In Her Own Words

Here's the latest on Mom - taken directly from her blog :)

Who Scrambled My Insides?

What is chemo like 3 weeks after major surgery?  It is the ultimate guessing game in which you try to figure out if  you are feeling "this way or that" because you just had surgery, or your hormones are imbalanced (a special bonus for having both ovaries removed simultaneously and welcoming premature menopause), or you have just intentionally decided to boil your insides with toxic chemicals.   There are no concise answers...it just feels like someone took a giant eggbeater and stirred your insides up.

There have been funny moments...when they let me take a business call just as my Benadryl infusion was taking hold, or when I panicked at the sight of a "horrible discharge emanating from my belly button" only to be slightly embarrassed to discover it was just accumulated surgery glue that was releasing itself from the wound and the then the moment you realize you are not "running a temperature"...simply having a "hot flash"

There have been scary moments....that first drip, drip, drip of caustic solution releasing itself into your veins, the first and second puncture into your newly installed port, and the first time you stand naked in front of the mirror and fully examine your Frankensteinish scar down the middle of your body for the first time.

There have been tender moments...when you close your eyes to endure a moment and are blessed with the spirit of comfort or you run into a new friend that you only met 3 weeks ago as you made recovery laps around the hospital together...and now share the same extended journey to the doctor's office, chemo infusion center, etc. 

There have been sad moments...when you know your illness is too painful for others to witness (they just feel so helpless and, if they are natural "fixers" by nature, it is 100 times worse...the fact that they can't make you better).

There have been unexpected mercies and kindnesses...cards, flowers, dinners, phone calls, visits, and expressions of concern.  One of the latest...my neighborhood gas station owner who literally walked around the counter and gave me a hug then sincerely told me he would pray for me every day until I was well.

What is chemo like after major surgery...it is a new adventure every day wondering how in the world your insides (including your brain) got so scrambled and what the ultimate result will end up being!

Chemo Day 3: Hit the Wall

Today Mom has been feeling pretty crappy. When I asked how it felt for her, she said she feels like she "hit the wall" today. One of her best friends who is also a cancer survivor texted me to check in and said day 3 and day 4 were always her worst days too. She said she hasn't really felt nauseated, though, so that's a good thing. We will take all the "good things" we can get.

~Candice

Walking, Working and Waiting

A quick update for everyone :)

Walking: Mom is doing well today. She took a walk with Grammy (Charlene - her mom) and Great Grandma (Anna - her grandmother) this morning and another one this evening. She mentioned wanting to aim for taking two walks a day so she remains active through this treatment. She is working on eating frequent, small meals in order to keep her nutrition levels up as well.

Working: I talked to Mom and she said she was able to get a solid day of work in today which seemed to make her very happy. The more productive she can be, the better. As we all know, Mom thrives on a challenge and this is just another challenge for her to figure out and overcome.

Waiting: This one is for me, mostly. I have never really been around anyone who has undergone chemo so it is hard to know what to expect. I find that there is a sense of waiting for the proverbial "other shoe" to drop. I can't help but feel as though we are waiting to see what happens, waiting to see how she does, etc. Just a lot of waiting. I just hope once it all arrives that we are ready for it :)

Side effects so far:
Funny taste buds, achy feeling all over, restless legs, uncomfortable tummy (though not specifically nauseated)

~Candice

Chemo Week One

I went with Mom to her first chemo appointment today. We arrived at around 8:15 am and left around 12:45 pm. They said this appointment would take longer than subsequent appointments but it was right on the mark as far as what they told her to expect. She received Taxol and Carboplatin today, next week and the week after she will only receive Taxol. She wanted to have some photos posted so everyone can see what the treatment rooms, etc are like. It's hard to imagine it all so we are in agreement that pictures can bridge that gap for everyone. Click HERE to see additional photos. She was a little bit of a ham . . . :o).

The treatment itself was relatively uneventful. The nurse explained a lot, got her port site prepped and then got her hooked up to the IV drip. It took about 3 hours for her to receive all of the pre-meds (a lot of anti nausea meds, benadryl, etc) and the 2 chemo drugs. She didn't report any side effects except that the benadryl made her sleepy. In fact, she slept through much of the infusion.

After treatment, we went and had lunch at a local vegetarian restaurant called Green, picked up her prescriptions at Walgreens and then came home. She is in great spirits and hasn't had any side effects so far except she reported a metallic taste just a minute ago (which is very common for chemo patients). The high point of the appointment was when the nurse explained that if she feels up to it, exercise is actually a great way to combat some of the chemo side effects so she has plans to take walks with Great Grandma regularly to keep moving forward.

~Candice

Family Fun Before Chemo Begins

It's true. Chemo starts tomorrow for Mom. But this sobering reality didn't stop her from enjoying her last chemo-free weekend (for a while anyway) with friends and family. It was a good weekend - free-flowing, relaxed and even a little bit silly. My sister, Kristen, flew into town late Friday night to spend the weekend in Phoenix. I was absolutely delighted to have her here and we spent hours talking together, laughing together, discussing style tips and tricks with Mom, and genuinely enjoying each others' company. I love my sister with all my heart and I don't know what I would do without her! Before she left, she and I and Delaney created a chemo bag for Mom that included all kinds of goodies to keep her occupied, entertained and distracted when she has her chemo appointments. The bag included: a magazine, 2 cool cancer books, chapstick, assorted mints and candies, gum, an iPod shuffle with 4 hours of music, comfy socks, a new scarf, hand cream, pockets for water and more (I'm sure I'm forgetting something!).

Mom was a great sport and let me and Kristen take lots of pictures over the weekend. There are way too many to post on the blog, but you are welcome to check out all of the fun by clicking HERE. We tried on scarves, played with her new wig and took comfort in the love that we are surrounded by. There is no doubt that we have some pretty big mountains to climb, but we are united in the adventure, no matter how treacherous the terrain! Mom has recently posted on her personal blog - Grammy Tammy's Family and Friends. Be sure to check it out if you haven't. It's nice to read about her journey in her own words. Much love and light to everyone that is in this with us - the prayers and love are an inspiration.

~Candice

A Good Heart "Attack"

I haven't seen Mom a whole lot the last couple of days since she has been more tired in the evenings and going to bed early. The procedure to put the port in went as well as expected and she now sports a bump under her skin where it was installed. I am curious to see how they actually access it when she has her chemo treatment. She remains in good spirits and was delighted by the "heart attack" consisting of lots and lots of colorful hearts attached all over the front of the house - decorated by little ones in Primary and hung up by a couple of church "angels." These are the things that consistently put a smile on Mom's face.

I have also included a link below to a feature on famous people who have been affected by ovarian cancer that I found on aol.com today. I was shocked to hear that Olympic gymnast Shannon Miller has been diagnosed and treated for ovarian cancer. Check it out :) http://www.huffingtonpost.com/2012/03/22/celebrities-ovarian-cancer_n_1370768.html?ref=healthy-living

~Candice

Port Tomorrow, Chemo Monday

Hi everyone, this will be pretty quick but Mom has been scheduled to go in tomorrow (Tuesday March 20th) and have a "port" installed (click here for more information) which is a less painful way for the nurses to administer the chemo as well as any other IV treatment she may require while she undergoes her chemotherapy. She is currently scheduled to receive her first treatment of chemo on Monday, March 26th. She seemed a bit relieved to have it set up for Monday as this means she has a few more days to get everything in order before feeling icky. Keep her in your prayers :).

~Candice

St. Patty's Day Treat

On Lisa's last day in town Saturday, the girls all met up at a family favorite restaurant in Scottsdale called Los Olivos. The lunch bunch included my Mom, Traci, Lisa, Marsha, Grammy (Charlene), Great Grandma (Ann), Delaney, Mia and me. It was a beautiful, sunshiny day with Spring Training fans milling all over downtown Scottsdale and our crazy bunch joking, laughing, reminiscing and just enjoying each others' company. What I enjoyed most was watching everyone interact and knowing that those moments of simple happiness are the moments that will help mom get through her upcoming treatment. And since pictures are worth a thousand words, I will spare everyone the additional words and give you the pictures from the fun afternoon.

As for the treatment schedule, Mom will be starting chemo this week, no later than Friday. I will post more when I know more. It is likely that she will go in and have a "port" put in near her collarbone to make it easier and less painful for the nurses to administer the chemo drugs as well as any other IV treatment she may need as she is going through the process. I will be sure and update everyone when I have additional information.

~Candice

Mom's Personal Blog

I wanted to be sure and point out that mom has her personal blog at http://grammytammys.blogspot.com/ and it's a great place to hear what she is up to and what she is thinking about. There are some great recent posts as well as photos - some I hadn't even seen yet :). You can always visit her blog by clicking on the link to the right that says "Grammy Tammy's Family and Friends."

~Candice

Photos from Today

Decision Time

Mom had her appointment today with her gynecological oncologist. She walked into the office with an entourage of 5 additional people which included me, my two brothers, my grandfather and cousin Lisa. As usual, everyone made friends in the waiting room before Mom was called back for her appointment. The doctor looked over her incision and then the family was called back into a room where the doctor would give his recommendation for treatment based on the pathology results. Here are some of the things that the doctor confirmed and the general treatment recommendation he gave Mom today:

1. He confirmed that she has Stage 3C ovarian cancer (Click here to learn more)
2. He said the cancer is grade 3 (Click here to learn more)
3. He indicated that the cancer was "optimally debulked" which means that he was able to remove the majority of her cancer during surgery. While he removed the most possible, he was not able to remove absolutely all of the disease.
4. He is recommending that she receive a weekly dose of Taxol (Click here to learn more)
5. He recommends that she receive a dose of Carboplatin every 3 weeks (Click here to learn more)
6. In addition to the above drugs, he would also recommend that Mom receive a dose of Avastin every three weeks if insurance will cover it. While he has seen some promising things in his research using Avastin, it is not a drug that is routinely used to treat ovarian cancer. (Click here to learn more)
7. The doctor recommends that Mom start the chemotherapy treatment next week (Thursday or Friday 3/22 or 3/23)
8. As part of her treatment, mom will meet with a team of specialists ranging from a genetic counselor, dietitian, etc.
9. Mom will still need 4 weeks for her major surgery to be healed.
10. She may be able to start driving in 2 weeks

So, there it is. This is what her doctor recommends. That being said, Mom has an appointment set up for tomorrow afternoon with a nutritionist she has been seeing for a year to discuss natural options for treatment/overall health and nutrition. Chaz also is working on gathering information he has found about effectiveness and dosing of cannabis treatment should she decide she wants to try something else. Her feeling right now is that she will have to make the decision that she feels is right for her based on all of the information she gathers and how she feels after fasting and praying about it as well.

This is not a decision she is taking lightly, and as cousin Detlef emphasized to her (he is currently battling Leukemia), it is important for her to be her own biggest advocate with regard to her care, health and well-being. Everyone can have an opinion, but ultimately it is her health and her decision how she will battle this cancer. She has a lot to think about this weekend and we are all supporting her by offering our insights, listening to her wants and needs, doing research and talking about it. There's definitely a lot of talking going on around here! Lisa will be here until Saturday night and I know she will play an integral role in helping Mom talk through all of her concerns, ideas and feelings about her treatment options. It's been a blessing have her here today :).

If you have questions, I suggest posting the question to the comments area and I will do my best to answer questions when I get home from work at night.

~Candice

The Calm Before the Storm

Tonight I got home from work and then drove with my mom to pick up my aunt Lisa, the chemo nurse I mentioned in the last post when she arrived tonight. While we drove, Mom and I had a chance to chat about a few things. One of these things revolved around a sense of peace that she reports feeling and that I also feel as we head toward Mom's cancer battle and the doctor's appointment that she has tomorrow morning where we will learn a lot more about the treatment plan and details. Now, I haven't been with her 24/7, but I have yet to see her breakdown and seem depressed during the past couple of weeks. There really has been a sense of peace and a sense that "everything is going to be ok" that has helped her and everyone in our family move forward each day, laughing, smiling and ready to do whatever needs to be done to keep Mom cancer free and as healthy as ever before.

I think of this time as the calm before the storm. We know the storm is coming and that Mom will need everyone at the ready, but for now we are stocking up our storehouses with good discussions, silly jokes, touching sentiments, action plans and strengthened faith - of all varieties. These are the things that I hope Mom can hang on to as she tackles the cancer and puts her body through the wringer with whatever treatment plan she chooses. And I know that while some of us may be physically closer to her than others, all of the people who are praying and sending healing energy to Mom right now are touching her through a mutual connection to the Spirit and through the hands of those who are helping Mom on a day-to-day basis. I have no doubt that these blessings will continue to manifest as she starts and finishes this cancer treatment.

As always, thanks for reading and thank you for the love and support. This is what keeps Mom holding her head high and knowing she is going to be ok through all of this.

~Candice

Blessings, Big and Small

Today's theme in the house has revolved around recognizing, receiving and appreciating the many blessings we have experienced as a family this past week and a half. I have had a few of my own - coincidences and conversations that give me goosebumps because they provided an unexpected support, timely answer to a struggle or just the right words at just the right time.

Mom shared an experience she had today as she called in to book a flight for my aunt Lisa. She knew the flight was last-minute and that it wouldn't come cheap. But instead of just doing it online, she called in and got a person on the other end of the phone. After giving the woman her information, the rep asked if she was Tammy Call from Las Vegas, NV. Surprised, mom replied that yes she is and discovered that the customer service rep was a long-time friend from Las Vegas who has been following mom's progress form the very beginning. She wasn't sure what she would be able to do so last minute, but somehow found a fare at the lowest price possible. Unbelievable! Such coincidences keep cropping up for us - it's crazy.

And then, my sister Kristen was called in and presented with a card from her boss and inside it included several hundred dollars worth of travel vouchers for her to be able to fly out to Phoenix and be with her family when she needs it. All of her team of 9 contributed and the gesture was above and beyond what she expected.

We are truly being looked after and cared for in our time of need, Thank you to everyone for your love and support :)

Know the Signs of Ovarian Cancer

When you research ovarian cancer, it is often referred to as "silent" because the symptoms are not overly alarming, or it may be easy to explain them away as the flu, or having eaten too much, etc. While not every woman who is diagnosed with ovarian cancer experiences these symptoms, it is important to know that there are symptoms and the earlier a woman is diagnosed, the better the general prognosis. And from what I have read, the "bladder troubles" often include frequent urination.

~Candice  

Evening Concert

Tongiht sleep evades me...and I listen to the music of Mike Ericksen sipping grape juice.  It is so peaceful!  Savoring the moment...

Back in the Saddle Again!

Okay so I am home "sleeping", or "sleep typing" as the case may be!  :)

I am really giving it my best shot at laying around, but somehow I just don't think I was designed to lounge around...even if it is doctor ordered!  So I thought I could add to the blog quickly and then make another attempt at "resting". 

(Note to doctor...pain killers just make it more tempting to move for some people)

Hello its me!  :)

Tomorrow I am going to get down to the business of "taking care of business"...paying bills, doing a little business follow up, setting up FMLA, deciding exactly how I want to fight this beast called cancer, etc.  Today...I am just going to be!

This morning I went to church.  The topic of discussion was agency and choice.  Its kind of ironic that many people believe that the Mormons are a large group of "followers"...today all that was encouraged was exercising agency, to discover, to think!  If anything we are encouraged to think and decide for ourselves.  This is God's plan for us...to act as Free Agents.  We literally have a choice...to follow the guy in red (or at least that is how they depict him)...making no choices, or to follow the Savior and make choices, knowing we will make mistakes, that we will be bumped, bruised, and broken in the journey in need of repentance.  Bottom line...life  = choices!

As I told my good friend Mr. Passman today via email, Today I choose to FIGHT!  I am so very grateful for the ability and the right to choose!

I thank you all for loving me and my family and supporting us in this journey.

Home Sweet Home

Mom is now home and sleeping peacefully. She is regaining her appetite and wanted some lo mein noodles and shrimp. Not sure how much she was actually able to eat, but it's good to hear that food is beginning to sound appealing now. The doctor said that she may attend church in the morning if she is feeling up to it so she may be there, or she may not. We will see how the night goes and how she feels in the morning. She is just thrilled to be home and in her own bed!

For now I think it's best to wait and see how she does at home before having visitors. I will post here when she feels like it would be ok. Then we can work on scheduling people at good times :). And now that she is here with all of her flowers - the house smells amazing!

~Candice

Please No Visitors Saturday 3/10/12

Mom called this morning and asked that I request no visitors today - for good reason! Her doctor stopped by to see her last night, he had been in Chicago meeting with a group of other gynecological oncologists from around the country. He is pleased with how she is doing and said that she may be able to be released today. Mom is requesting no visitors so she can focus her energy on getting out of the hospital today if possible.

So, pray for her and I will let everyone know what happens! :)

~Candice

Pictures!! 3-9-12

Mom took a shower tonight and got spiffied up so I asked if she would approve of some photos and she obliged :). Cam and Chaz stopped by for a very short visit so we took the opportunity for a photo op. Enjoy!

~ Candice

Feeling Better But Still Resting - March 9, 2012 Update

I am at the hospital right now with Mom and she is doing better than she was yesterday and the day before. Today she has been up and has walked around and she even went outside for 2 walks today. Hooray for fresh air! And the weather was accommodating as well - I think the high today was about 72 and the sun was shining. She still has not been cleared to come home. The doctors want to make sure she is healthy and she is meeting digestive and breathing milestones before they give her the green light to come home.

As for other updates, Grammy (Charlene) was telling me that Mom will likely be on chemo for about six months. This will require her to go in once a week for the chemo to be administered. I don't know much more about that just yet but I will add info as I have it. She looks good today and it was nice to be able to see her after being at work for a few days. The flowers in her room really are beautiful and the blessings just keep rolling in . . . many thanks to everyone for your well wishes, flowers and acts of kindness. We appreciate it all very much :).

~Candice

Update: March 8, 2012 Doctor's Orders: R&R

Hi everyone,

It's late but I wanted to update everyone on what is happening today. As the title indicates, Mom's doctor has given her orders to rest and relax in order to heal so no more visitors for the time being. Her facebook posts pretty much tell it all, "Few will be surprised....seems I did a little too much yesterday and am now running a fever compliments of a touch of pneumonia....what does this mean in lay man's terms? I get another day at St Joes and of course...... Finally.....Official confirmation that I am HOT! ;)." Then, a couple hours later, "I feel like I am back in high school...just got chastised by my surgeon for being "too social".....I have bee cut off from holding events in my room. I am no longer the hostesses with the mostess....turning off my phone for awhile also.....R&R time.... Let the antibiotics flow!"

So, as she said, she has turned off her phone and will be resting more until the fluid in her lungs and the pneumonia clear up. She did walk around the floor 5 times today so that is good physical progress but it is important for her to take time to rest and that is what she's doing. In fact, for those of you who know her dad, Ralph, he is on a personal mission to ensure that the doctor's orders are followed. When Traci (her sister) dropped in tonight, he made certain that she didn't overstay her welcome or pose an additional social burden on Mom. His love for her is inspiring.

Cameron's update earlier also cracked me up, "walked around the hospital floor 5 times - still stubborn as can be." Indeed, this stubbornness is likely to be one of her greatest assets in this fight. 

Finally, Mom asked me to please let everyone know how much she appreciates the prayers, flowers, phone calls, cards and other demonstrations of love and support. It has been the foundation for her high spirits and feelings of peace and comfort during this time. Thank you all!

And just so everyone knows - I am back to work and am unable to answer many calls or text messages during my work hours because I am on the phone all day long. I will do my best to update here every night - I appreciate your patience with me as well. Thanks again everyone :)

~Candice

Update: Wednesday March 7th, 2012

I have been busy getting the blog set up but I wanted to include a quick update for everyone who is wondering how my Mom is doing today. I talked to my siblings who were able to visit with her today and I was told that she looks good today - she had a shower and took three walks. She is in high spirits and so far there is no additional information as to next steps. We know that she should be starting chemo in about three weeks, however. She will have an appointment with the doctor next week and he will go over the treatment plan then as we understand. From what we heard the other day, she could be coming home on Friday.

She has received tons of beautiful flower bouquets and many phone calls, emails and messages on facebook. Each little note, message, call, etc. puts a smile on her face. We have been humbled by the outpouring of love and support. She is grateful for every single gesture of love and support :).

Love,
Candice

The Beginning of Tammy's Journey Battling Ovarian Cancer

On Monday, March 5, 2012 my Mom, Tammy was diagnosed with Stage 3C ovarian cancer. She had both of her ovaries removed, the omentum removed and a significant portion of her lower intestine removed to rid her of the cancerous tumors. She was surrounded by family as she went into surgery and she was surrrounded  by family as she awoke after surgery. In the course of one night I sent close to 200 text messages to friends and family near and far, updated Facebook repeatedly, and my mom asked about people by name to make sure they had all received notification. Kristen (my sister) flew in from California and Mom also had her sons Cameron and Chaz, myself (Candice) as well as her sister Traci and her parents by her side. In the midst of the chaos, uncertainty and pain, my mom was surrounded by a physical representation of the greater support network that surrounds her right now as she battles this terrible illness.

For those who are reading this blog and who don't know much about ovarian cancer (as none of us did a week ago!) here is some information that I have found useful as I have researched the diagnosis and tried to make sense of the whys behind something like this. I will use this blog as the central place to update everyone on mom's progress and condition. As it stands right now, the doc has said that she will be in the hospital until around Friday when she may be released to come home :
http://www.ovariancancer.org/about-ovarian-cancer/introduction/
Overview

Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries (women’s reproductive glands that produce ova). Cancer that spreads to the ovaries but originates at another site is not considered ovarian cancer. 

Ovarian tumors can be benign (noncancerous) or malignant (cancerous). Although abnormal, cells of benign tumors do not metastasize (spread to other parts of the body).  Malignant cancer cells in the ovaries can metastasize in two ways:  directly to other organs in the pelvis and abdomen (the more common way), through the bloodstream or lymph nodes to other parts of the body.
While the causes of ovarian cancer are unknown, some theories exist: Genetic errors may occur because of damage from the normal monthly release of an egg. Increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.

Types of Ovarian Cancer

Different types of ovarian cancer are classified according to the type of cell from which they start.
Epithelial tumors – About 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers the ovaries. This form of ovarian cancer generally occurs in postmenopausal women.
Germ cell carcinoma tumors –Making up about five percent of ovarian cancer cases, this type begins in the cells that form eggs. While germ cell carcinoma can occur in women of any age, it tends to be found most often in women in their early 20s. Six main kinds of germ cell carcinoma exist, but the three most common types are: teratomas, dysgerminomas, and endodermal sinus tumors. Many tumors that arise in the germ cells are benign.
Stromal carcinoma tumors – Ovarian stromal carcinoma accounts for about five percent of ovarian cancer cases. It develops in the connective tissue cells that hold the ovary together and those that produce the female hormones estrogen and progesterone. The two most common types are granulosa cell tumors and sertoli-leydig cell tumors. Unlike with epithelial ovarian carcinoma, 70 percent of stromal carcinoma cases are diagnosed in Stage I.

Stages of Ovarian Cancer

The stages of ovarian cancer are determined by how far the cancer has spread. The stage of ovarian cancer at diagnosis is the most important indicator of prognosis.
Stage I – Cancer is limited to one or both ovaries.
IA – Cancer is limited to one ovary and the tumor is confined to the inside of the ovary. No ascites containing malignant cells is present, and the surface of the tumor has not ruptured.
IB – Cancer is limited to both ovaries without any tumors on the ovaries’ outer surfaces. No ascites containing malignant cells is present, and the surface of the tumor has not ruptured.
IC – The tumor is classified as either Stage IA or IB and one or more of the following conditions exist:
a tumor on the outer surface of one or both ovaries;
at least one ruptured tumor;
ascites or abdominal (peritoneal) washings containing malignant cells.
Stage II – The tumor involves one or both ovaries and extends to other pelvic structures.
IIA – The cancer has extended to and/or involves the uterus and/or the fallopian tubes.
IIB – The cancer has extended to the bladder or rectum.
IIC – The tumor is classified as either Stage IIA or IIB and one or more of the following conditions exist:
a tumor on the outer surface of one or both ovaries;
at least one ruptured tumor;
ascites containing malignant cells or abdominal (peritoneal) washings containing malignant cells.
Stage III – The tumor involves one or both ovaries, and one or both of the following exist:

• The cancer has spread beyond the pelvis to the lining of the abdomen;
• The cancer has spread to the lymph nodes. The tumor is limited to the true pelvis but with histologically-proven malignant extension to the small bowel or omentum (peritoneum fold).

IIIA – The tumor is in one or both of the ovaries. While surgeons cannot see cancer in the abdomen, and the cancer has not spread to the lymph nodes, biopsies checked under a microscope reveal tiny deposits of cancer in the abdominal (peritoneal) surfaces.
IIIB – The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but do not exceed two cm in diameter. The cancer has not spread to the lymph nodes.
IIIC – The tumor is visible in one or both ovaries, and one or both of the following conditions exists:

• the cancer has spread to lymph nodes;
• the deposits of cancer exceed two cm in diameter and are found in the abdomen.

Stage IV- Growth of the cancer involves one or both ovaries and distant metastases to the liver or lungs have occurred. Finding ovarian cancer cells in the excess fluid accumulated around the lungs (pleural fluid) also shows evidence of stage IV.