Ovarian cancer (staging)

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Ovarian cancer ~~staging~~(staging)

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

CT is considered the best imaging modality for staging ovarian cancer. ⁴.

stage I: tumour limited to the ovary 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 involves both ovaries and fallopian tubes; otherwise similar to Ia
    - capsule intact
    - no tumour on ovarian surface
    - no malignant cells in ascites or peritoneal washings
- stage Ic:
  - tumor involves 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
- 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): metastasic retroperitoneal node measuring ≤10 mm
    - stage IIIa1(ii): metastasic retroperitoneal node measuring >10 mm
  - stage IIIa2: microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
- stage IIIb: macroscopic peritoneal metastasis beyond the pelvis up ≤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 metastasis to the retroperitoneal lymph nodes
  - includes extension of tumor 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)

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