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TNM and FIGO Classifications for Ovarian Cancer
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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)

Questions & Answers

Overview

How is ovarian cancer staged?

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?

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Table. TNM and FIGO Classifications for Ovarian Cancer

Table. TNM and FIGO Classifications for Ovarian Cancer

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

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Author

Shannon M Grabosch, MD Assistant Professor of Gynecologic Oncology, St Louis University School of Medicine

Shannon M Grabosch, MD is a member of the following medical societies: American Association for Cancer Research, American Association of Gynecologic Laparoscopists, American Association of Immunologists, American College of Obstetricians and Gynecologists, American Society of Clinical Oncology, Society for Immunotherapy of Cancer, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Robert P Edwards, MD Professor, Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh School of Medicine; Vice-Chair, Clinical Affairs, Director, Ovarian Cancer Center of Excellence, Magee-Womens Hospital, University of Pittsburgh Medical Center

Robert P Edwards, MD is a member of the following medical societies: American Association for Cancer Research, American College of Obstetricians and Gynecologists, American College of Surgeons, American Medical Association, Society for Reproductive Investigation

Disclosure: Nothing to disclose.

C William Helm, MBBCh, MA, FRCS, FRCS(Edin) Consultant in Gynecologic Oncology

C William Helm, MBBCh, MA, FRCS, FRCS(Edin) is a member of the following medical societies: European Society of Gynaecological Oncology, International Gynecologic Cancer Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Yukio Sonoda, MD Associate Professor, Weill Cornell Medical College; Associate Attending Surgeon, Gynecology Service, Department of Surgery, Memorial Hospital for Cancer and Allied Diseases; Associate Member, Memorial Sloan-Kettering Cancer Center

Yukio Sonoda, MD is a member of the following medical societies: AAGL, American College of Obstetricians and Gynecologists, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, International Gynecologic Cancer Society, Japanese Medical Society of America, Korean American Medical Assocation, Society of Gynecologic Oncology, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.