Radiation Oncology/Ovary/Staging

Ovarian Cancer Staging

FIGO (2014)
2014 FIGO staging
 * Ovarian cancer staging is by FIGO staging system and uses information obtained after surgery, which should include a total abdominal hysterectomy, removal of (usually) both ovaries, pelvic (peritoneal) washings for cytology, and biopsies (omentum, mesentery, diaphragm, peritoneal surfaces, pelvic and para-aortic nodes)
 * Also includes primary peritoneal carcinoma

Primary Tumor: (FIGO stage in parentheses)
 * I - limited to one or both ovaries
 * IA - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
 * IB - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
 * IC - tumor limited to ovaries with any of the following: surgical spill (IC1), capsule ruptured or tumor on ovarian surface (IC2), positive washings (IC3)
 * II - pelvic extension or primary peritoneal cancer
 * IIA - extension or implants onto uterus or fallopian tube
 * IIB - extension or implants onto other pelvic structures
 * III - microscopic peritoneal implants outside of the pelvis or positive LN
 * IIIA
 * IIIA1 - retroperitoneal lymph nodes; IIIA1(i) - &le; 10 mm; IIIA1(ii) - > 10 mm
 * IIIA2 - microscopic peritoneal metastases beyond pelvis (w/ or w/o positive LN)
 * IIIB - macroscopic peritoneal metastases beyond pelvis &le; 2cm (w/ or w/o positive LN). Includes extension to capsule of liver or spleen.
 * IIIC - peritoneal metastases beyond pelvis > 2 cm (w/ or w/o positive LN). Includes extension to capsule of liver or spleen.
 * IV - distant metastases
 * IVA - pleural effusion with positive cytology
 * IVB - hepatic or splenic parenchymal metastases, extra-abdominal metastases, or distant LNs (inguinal LN, or LNs outside of abdominal cavity)

Changes from from AJCC 7th Edition:
 * Substaging of IC into IC1-3. Removed stage IIC. Positive lymph nodes are IIIA (previously IIIC). IIIA subdivided into IIIA1(i-ii) and IIIA2. IV subdivided into IVA and B. Inguinal lymph nodes are Stage IV (all LNs previously IIIC).

AJCC 7th Edition (2009)

 * Ovarian cancer staging is by FIGO staging system and uses information obtained after surgery, which should include a total abdominal hysterectomy, removal of (usually) both ovaries, pelvic (peritoneal) washings for cytology, and biopsies (omentum, mesentery, diaphragm, peritoneal surfaces, pelvic and para-aortic nodes)
 * The AJCC stage is the same as the FIGO stage
 * Also includes primary peritoneal carcinoma

Primary Tumor: (FIGO stage in parentheses)
 * T1 (I) - limited to one or both ovaries
 * T1a (IA) - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
 * T1b (IB) - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
 * T1c (IC) - tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
 * T2 (II) - pelvic extension or implants
 * T2a (IIA) - extension or implants onto uterus or fallopian tube; negative washings
 * T2b (IIB) - extension or implants onto other pelvic structures; negative washings
 * T2c (IIC) - pelvic extension or implants (T2a or T2b) with positive peritoneal washings
 * T3 (III) - microscopic peritoneal implants outside of the pelvis
 * T3a (IIIA) - microscopic peritoneal metastases beyond pelvis
 * T3b (IIIB) - macroscopic peritoneal metastases beyond pelvis less than 2cm in size
 * T3c (IIIC) - peritoneal metastases beyond pelvis > 2 cm. (lymph node metastasis is also IIIC for FIGO)

Regional Lymph Nodes: includes pelvic, para-aortic, inguinal, retroperitoneal
 * N0 - no
 * N1 (IIIC) - yes

Distant Metastases:
 * M0 - no
 * M1 (IV) - yes

Stage Grouping:
 * Follows FIGO staging above (in parentheses). T3c and N1 are both IIIC.
 * Note: primary peritoneal tumors are usually either Stage III or IV
 * Note: seeding of the liver capsule is Stage III but liver parenchymal mets are Stage IV.

Older staging systems
AJCC 6th Edition (2002)


 * Same as 7th Edition, except primary peritoneal carcinoma is always metastatic (M1) at diagnosis