Ovarian germ cell tumor staging

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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.

Staging

Ovarian germ cell tumor is surgically staged using the FIGO and TNM cancer staging system:

Tumor size	FIGO stage	Finding
T1	I	Growth limited to the 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 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	IIIa	Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery
T3b	IIIb	Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative
T3c	IIIc	Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive regional lymph nodes
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.
Tumor size	FIGO stage	Finding
T1	I	Growth limited to the 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 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	IIIa	Tumor grossly limited to the true pelvis, with negative nodes, but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery
T3b	IIIb	Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative
T3c	IIIc	Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive regional lymph nodes
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

• 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