Ovarian germ cell tumor staging: Difference between revisions
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{{CMG}}{{AE}} {{Sahar}} {{MD}} | {{CMG}}{{AE}} {{Sahar}} {{MD}} | ||
==Overview== | ==Overview== | ||
According to the [[FIGO]] and [[TNM]] [[cancer staging]] system, there are 4 [[stages]] of [[ovarian]] [[germ cell]] [[tumor]]. | According to the [[FIGO]] and [[TNM]] [[cancer staging]] system, there are 4 [[stages]] of [[ovarian]] [[germ cell]] [[tumor]]. [[Surgery]] is the mainstay of staging for [[ovarian]] [[germ cell]] [[tumors]]. | ||
==Staging== | ==Staging== | ||
Ovarian germ cell tumor is surgically staged using the [[International Federation of Gynecology and Obstetrics|FIGO]] and TNM [[cancer staging]] system:<ref name="mmm">Stage Information for Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_8. URL Accessed on November 5, 2015</ref><ref name="Prat2014">{{cite journal|last1=Prat|first1=Jaime|title=Staging classification for cancer of the ovary, fallopian tube, and peritoneum|journal=International Journal of Gynecology & Obstetrics|volume=124|issue=1|year=2014|pages=1–5|issn=00207292|doi=10.1016/j.ijgo.2013.10.001}}</ref> | [[Ovarian]] [[germ cell]] [[tumor]] is [[Surgery|surgically]] staged using the [[International Federation of Gynecology and Obstetrics|FIGO]] and [[TNM classification|TNM]] [[cancer staging]] system:<ref name="mmm">Stage Information for Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_8. URL Accessed on November 5, 2015</ref><ref name="Prat2014">{{cite journal|last1=Prat|first1=Jaime|title=Staging classification for cancer of the ovary, fallopian tube, and peritoneum|journal=International Journal of Gynecology & Obstetrics|volume=124|issue=1|year=2014|pages=1–5|issn=00207292|doi=10.1016/j.ijgo.2013.10.001}}</ref> | ||
During the [[surgical]] staging, the followings must be evaluated:<ref name="LowIlancheran2012">{{cite journal|last1=Low|first1=Jeffrey J.H.|last2=Ilancheran|first2=Arunachalam|last3=Ng|first3=Joseph S.|title=Malignant ovarian germ-cell tumours|journal=Best Practice & Research Clinical Obstetrics & Gynaecology|volume=26|issue=3|year=2012|pages=347–355|issn=15216934|doi=10.1016/j.bpobgyn.2012.01.002}}</ref> | |||
*[[Peritoneal fluid]] [[cytology]] | |||
*[[Biopsy]] of any suspicious areas on the [[peritoneal]] surfaces | |||
*[[Retroperitoneal]] [[lymph node]] sampling such as: | |||
**[[Pelvic]] | |||
**High [[Paraaortic lymph nodes|para-aortic]] | |||
**Infracolic | |||
{| | {| class="wikitable" | ||
|+ | |||
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Primary tumor | |||
|- | |||
| align="center" style="background:#f0f0f0;" |'''Tumor size''' | | align="center" style="background:#f0f0f0;" |'''Tumor size''' | ||
| align="center" style="background:#f0f0f0;" |'''FIGO stage''' | | align="center" style="background:#f0f0f0;" |'''FIGO stage''' | ||
| Line 14: | Line 25: | ||
|- | |- | ||
| T1 | | T1 | ||
| I||Growth limited to | | I||Growth limited to one or both [[ovaries]], | ||
|- | |- | ||
| T1a | | T1a | ||
| Ia||Growth limited to one [[ovary]]; no [[ascites]] present containing [[malignant]] cells. No [[tumor]] on the external [[Surface anatomy|surface]]; [[capsule]] intact | | Ia||Growth limited to one [[ovary]]; no [[ascites]] present containing [[malignant]] cells. No [[tumor]] on the external [[Surface anatomy|surface]]; [[capsule]] intact | ||
|- | |- | ||
| T1b | | T1b | ||
| Ib||Growth limited to both [[ovaries]]; no [[ascites]] present containing [[malignant]] cells. No [[tumor]] on the external [[Surface anatomy|surfaces]]; [[capsules]] intact | | Ib||Growth limited to one or both [[ovaries]]; no [[ascites]] present containing [[malignant]] cells. No [[tumor]] on the external [[Surface anatomy|surfaces]]; [[capsules]] intact | ||
|- | |- | ||
| T1c | | T1c | ||
| Ic||[[Tumor]] either stage Ia or Ib, but with the [[tumor]] on [[Surface anatomy|surface]] of one or both [[ovaries]], or with [[capsule]] [[Rupture|ruptured]], or with [[ascites]] present containing [[malignant]] cells, or with positive [[peritoneal]] washings | | Ic||[[Tumor]] either stage Ia or Ib, but with the [[tumor]] on [[Surface anatomy|surface]] of one or both [[ovaries]], or with [[capsule]] [[Rupture|ruptured]], or with [[ascites]] present containing [[malignant]] [[cells]], or with positive [[peritoneal]] washings | ||
|- | |- | ||
| T2 | | T2 | ||
| II||Growth involving one or both [[ovaries]] with [[pelvic]] extension | | II||Growth involving one or both [[ovaries]] with [[pelvic]] [[extension]] | ||
|- | |- | ||
| T2a | | T2a | ||
| IIa||Extension and/or [[metastases]] to the [[uterus]] and/or tubes | | IIa||[[Extension]] and/or [[metastases]] to the [[uterus]] and/or tubes | ||
|- | |- | ||
| T2b | | T2b | ||
| IIb||Extension to other [[pelvic]] tissues | | IIb||[[Extension]] to other [[pelvic]] [[tissues]] | ||
|- | |- | ||
| T2c | | T2c | ||
| IIc||[[Tumor]] either stage IIa or IIb, but with the [[tumor]] on [[Surface anatomy|surface]] of one or both [[ovaries]], or with [[Capsule|capsule(s)]] ruptured, or with [[ascites]] present containing [[malignant]] cells, or with positive [[peritoneal]] washings | | IIc||[[Tumor]] either stage IIa or IIb, but with the [[tumor]] on [[Surface anatomy|surface]] of one or both [[ovaries]], or with [[Capsule|capsule(s)]] [[Rupture|ruptured]], or with [[ascites]] present containing [[malignant]] cells, or with positive [[peritoneal]] washings | ||
|- | |- | ||
| T3 | | T3 | ||
| III||[[Tumor]] involving one or both [[ovaries]] with [[histologically]] confirmed [[peritoneal]] implants outside the [[pelvis]] and/or positive regional [[lymph nodes]]. [[Superficial]] [[liver]] [[metastases]] equal stage III. The [[tumor]] is limited to the [[true pelvis]], but with [[histologically]] proven [[malignant]] extension to [[small bowel]] or [[omentum]] | | III||[[Tumor]] involving one or both [[ovaries]] with [[histologically]] confirmed [[peritoneal]] [[implants]] outside the [[pelvis]] and/or positive regional [[lymph nodes]]. [[Superficial]] [[liver]] [[metastases]] equal stage III. The [[tumor]] is limited to the [[true pelvis]], but with [[histologically]] proven [[malignant]] extension to [[small bowel]] or [[omentum]] | ||
|- | |- | ||
| T3a | | T3a | ||
| | | IIIa2||[[Tumor]] grossly limited to the [[true pelvis]] with [[histologically]] confirmed [[microscopic]] seeding of [[abdominal]] [[peritoneal]] [[Surface area|surfaces]], or [[histologic]] proven [[extension]] to [[small bowel]] or [[mesentery]] with or without positive [[retroperitoneal]] [[lymph nodes]] | ||
|- | |- | ||
| T3b | | T3b | ||
| IIIb||[[Tumor]] of one or both [[ovaries]] with [[histologically]] confirmed implants, [[peritoneal]] [[metastasis]] of [[abdominal]] [[peritoneal]] surfaces, none exceeding 2 cm in diameter | | IIIb||[[Tumor]] of one or both [[ovaries]] with [[histologically]] confirmed [[implants]], [[peritoneal]] [[metastasis]] of [[abdominal]] [[peritoneal]] [[Surface area|surfaces]], none exceeding 2 cm in diameter with or without [[extension]] [[metastasis]] to the [[retroperitoneal]] [[Lymph node|lymph nodes]] | ||
|- | |- | ||
| T3c | | T3c | ||
| IIIc||[[Peritoneal]] [[metastasis]] beyond the pelvis >2 cm in diameter | | IIIc||[[Peritoneal]] [[metastasis]] beyond the [[pelvis]] >2 cm in diameter with or without [[metastasis]] to the [[retroperitoneal]] [[lymph nodes]] (includes the [[extension]] of [[tumor]] to the [[capsule]] of [[liver]] and [[spleen]] without [[parenchymal]] involvement of either [[Organ (anatomy)|organ]]) | ||
|- | |- | ||
| AnyT | | AnyT | ||
| IV||Growth involving one or both [[ovaries]] with distant [[Metastasis|metastases]]. If [[pleural effusion]] is present, there must be positive [[cytology]] to allow a case to stage IV. Parenchymal liver metastasis equals stage IV | | IV||Growth involving one or both [[ovaries]] with distant [[Metastasis|metastases]]. If [[pleural effusion]] is present, there must be positive [[cytology]] to allow a case to stage IV. [[Parenchymal]] [[liver]] [[metastasis]] equals stage IV. | ||
|- | |||
|+ | |||
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Regional lymph node involvement | |||
|- | |||
| align="center" style="background:#f0f0f0;" |'''Node involvement''' | |||
| align="center" style="background:#f0f0f0;" |'''FIGO stage''' | |||
| align="center" style="background:#f0f0f0;" |'''Finding''' | |||
|- | |||
| N0 | |||
| ||No [[lymph node]] involvement | |||
|- | |||
| N0(i+) | |||
| ||[[Tumor cell|Tumor cells]] are present in regional [[Lymph nodes|lymph node(s)]], no greater than 0.2 mm | |||
|- | |||
| N1 | |||
| IIIA1||[[Histologically]] confirmed [[Retroperitoneal|retroperitonea]]<nowiki/>l [[lymph nodes]] | |||
|- | |||
| N1a | |||
| IIIA1i||[[Metastasis]] <and= 10 mm in greatest dimension | |||
|- | |||
| N1b | |||
| IIIA1ii||[[Metastasis]] more than 10 mm in greatest dimension | |||
|- | |||
|+ | |||
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Distant metastasis | |||
|- | |||
| align="center" style="background:#f0f0f0;" |'''Presence of metastasis''' | |||
| align="center" style="background:#f0f0f0;" |'''FIGO stage''' | |||
| align="center" style="background:#f0f0f0;" |'''Finding''' | |||
|- | |||
| M0 | |||
| ||No distant [[metastasis]] | |||
|- | |||
| M1 | |||
| IV||Distant [[metastasis]], including positive [[cytology]] of [[pleural effusion]]; [[liver]] or [[splenic]] [[parenchymal]] [[metastasis]]; [[metastasis]] to extra-[[abdominal]] [[organs]] (including [[inguinal lymph nodes]] and [[lymph nodes]] outside the [[abdominal cavity]]); and transmural involvement of [[intestine]] | |||
|- | |||
| M1a | |||
| IVa||[[Pleural effusion]] with positive [[cytology]] | |||
|- | |||
| M1b | |||
| IVb||[[Liver]] or [[splenic]] [[parenchymal]] [[metastases]]; [[metastases]] to extra-[[abdominal]] [[organs]] (including [[inguinal lymph nodes]] and [[lymph nodes]] outside the [[abdominal]] [[Abdominal cavity|cavity]]); transmural involvement of [[intestine]] | |||
|- | |||
|} | |} | ||
*[[TNM staging system|TNM staging]] of [[Ovary|ovarian]] [[germ cell]] [[tumor]]: | *[[TNM staging system|TNM staging]] of [[Ovary|ovarian]] [[germ cell]] [[tumor]]: | ||
Latest revision as of 19:07, 22 March 2019
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Ovarian germ cell tumor Microchapters |
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Ovarian germ cell tumor staging On the Web |
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American Roentgen Ray Society Images of Ovarian germ cell tumor staging |
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Risk calculators and risk factors for Ovarian germ cell tumor staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
According to the FIGO and TNM cancer staging system, there are 4 stages of ovarian germ cell tumor. Surgery is the mainstay of staging for ovarian germ cell tumors.
Staging
Ovarian germ cell tumor is surgically staged using the FIGO and TNM cancer staging system:[1][2] During the surgical staging, the followings must be evaluated:[3]
- Peritoneal fluid cytology
- Biopsy of any suspicious areas on the peritoneal surfaces
- Retroperitoneal lymph node sampling such as:
- Pelvic
- High para-aortic
- Infracolic
| Primary tumor | ||
|---|---|---|
| Tumor size | FIGO stage | Finding |
| T1 | I | Growth limited to one or both ovaries, |
| T1a | Ia | Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact |
| T1b | Ib | Growth limited to one or both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact |
| T1c | Ic | Tumor either stage Ia or Ib, but with the tumor on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings |
| T2 | II | Growth involving one or both ovaries with pelvic extension |
| T2a | IIa | Extension and/or metastases to the uterus and/or tubes |
| T2b | IIb | Extension to other pelvic tissues |
| T2c | IIc | Tumor either stage IIa or IIb, but with the tumor on surface of one or both ovaries, or with capsule(s) ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings |
| T3 | III | Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastases equal stage III. The tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum |
| T3a | IIIa2 | Tumor grossly limited to the true pelvis with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery with or without positive retroperitoneal lymph nodes |
| T3b | IIIb | Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter with or without extension metastasis to the retroperitoneal lymph nodes |
| T3c | IIIc | Peritoneal metastasis beyond the pelvis >2 cm in diameter with or without metastasis to the retroperitoneal lymph nodes (includes the extension of tumor to the capsule of liver and spleen without parenchymal involvement of either organ) |
| AnyT | IV | Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allow a case to stage IV. Parenchymal liver metastasis equals stage IV. |
| Regional lymph node involvement | ||
| Node involvement | FIGO stage | Finding |
| N0 | No lymph node involvement | |
| N0(i+) | Tumor cells are present in regional lymph node(s), no greater than 0.2 mm | |
| N1 | IIIA1 | Histologically confirmed retroperitoneal lymph nodes |
| N1a | IIIA1i | Metastasis <and= 10 mm in greatest dimension |
| N1b | IIIA1ii | Metastasis more than 10 mm in greatest dimension |
| Distant metastasis | ||
| Presence of metastasis | FIGO stage | Finding |
| M0 | No distant metastasis | |
| M1 | IV | Distant metastasis, including positive cytology of pleural effusion; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); and transmural involvement of intestine |
| M1a | IVa | Pleural effusion with positive cytology |
| M1b | IVb | Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine |
- TNM staging of ovarian germ cell tumor:
- M1: Distant metastasis, M1a: Pleural effusion with cytology, M1b: Liver or splenic parenchymal metastases; extra-abdominal metastases; transmural involvement of intestine
| FIGO stage | T | N | M |
| I | T1 | N0 | M0 |
| Ia | T1a | N0 | M0 |
| Ib | T1b | N0 | M0 |
| Ic | T1c | N0 | M0 |
| II | T2 | N0 | M0 |
| IIa | T2a | N0 | M0 |
| IIb | T2b | N0 | M0 |
| IIc | T2c | N0 | M0 |
| III | T3 | N0 | M0 |
| IIIa | T3a | N0/N1 | M0 |
| IIIb | T3b | N0/N1 | M0 |
| IIIc | T3c | N0/N1 | M0 |
| IV | AnyT | AnyN | M1 |
| IVa | AnyT | AnyN | M1a |
| IVb | AnyT | AnyN | M1b |
References
- ↑ Stage Information for Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_8. URL Accessed on November 5, 2015
- ↑ Prat, Jaime (2014). "Staging classification for cancer of the ovary, fallopian tube, and peritoneum". International Journal of Gynecology & Obstetrics. 124 (1): 1–5. doi:10.1016/j.ijgo.2013.10.001. ISSN 0020-7292.
- ↑ Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). "Malignant ovarian germ-cell tumours". Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.