Ovarian cancer (staging)

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

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

• stage I:  tumor limited to the ovaries

  • stage Ia: 

    • ​tumor limited to one ovary

    • capsule intact

    • no tumor on ovarian surface

    • no malignant cells in ascites or peritoneal washings

  • stage Ib: 

    • ​tumor involves both ovaries; otherwise similar to stage Ia

      • capsule intact

      • no tumor 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/intraoperative spill

      • stage Ic2: capsule ruptured before surgery, or tumor on ovarian or fallopian tube surface

      • stage Ic3: malignant cells in the ascites or peritoneal washings

• stage II: tumor 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: tumor 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 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)

Notes:

• bilateral ovarian tumors 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

See also

• endometrial cancer staging

• cervical cancer staging

• choriocarcinoma staging

• tubal cancer staging

• vaginal cancer staging

• vulval cancer staging

• FIGO staging system