Staging and grading assists in determining treatment plans moving forward. It is only at this point that the difference between OC and a BOT will be determined.
This happens post-operatively as the tumour and anything else removed – e.g. ovary/ovaries, fallopian tube/s, uterus, omentum, fluid from your abdominal cavity – will be analysed under the microscope.
This is why – in most cases – it is not possible to determine whether a suspicious growth is OC or a BOT before surgery. Most growths will be biopsied at the time of surgery. The wait for the histology report post-surgery is nerve-wracking. After surgery, I was told to expect a stage 2 OC diagnosis…. and that there was less than 10% chance of the growth being found to be borderline.
The histologist will look at a range of things, including how the tumour cells look under the microscope. This is GRADING.
Determining if and how the tumour has spread is called STAGING.
In my case, the histology report indicated that I had:
GRADE: borderline tumour (i.e. what is known as a BOT; this is NOT the same as “typical” OC)
STAGE: 2c (the tumour had spread beyond the ovary but within the pelvis, and tumour cells were found in the fluid taken from my abdomen during surgery)
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GRADING
A BOT is – by definition – graded as a BORDERLINE TUMOUR: these are made up of abnormal cells rather than cancer cells. This means that the cells are not the same as those found in typical OC; a BOT is NOT typical OC.
The other grades apply to typical, frankly invasive OC, i.e. grades 1, 2 and 3.
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STAGING
BOTs are staged in the same way as OC.
The stage of a cancer is a term used to describe its size and whether it’s spread beyond its original area of the body. It’s often not possible to tell exactly what the stage of an ovarian cancer is until an operation has been done to remove it.
This is a commonly used staging system, called the FIGO staging system. It divides ovarian cancers into four stages.
There’s a good overview on the Macmillan website here.
But remember: as BOTs are staged the same as OC, the word “cancer” is used in the staging rather than the word “tumour”.
Stage 1
The cancer only affects the ovaries. Stage 1 can be subdivided into:
Stage 1a The cancer is only in one ovary.
Stage 1b The cancer is in both ovaries.
Stage 1c The cancer is in one or both ovaries and either there are cancer cells on the surface of one or both ovaries OR there are cancer cells in the fluid taken from the abdomen during surgery OR the ovary has burst (ruptured) before or during surgery.
Stage 2
The cancer has spread outside the ovaries to other areas within the pelvis. Stage 2 can be subdivided into:
Stage 2a The cancer has spread to the womb or fallopian tubes.
Stage 2b The cancer has spread to other structures within the pelvis, such as the rectum or bladder.
Stage 2c The cancer is at either stage 2a or 2b, and there are cancer cells in the fluid taken from within the abdomen during surgery.
Stage 3
The cancer has spread beyond the pelvis to the omentum and/or to organs in the abdomen, such as the lymph nodes in the abdomen or the upper part of the bowel. Stage 3 can be subdivided into:
Stage 3a The tumours in the abdomen are very small and can only be seen under a microscope.
Stage 3b The tumours in the abdomen can be seen but they’re 2cm or smaller.
Stage 3c The tumours in the abdomen are larger than 2cm OR they may have spread to nearby lymph nodes OR they have spread to nearby lymph nodes.
Stage 4
The cancer has spread to other parts of the body, such as the liver, lungs or distant lymph nodes (for example in the neck).
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