCA1 or BRCA2 , it can help inform treatment options.

Women should keep an eye out for symptoms of ovarian cancer, including bloating, abdominal pain and changes in bowel habits. It’s helpful to be proactive about asking a doctor about any of these symptoms, according to Dr. Jose Alejandro Rauh-Hain, a Gynecologic Oncologist on staff at the University of Texas MD Anderson Cancer Center. He emphasized the importance of early detection.

“It’s very important the patients are not afraid to ask questions to their physicians,’ Dr. Rauh-Hain says, emphasizing the importance of the patient becoming highly informed and advocating for herself. “It’s important that they not be afraid of asking those questions, because the sooner we can diagnose the cancer, the better the prognosis.”

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Dr. Emese Zsiros is an OB/GYN and gynecologic oncologist at Roswell Park Comprehensive Cancer Center. Read More

Ovarian Cancer Initial Treatment

Deciding the first course of care for ovarian cancer is a crucial conversation between a woman and her gynecologic oncologist. Following a detailed diagnosis of the type of ovarian cancer, doctors typically recommend an aggressive combination of surgery and chemotherapy. Which treatment comes first depends on the stage and grade of the cancer.