Ovarian cancer (staging)

The most commonly adopted ovarian cancer staging system is the FIGO staging system. The most recent staging system is from 2014 ¹:

This following system has since been revisedCT is considered the best imaging modality for staging ovarian cancer. ³⁴. To be updated soon

• stage I:  tumour limited to the ovariesovary or fallopian tube
  • stage Ia: 
    • ​tumour limited to one ovary; or fallopian tube
    • capsule intact,
    • no tumour on ovarian surface;
    • no malignant cells in ascites or peritoneal washings
  • stage Ib: 
    • ​tumour limited toinvolves both ovaries and fallopian tubes; capsulesotherwise similar to Ia
      • capsule intact,
      • no tumour on ovarian surface;
      • no malignant cells in ascites or peritoneal washings
  • stage Ic: 
    • ​tumor limited toinvolves one or both ovaries, with any of the following: 
      • stage Ic1: surgical/intra-operative spill
      • stage Ic2: capsule ruptured before surgery, or tumour on ovarian or fallopian tube surface
      • stage Ic3: malignant cells in the ascites or peritoneal washings

• stage II: tumour involves one or both ovaries with pelvic extension or primary peritoneal cancer (below pelvic brim)
  • stage IIa: extension or implants on the uterus or fallopian tubes, no malignant ascites/negative peritoneal washings
  • stage IIb: extension to other pelvic intraperitoneal tissues

• stage III: tumour involves one or both ovaries or fallopian tubes with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes
  • stage IIIa: positive retroperitoneal lymph nodes and /or microscopic metastasis beyond the pelvis:
    • stage IIIa1: positive (cytologically or histologically proven) retroperitoneal lymph nodes only
      • stage IIIa1(i): metastasis up to 10metastasic retroperitoneal node measuring ≤10 mm in greatest dimension
      • stage IIIa1(ii): metastasis more than 10metastasic retroperitoneal node measuring >10 mm in greatest dimension
    • stage IIIa2: microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
  • stage IIIb: involves macroscopic peritoneal metastasis beyond the pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
  • stage IIIc: involves macroscopic peritoneal metastasis beyond the pelvis more than 2≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
    • includes extension of tumor to the capsule of liver and spleen
  • stage IIIc: macroscopic extrapelvic peritoneal metastases >2 cm in greatest dimension, with or without parenchymal involvementmetastasis to the retroperitoneal lymph nodes
    • includes extension of either organtumor to the capsule of liver and spleen

• stage IV: consists of distant metastasis, excluding peritoneal metastases, and includes the following:
  • stage IVa: pleural effusion with positive cytology
  • stage IVb:distant metastases
    • parenchymal metastases and metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity)

Notes:

• bilateral ovarian tumours may represent stage I disease, but represent metastases in ~30% of patients ⁵
• one of the potential difficulties in differentiating stage II from stage III disease is differentiating between involvement of pelvic and extrapelvic peritoneum ³
• the majority of ovarian cancers present as stage III ⁶
• presence of metastatic lymph nodes is important, but the number of nodes does not carry prognostic significance ⁷
• the amount of peritoneal involvement carries prognostic significance, but the 2 cm cut off in the staging system is subjective

See also

• endometrial cancer staging
• cervical cancer staging
• choriocarcinoma staging
• tubal cancer staging
• vaginal cancer staging
• vulval cancer staging
• FIGO staging system