Ovarian cancer (staging)
Updates to Article Attributes
Body
was changed:
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.
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stage I: tumour limited to the
ovary or fallopian tubeovaries-
stage Ia:
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tumour limited to one ovary
or fallopian tube - capsule intact
- no tumour on ovarian surface
- no malignant cells in ascites or peritoneal washings
-
tumour limited to one ovary
-
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
-
tumour involves both ovaries
-
stage Ic:
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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
-
tumor involves one or both ovaries, with any of the following:
-
stage Ia:
-
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
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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
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stage IIIa: positive retroperitoneal lymph nodes and /or microscopic metastasis beyond the pelvis:
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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
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stage IIIa1: positive (cytologically or histologically proven) retroperitoneal lymph nodes only
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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
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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
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stage IIIa: positive retroperitoneal lymph nodes and /or microscopic metastasis beyond the pelvis:
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stage IV: consists of distant metastasis, excluding peritoneal metastases, and includes the following:
- stage IVa: pleural effusion with positive cytology
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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
-<strong>stage I: </strong> tumour limited to the ovary or fallopian tube<ul>- +<strong>stage I: </strong> tumour limited to the ovaries<ul>
-<strong></strong>tumour limited to one ovary or fallopian tube</li>- +<strong></strong>tumour limited to one ovary</li>
-<strong></strong>tumour involves both ovaries and fallopian tubes; otherwise similar to Ia<ul>- +<strong></strong>tumour involves both ovaries; otherwise similar to Ia<ul>