How is ovarian cancer staged?

Updated: Sep 03, 2019
  • Author: Shannon M Grabosch, MD; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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Answer

Answer

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 following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings

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); no malignant cells in ascites or peritoneal washings

T2b

IIB

Extension to and/or implants in other pelvic tissues; no malignant cells in ascites or peritoneal washings

T2c

IIC

Pelvic extension and/or implants (T2a or T2b) with malignant cells in ascites or peritoneal washings

T3

III*

Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis

T3a

IIIA

Microscopic peritoneal metastasis beyond the pelvis (no macroscopic tumor)

T3b

IIIB

Macroscopic peritoneal metastasis beyond the pelvis 2 cm or less in greatest dimension

T3c

IIIC

Macroscopic peritoneal metastasis beyond the pelvis >2 cm in greatest dimension and/or regional lymph node metastasis

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

IIIA-1

Positive retroperitoneal lymph nodes only (histologically confirmed)

N1a

IIIAIi

Metastasis ≤10 mm in greatest dimension

N1b

IIIAIii

Metastasis ≤10 mm in greatest dimension

Distant metastasis (M)

TNM

FIGO

 

M0

 

No distant metastasis

M1

IV

Distant metastasis (excludes peritoneal metastasis)

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

Note:

  • The presence of nonmalignant ascites is not classified; the presence of ascites does not affect staging unless malignant cells are present.


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