At the time of diagnosis and first treatment, ovarian cancers are assigned to a stage based upon tumor size, the involvement of lymph nodes and the spread to body parts beyond the lymph nodes. Stage IIIC ovarian cancer is a tumor of any size that has either spread to lymph nodes near the ovary or has produced cancerous implants in the lining of the abdominal cavity greater than 2 centimeters in diameter. According to the American Cancer Society, those with stage IIIC have a 35 percent chance of living for 5 years after diagnosis. That statistic includes all women regardless of other factors or types of treatment.
The Effect of Location
Although the stage IIIC designation does not distinguish between them, women with spread only to the lymph nodes appear to have a higher survival than women with spread to the lining of the abdominal cavity. In the December 2008 issue of "The Journal of Gynecologic Oncology," researchers reported a disease-free 5-year survival of approximately 65 percent in women with node-only spread. Women with spread to the abdominal lining had a disease-free 5-year survival of 15 to 20 percent. Other investigators have reported similar findings.
The Effect of Tumor Grade, Obesity, Reproductive Factors and Genes
Under the microscope, each cancer bears more or less resemblance to the normal tissue from which it arises. Pathologists classify those that are least normal in appearance as "poorly differentiated." As reported in May 2008 in "The International Journal of Cancer," women with poorly differentiated cancers have a 25 percent lower 10-year survival than women with well differentiated cancers. Obesity at age 18 was a risk factor for a higher death rate, but oral contraceptive use, age at childbirth, age at first menstruation and age at menopause had no adverse effect on survival. Ovarian cancers are not all alike at the genetic level, and those differences can affect response to therapy and survival. An example is the gene that produces a protein called CD70. Research published in 2013 in "OncoTargets and Therapy" established that overactivity of that gene made patients less responsive to cisplatin drugs, the otherwise most effective chemotherapy agents for ovarian cancer.
The Effect of Age and Treatment
According to research published by the American Society of Clinical Oncology in 2013, women older than 65 receive the optimal combination of surgery and chemotherapy less often than younger women. The resulting mortality rate for older women is worse, but it can be improved by individualizing treatment according each woman's state of health and ability to tolerate that treatment.
Optimal Treatment for Stage IIIC Ovarian Cancer
According to the National Comprehensive Cancer Network Guidelines, women with stage IIIC disease should undergo surgery to remove the ovaries, uterus, lymph nodes in the pelvis, lymph nodes around the major blood vessels, all visible cancerous implants and the fatty membrane overlying the intestines, which is called the omentum. Surgery should be combined with chemotherapy administered directly into the abdominal cavity and followed by chemotherapy administered by vein for 6 to 8 months. As reported in 2013 in "PLos One," patients who receive complete treatment have a disease-free survival of 20 to 24 months on average. Those who receive chemotherapy without surgery are disease free and alive for an average of only 8 months.
Is This an Emergency?
- The International Journal of Cancer: Predictors of Ovarian Cancer Survival -- A Population-Based Prospective Study in Sweden
- PLoS One: Clinical Course of Patients Treated for Advanced Ovarian Carcinoma Without Surgical Intervention
- OncoTargets and Therapy: Increased CD70 Expression is Associated With Clinical Resistance to Cisplatin-Based Chemotherapy and Poor Survival in Advanced Ovarian Carcinomas
- American Society of Clinical Oncology: Treatment and Trials -- Ovarian Cancer in Older Women
- American Society of Clinical Oncology: Obesity and Gynecologic Cancer Etiology and Survival
- The British Medical Journal: Cancer Incidence and Mortality in Relation to Body Mass Index in the Million Women Study-Cohort Study
- The Journal of Gynecologic Oncology: Stage IIIC Epithelial Ovarian Cancer Classified Solely by Lymph Node Metastasis Has a More Favorable Prognosis Than Other Types of Stage IIIC Epithelial Ovarian Cancer
- National Comprehensive Cancer Network: Ovarian Cancer