Calc Function

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    Patent Pending

    FIGO Staging for Ovarian Cancer (2014)

    Stages cancer of the ovary, fallopian tube, and peritoneum.
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    When to Use
    Pearls/Pitfalls

    Use postoperatively in patients with histologically-proven ovarian cancer (surgical pathology is needed in order to stage).

    • Stage IB (bilateral involvement) is uncommon and only occurs in 1-5% of stage I cases (Heintz 2006). Large stage IB ovarian tumors associated with a contralateral normal‐size ovary with small superficial tumor foci suggest the latter are metastatic (⅓ of stage I tumors with bilateral involvement look like this) (Prat 2013).

    • Controversy exists around whether positive lymph nodes (macroscopic) above the renal vessels should be considered stage III or IV, and are not addressed by the current guidelines.

    Tumor confined to ovaries
    Tumor involves 1 or both ovaries with pelvic extension (below the pelvic brim) or primary peritoneal cancer
    Tumor involves 1 or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes
    Distant metastasis excluding peritoneal metastasis

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Treat according to stage and consideration for patient preferences.

    Formula

    Stage I: Tumor confined to ovaries

    IA

    Tumor limited to 1 ovary, capsule intact, no tumor on surface, negative washings

    IB

    Tumor involves both ovaries otherwise like IA

    IC

    Tumor limited to 1 or both ovaries

    IC1

    Surgical spill

    IC2

    Capsule rupture before surgery or tumor on ovarian surface

    IC3

    Malignant cells in the ascites or peritoneal washings

    Stage II: Tumor involves 1 or both ovaries with pelvic extension (below the pelvic brim) or primary peritoneal cancer

    IIA

    Extension and/or implant on uterus and/or fallopian tubes

    IIB

    Extension to other pelvic intraperitoneal tissues

    Stage III: Tumor involves 1 or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes

    IIIA

    Positive retroperitoneal lymph nodes and/or microscopic metastasis beyond the pelvis

    IIIA1

    Positive retroperitoneal lymph nodes only

    IIIA1(i)

    Metastasis ≤10 mm

    IIIA1(ii)

    Metastasis >10 mm

    IIIA2

    Microscopic, extrapelvic (above the brim) peritoneal involvement ± positive retroperitoneal lymph nodes

    IIIB

    Macroscopic, extrapelvic, peritoneal metastasis ≤2 cm ± positive retroperitoneal lymph nodes; includes extension to capsule of liver/spleen

    IIIC

    Macroscopic, extrapelvic, peritoneal metastasis >2 cm ± positive retroperitoneal lymph nodes; includes extension to capsule of liver/spleen

    Stage IV: Distant metastasis excluding peritoneal metastasis

    IVA

    Pleural effusion with positive cytology

    IVB

    Hepatic and/or splenic parenchymal metastasis, metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity)

    Dr. Jaime Prat

    About the Creator

    Jaime Prat, MD, is an honorary professor at Autonomous University of Barcelona and a senior consultant in pathology at Hospital Sant Pau in Barcelona, Spain. He is also a member of the World Health Organization (WHO) Committee for Classification of Tumors of the Female Genital Tract and the International Federation of Obstetricians and Gynecologists (FIGO). Dr. Prat’s primary research is focused on gynecologic oncology.

    To view Dr. Jaime Prat's publications, visit PubMed

    About the Creator
    Dr. Jaime Prat