Guideline 75: Epithelial ovarian cancer

Epithelial ovarian cancer
Annex 1

Staging carcinoma of the ovary
International Federation of Gynaecology and Obstetrics (FIGO) nomenclature⁸

Stage I - Growth limited to the ovaries

Ia Growth limited to one ovary; no ascites containing malignant cells present. No tumour on the external surface; capsule intact
Ib Growth limited to both ovaries; no ascites containing malignant cells present. No tumour on the external surfaces; capsules intact
Ic *Tumour either Stage Ia or Ib, but with tumour on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings.

Stage II - Growth involving one or both ovaries with pelvic extension

IIa Extension and/or metastases to the uterus and/or Fallopian tubes
IIb Extension to other pelvic tissues
IIc *Tumour either Stage IIa or IIb, but with tumour on surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive
peritoneal washings.

Stage III - Tumour involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastases equals stage III. Tumour is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum.

IIIa Tumour grossly limited to the true pelvis, with negative nodes, but with histologically
confirmed microscopic seeding of abdominal peritoneal surfaces, or histologically proven extension to small bowel or mesentery
IIIb Tumour of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative
IIIc Peritoneal metastasis beyond the pelvis >2 cm in diameter and/or positive retroperitoneal or inguinal nodes.

Stage IV

Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allot a case to Stage IV. Parenchymal liver metastasis equals Stage IV.

* In order to evaluate the impact on prognosis of the different criteria for allotting cases to Stage Ic or IIc, it would be of value to know if rupture of the capsule was spontaneous, or caused by the surgeon; and if the source of malignant cells detected was peritoneal washings, or ascites.