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 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 following should be considered when evaluating the tumor:
  • Is it primary or secondary
  • Involvement of both ovaries or ovarian tube
  • Involvement of 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 cancer, fallopian tube cancer, and peritoneal carcinoma with large variations based on the histologic subtypes
• 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 lymph 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)