Ovarian cancer staging
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Staging
- Ovarian cancer staging is by the International Federation of Gynecology and Obstetrics (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.
- The staging system is based on the surgical information about the tumor, lymph nodes, and metastasis.
- The tumor evaluation is based on:
- Is it primary or secondary
- Involve both ovaries or ovarian tube
- Involve ovarian surface and hence, expose peritoneum to the tumor cells
- Rupture of the capsule
- Presence of dense adhesions
- The staging system is the same for ovarian, fallopian tube, and peritoneal carcinoma with large variations based on the histologic subtypes[1]
- To achieve better outcome, the surgical staging procedure should be operated by gynecologist oncologist.
| Stage | Definition |
| I | Tumor confined to ovaries or fallopian tubes |
| 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 |
| 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 |
| 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) |
References
- ↑ Prat J, FIGO Committee on Gynecologic Oncology (2014). "Staging classification for cancer of the ovary, fallopian tube, and peritoneum". Int J Gynaecol Obstet. 124 (1): 1–5. doi:10.1016/j.ijgo.2013.10.001. PMID 24219974.