How quickly can ovarian cancer spread?

How Quickly Ovarian Cancer Can Spread

Ovarian cancer can spread rapidly, with high-grade serous carcinomas (the most common type) potentially progressing from early to advanced stages within months, leading to peritoneal carcinomatosis that significantly impacts mortality and quality of life. 1

Progression Rate by Cancer Type

The speed of ovarian cancer spread depends primarily on the histological subtype:

• Type II ovarian cancers (70-80% of cases):

  • High-grade serous carcinomas
  • High-grade endometrioid carcinomas
  • Carcinosarcomas
  • Undifferentiated carcinomas

  These aggressive cancers can spread rapidly throughout the peritoneal cavity, often within months of initial development. They frequently present at advanced stages (III-IV) due to their aggressive nature and lack of early symptoms. 1, 2

• Type I ovarian cancers:

  • Low-grade serous carcinomas
  • Low-grade endometrioid carcinomas
  • Clear cell carcinomas
  • Mucinous carcinomas

  These tend to grow more slowly and may remain confined to the ovary for longer periods, sometimes years. 1

Patterns of Spread

Ovarian cancer typically spreads in a predictable pattern:

1. Initial spread: From ovary to pelvic structures (uterus, fallopian tubes, bladder peritoneum)
2. Peritoneal dissemination: Cancer cells shed into peritoneal fluid, implanting on peritoneal surfaces
3. Lymphatic spread: To pelvic and para-aortic lymph nodes
4. Advanced spread: To distant organs (liver surface, pleural cavity) 1

The British Journal of Cancer guidelines note that malignant ovarian cancers can rapidly progress to peritoneal carcinomatosis, requiring urgent surgical intervention in a specialist cancer setting. 1

Staging and Survival Implications

The speed of spread directly impacts staging and survival:

• Stage I (confined to ovaries): 5-year survival rate of 90%
• Stage II (pelvic extension): 5-year survival rate of 70%
• Stage III (peritoneal implants beyond pelvis): 5-year survival rate <30%
• Stage IV (distant metastasis): 5-year survival rate <30% 1, 2

Unfortunately, approximately 51% of ovarian cancers are diagnosed at Stage III and 29% at Stage IV, indicating how rapidly these cancers can spread before detection. 1

Risk Factors for Rapid Spread

Certain factors are associated with more aggressive spread:

• BRCA1/2 mutations: Increase risk and may be associated with more aggressive disease
• TP53 mutations: Common in Type II cancers and associated with rapid progression
• High-grade histology: Higher grade tumors spread more quickly
• Advanced age: Older patients often have more aggressive disease 1, 2

Clinical Implications

The rapid spread of ovarian cancer has important clinical implications:

• Surgical urgency: Malignant ovarian cancers presenting as peritoneal carcinomatosis must be treated surgically without delay 1
• Complete surgical staging: Essential for accurate assessment of disease extent 1
• Residual disease impact: The volume of tumor left after surgery significantly affects prognosis 1

Common Pitfalls in Assessment

• Underestimating spread: Microscopic peritoneal metastases may be present even when not visible on imaging
• Inadequate surgical staging: Can lead to underestimation of disease extent
• Relying solely on imaging: CT scans have limited ability to detect small peritoneal implants 1, 3

The rapid progression of ovarian cancer, particularly high-grade serous carcinomas, underscores the importance of prompt diagnosis and comprehensive surgical staging to accurately assess disease extent and guide appropriate treatment.