Ovarian Cancer Staging 

Updated: Sep 03, 2019
  • Author: Shannon M Grabosch, MD; 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, 4]

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 subcategories below (IC1-3)

T1c1

IC1

Surgical spill

T1c2

IC2

Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface

T1c3

IC3

Malignant cells in ascites or peritoneal washings

T2

II

Tumor involves one or both ovaries with pelvic extension below pelvic brim

T2a

IIA

Extension and/or implants on the uterus and/or tube(s)

T2b

IIB

Extension to and/or implants in other pelvic tissues

T3 III Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or retroperitoneal lymph node involvement

T3a

IIIA2

Microscopic peritoneal metastasis beyond the pelvis with or without positive retroperitoneal lymph nodes

T3b

IIIB

Macroscopic peritoneal metastasis beyond the pelvis 2 cm or less in greatest dimension with or without positive retroperitoneal lymph nodes

T3c

IIIC

Macroscopic peritoneal metastasis beyond the pelvis >2 cm in greatest dimension including extension to liver capsule or spleen without parenchymal involvement of those organs and with or without positive retroperitoneal lymph nodes

Regional lymph nodes (N)

TNM

FIGO

 

NX

 

Regional lymph nodes cannot be assessed

N0

 

No regional lymph node metastasis

N0(i+)

 

Isolated tumor cells in regional lymph node(s) ≤0.2 mm

N1

IIIA1

Positive (histologically confirmed) retroperitoneal lymph nodes

N1a

IIIAIi

Metastasis ≤10 mm in greatest dimension

N1b

IIIAIii

Metastasis more than 10 mm in greatest dimension

Distant metastasis (M)

TNM

FIGO

 

M0

 

No distant metastasis

M1

IV

Distant metastasis including cytology-positive pleural effusion; liver or splenic parenchymal involvement; extra-abdominal organ involvement including inguinal lymph nodes; transmural intestinal involvement

M1a

IVA

Pleural effusion with positive cytology

M1b

IVB

Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine

 

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

FIGO staging criteria and equivalent TNM classifications are listed below. [4]

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)
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