Radiation Oncology/Ovary/Staging

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Ovarian Cancer Staging


FIGO (2014)[edit]

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) - ≤ 10 mm; IIIA1(ii) - > 10 mm
      • IIIA2 - microscopic peritoneal metastases beyond pelvis (w/ or w/o positive LN)
    • IIIB - macroscopic peritoneal metastases beyond pelvis ≤ 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)[edit]

  • 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[edit]

AJCC 6th Edition (2002)

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