Stage

The stage of a cancer describes the size of the tumour and how far it has grown and spread; a larger number indicates a later stage and more extensive disease. Disease staging is fundamental to the management of cancer cases, and all diagnosed cases of ovary, fallopian tube and primary peritoneal carcinomas should be staged by the MDT managing the case. When the patient is too unwell at the time of diagnosis (due to very advanced disease or comorbidities) to undergo full investigations and / or surgery, it may not be possible for the MDT to record stage data.

Stage presented in this report is FIGO stage at diagnosis of the tumour. Tumour stages are numbered from 1 to 4, with a higher value indicating more advanced disease. If no staging data were available at the time of analysis, the corresponding tumour was defined as ‘stage unknown’ or ‘stage not recorded’.

For more detailed information on staging, see Appendix 2. The cohort used includes all ovary, fallopian tube and primary peritoneal carcinomas, including borderline tumours. See Appendix 1 for the cohort definition in terms of ICD-10 and ICD-O-2 codes.

Figure 5. Stage at diagnosis of ovary, fallopian tube and primary peritoneal carcinomas in England, 2015 to 2017 (Source: CAS AV1906)

The proportion of tumours diagnosed at Stage 1 ranged from 10.0% to 47.9% among the 195 CCGs.

Figure 6. Stage at diagnosis of ovary, fallopian tube and primary peritoneal carcinomas by CCG, 2015 to 2017  (Source: CAS AV1906)

There are substantial differences in the stage profile across different geographies. Regional variation in stage data should be interpreted with care. Differences may be driven by how the data has been recorded or by real variation in the profile of cases diagnosed in different regions. Potential explanations for any real variation in stage profiles include differences in diagnostic pathways between regions, varying patterns of the time taken for patients to seek to consult their GP after first experiencing symptoms, inequality in ease of access in primary care to consult a GP for assessment of symptoms, variations in referral practices amongst GPs, and regional differences in primary care access to investigations such as ultrasound.

The proportion of tumours registered with stage recorded ranged from 100% to 52.6% amongst the CCGs.

Figure 7. Ovary, fallopian tube and primary peritoneal carcinomas with stage recorded by CCG, 2015 to 2017 (Source: CAS AV1906)

A total of 17% of cases considered in this report do not have stage recorded; this varies geographically with up to 48% of cases in particular CCGs having unknown stage.

The Ovarian Cancer Audit Feasibility Pilot reports the completeness of stage data in the datasets uploaded to the cancer registry by MDTs on a routine basis, with the aim of improving the completeness of this data where this is clinically appropriate. This information is available to NHS staff via the CancerStats website (this opens in a new window).

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The proportion of tumours diagnosed at early stage (stages 1 and 2) ranged from 62.9% to 21.8% amongst the CCGs. The definition of “early stage” as stage 1 or 2 and “late stage” as stage 3 or 4 is the same as the definition in the NHS Long Term Plan which sets an ambition for 75% of cancers to be diagnosed at stage 1 or 2 by 2028.

Figure 8. Ovary, fallopian tube and primary peritoneal carcinomas diagnosed at early or late stage by CCG, 2015 to 2017 (Source: CAS AV1906)

There are substantial differences in the early stage profile across different geographies. Potential explanations for this variation include differences in stage completeness, as well as referral and diagnostic pathways. This project’s future work analysing Routes to Diagnosis and treatments for ovarian cancer in England may help to disentangle the causes and consequences of variation in stage at diagnosis.