Fast Five Quiz: Ovarian Cancer

Michel E. Rivlin, MD

Disclosures

September 27, 2018

Ovarian cancer is typically staged using the system formulated and updated by the International Federation of Obstetrics and Gynecology, as listed below.

Stage I

In stage I, growth is limited to the ovaries. Substages are as follows:

  • Stage IA: Tumor limited to one ovary, capsule intact, no tumor on external surface

  • Stage IB: Tumor involves both ovaries, capsule intact, no tumor on external surface

  • Stage IC: Tumor either stage IA or IB, plus surgical spill (IC1), capsule rupture before surgery or tumor on ovarian surface (IC2), or malignant cells in the ascites or peritoneal washings (IC3)

Stage II

In stage II, tumor involves one or both ovaries, with pelvic extension (below the pelvic brim) or primary peritoneal cancer. Substages are as follows:

  • Stage IIA: Extension to and/or implants on the uterus or fallopian tubes

  • Stage IIB: Extension to other pelvic intraperitoneal tissues

Stage III

In stage III, tumor involves one or both ovaries, with cytologically or histologically confirmed spread to the peritoneum outside the pelvis, and/or metastasis to the retroperitoneal lymph nodes. Substages are as follows:

  • Stage IIIA: Positive retroperitoneal lymph nodes and/or microscopic metastasis beyond the pelvis

  • Stage IIIA1: Positive retroperitoneal lymph nodes only (IIIA1), metastasis ≤ 10 mm (IIIA1[i]), or metastasis > 10 mm (IIIA1[ii])

  • Stage IIIA2: Microscopic, extrapelvic (above the brim) peritoneal involvement ± positive retroperitoneal lymph nodes

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

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

Stage IV

Stage IV comprises distant metastasis, excluding peritoneal metastasis. Substages are as follows:

  • Stage IVA: Pleural effusion with positive cytology

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

For more on ovarian cancer staging, read here.

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