Ovarian cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Staging

Ovarian cancer staging is by the FIGO staging system and uses information obtained after surgery, which can include a total abdominal hysterectomy, removal of (usually) both ovaries and fallopian tubes, (usually) the omentum, and pelvic (peritoneal) washings for cytology. The American Joint Committee on Cancer (AJCC) stage is the same as the FIGO stage.

• Stage I - limited to one or both ovaries
  • IA - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
  • IB - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
  • IC - tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
• Stage II - pelvic extension or implants
  • IIA - extension or implants onto uterus or fallopian tube; negative washings
  • IIB - extension or implants onto other pelvic structures; negative washings
  • IIC - pelvic extension or implants with positive peritoneal washings
• Stage III - microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum
  • IIIA - microscopic peritoneal metastases beyond pelvis
  • IIIB - macroscopic peritoneal metastases beyond pelvis less than 2 cm in size
  • IIIC - peritoneal metastases beyond pelvis > 2 cm or lymph node metastases
• Stage IV - distant metastases--in the liver, or outside the peritoneal cavity

Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC).

Stage	Definition
I	Tumor confined to ovaries or fallopian tube(s).
IA	Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings.
IB	Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings.
IC	Tumor limited to one or both ovaries or fallopian tubes, with any of the following:
IC1	Surgical spill intraoperatively.
IC2	Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface.
IC3	Malignant cells present in the ascites or peritoneal washings.
II	Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer (Tp).
IIA	Extension and/or implants on the uterus and/or fallopian tubes and/or ovaries.
IIB	Extension to other pelvic intraperitoneal tissues.
III	Tumor involves one or both ovaries, or fallopian tubes, or primary peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside of the pelvis and/or metastasis to the retroperitoneal lymph nodes.
IIIA	Metastasis to the retroperitoneal lymph nodes with or without microscopic peritoneal involvement beyond the pelvis.
IIIA(i)	Positive retroperitoneal lymph nodes only (cytologically or histologically proven).
IIIA(ii)	Metastasis >10 mm in greatest dimension.
IIIA2	Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes.
IIIB	Macroscopic peritoneal metastases beyond the pelvic brim ≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes.
IIIC	Macroscopic peritoneal metastases beyond the pelvic brim >2 cm in greatest dimension, with or without metastases to the retroperitoneal nodes.a
IV	Distant metastasis excluding peritoneal metastases.
IVA	Pleural effusion with positive cytology.
IVB	Metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity).b