Ovarian Cancer Staging 

Updated: May 05, 2016
  • Author: C William Helm, MBBCh, MA, FRCS, FRCS(Edin); Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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TNM and FIGO Classifications for Ovarian Cancer

The tumor-node-metastasis (TNM) and International Federation of Gynecology and Obstetrics (FIGO) classifications for staging ovarian cancer are provided below. [1, 2, 3]

Table. TNM and FIGO Classifications for Ovarian Cancer  (Open Table in a new window)

Primary tumor (T)
TNM FIGO  
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
T1 I Tumor limited to the ovaries (one or both)
T1a IA Tumor limited to one ovary; capsule intact, no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
T1b IB Tumor limited to both ovaries; capsules intact, no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
T1c IC* Tumor limited to one or both ovaries with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings
T2 II Tumor involves one or both ovaries with pelvic extension
T2a IIA Extension and/or implants on the uterus and/or tube(s); no malignant cells in ascites or peritoneal washings
T2b IIB Extension to and/or implants in other pelvic tissues; no malignant cells in ascites or peritoneal washings
T2c IIC* Pelvic extension and/or implants (T2a or T2b) with malignant cells in ascites or peritoneal washings
T3 III* Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis
T3a IIIA* Microscopic peritoneal metastasis beyond the pelvis (no macroscopic tumor)
T3b IIIB* Macroscopic peritoneal metastasis beyond the pelvis 2 cm or less in greatest dimension
T3c IIIC* Macroscopic peritoneal metastasis beyond the pelvis >2 cm in greatest dimension and/or regional lymph node metastasis
Regional lymph nodes (N)
TNM FIGO  
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1 IIIC Regional lymph node metastasis
Distant metastasis (M)
TNM FIGO  
M0   No distant metastasis
M1 IV* Distant metastasis (excludes peritoneal metastasis)
*Changes have been made to FIGO Staging Criteria [2] that have not yet been resolved with the TNM system. FIGO Stage IIC has been eliminated.



Notes:



  • The presence of nonmalignant ascites is not classified; the presence of ascites does not affect staging unless malignant cells are present.
  • Liver capsule metastasis is T3/stage III; liver parenchymal metastasis, M1/stage IV. Pleural effusion must have positive cytology for MI/stage IV.

 

FIGO staging criteria for cancer of the ovary, fallopian tube, and peritoneum

FIGO updated its staging criteria in 2014. [2] The equivalent proposed TNM staging is included for each FIGO stage, although this TNM staging has not yet been formally published.

Stage I

Stage I  (T1-N0-M0) consists of tumor limited to the ovaries or fallopian tubes.

Stage IA  (T1a-N0-M0) includes the following:

  • Tumor limited to one ovary (capsule intact) or fallopian tube
  • No tumor on the external surface of the ovary or fallopian tube
  • No malignant cells in ascites or peritoneal washings

Stage IB (T1b-N0-M0) includes the following: 

  • Tumor limited to both ovaries (capsules intact) or fallopian tubes
  • No tumor on the external surface of the ovaries or fallopian tubes
  • No malignant cells in ascites or peritoneal washings

Stage IC includes tumor limited to one or both ovaries or fallopian tubes, with any of the following:

  • Stage IC1: (T1C1-N0-M0)  Surgical spill
  • Stage IC2: (T1C2-N0-M0) Capsule ruptured before surgery, or tumor on ovarian or fallopian tube surface
  • Stage IC3: (T1C3-N0-M0) Malignant cells in the ascites or peritoneal washings

Stage II

In stage II  (T2-N0-M0) tumor involves one or both ovaries or fallopian tubes, with pelvic extension (below pelvic brim) or primary peritoneal cancer .

  • Stage IIA: (T2a-N0-M0) Extension and/or implants on the uterus and/or ovaries and/or fallopian tubes
  • Stage IIB: (T2b-N0-M0) Extension to other pelvic intraperitoneal tissues

Stage III

In stage III, tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes (T1/T2-N1-M0).

Stage IIIA includes the following:

  • Stage IIIA1: (T1/2-N1-M0) Positive (cytologically or histologically proven) retroperitoneal lymph nodes only
  • Stage IIIA1(i) Metastasis up to 10 mm in greatest dimension
  • Stage IIIA1(ii) Metastasis more than 10 mm in greatest dimension
  • Stage IIIA2: (T3a2-N0/N1-M0) Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes

Stage IIIB (T3b-N0/N1-M0) involves macroscopic peritoneal metastasis beyond the pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes.

Stage IIIC (T3c-N0/N1-M0) involves macroscopic peritoneal metastasis beyond the pelvis more than 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes. Stage IIIC includes extension of tumor to the capsule of liver and spleen without parenchymal involvement of either organ.

Stage IV

Stage IV (any T–any N–M1) consists of distant metastasis, excluding peritoneal metastases, and includes the following:

  • Stage IVA: Pleural effusion with positive cytology
  • Stage IVB: Parenchymal metastases and metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity)