Ovarian cancer (staging)

Last revised by David Luong on 13 Mar 2022

Citation, DOI, disclosures and article data

Citation:

Radswiki T, Luong D, Weerakkody Y, et al. Ovarian cancer (staging). Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-13249

DOI:

https://doi.org/10.53347/rID-13249

Permalink:

https://radiopaedia.org/articles/13249

rID:

13249

Article created:

18 Mar 2011, The Radswiki ◉

Disclosures:

At the time the article was created The Radswiki had no recorded disclosures.

View The Radswiki's current disclosures

Last revised:

13 Mar 2022, David Luong ◉

Disclosures:

At the time the article was last revised David Luong had no recorded disclosures.

View David Luong's current disclosures

Revisions:

13 times, by 10 contributors - see full revision history and disclosures

Systems:

Gynaecology, Oncology

Sections:

Staging

Tags:

figo, cases, ovarian, ovary, ovarian cancer, staging

Synonyms:

Staging of ovarian cancer
Staging of ovarian neoplasms

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 ovaries
- stage Ia:
  - tumour limited to one ovary
  - capsule intact
  - no tumour on ovarian surface
  - no malignant cells in ascites or peritoneal washings
- stage Ib:
  - tumour involves both ovaries; otherwise similar to stage Ia
    - capsule intact
    - no tumour on ovarian surface
    - no malignant cells in ascites or peritoneal washings
- stage Ic:
  - tumour involves one or both ovaries, with any of the following:
    - stage Ic1: surgical/intraoperative 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): metastatic retroperitoneal node measuring ≤10 mm
    - stage IIIa1(ii): metastatic 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 tumour 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 tumour 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 extra-pelvic 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