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) |
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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) |
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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) |
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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
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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:
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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
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Stage IC2: (T1C2-N0-M0) Capsule ruptured before surgery, or tumor on ovarian or fallopian tube surface
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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 .
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Stage IIA: (T2a-N0-M0) Extension and/or implants on the uterus and/or ovaries and/or fallopian tubes
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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:
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Stage IIIA1: (T1/2-N1-M0) Positive (cytologically or histologically proven) retroperitoneal lymph nodes only
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Stage IIIA1(i) Metastasis up to 10 mm in greatest dimension
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Stage IIIA1(ii) Metastasis more than 10 mm in greatest dimension
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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:
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Stage IVA: Pleural effusion with positive cytology
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Stage IVB: Parenchymal metastases and metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity)
Questions & Answers
Overview
What are the FIGO criteria for stage I cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IA cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IB cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IC cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage II cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage III cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IIIA cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IIIB cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IIIC cancer of the ovary, fallopian tube, and peritoneum?
What are the FIGO criteria for stage IV cancer of the ovary, fallopian tube, and peritoneum?