Understand Ovarian Cancer FIGO Staging

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Staging helps to determine the disease prognosis, and to select an appropriate treatment strategy. Ovarian Cancer FIGO staging is the most commonly used staging system for the disease. FIGO stands for International Federation of Gynecology and Obstetrics.

Stage IA – Tumor limited to one ovary/fallopian tube, with capsule intact, with no disease on ovary/fallopian tube surface.
No cancer cells detected in ascites or peritoneal washings.

Stage IB – Tumor limited to both ovaries/fallopian tubes, with capsule intact, with no disease on ovary/fallopian tube surface.
No cancer cells detected in ascites or peritoneal washings.

Stage IC1 – The cancer cells leak into the abdomen/pelvis during surgery (surgical spill)

Stage IC2 – Tumor present on the capsule of the ovary/fallopian tube or the capsule ruptured before surgery

Stage IC3 – The cancer cells are detected in ascites or peritoneal washings

Stage IIA – Tumor extension/implants from ovaries/fallopian tubes to uterus.

Stage IIB – Tumor extension/implants from ovaries/fallopian tubes to bladder, sigmoid colon, rectum, or other pelvic tissues.

Ovarian Cancer FIGO Staging Infographic
Ovary Cancer – Stage I and II

Stage IIIA1 – Tumor involves one or both ovaries/fallopian tubes or primary peritoneal cancer with spread to retroperitoneal lymph nodes only.

Stage IIIA2 – Tumor involves one or both ovaries/fallopian tubes with microscopic peritoneal deposits with/without spread to retroperitoneal lymph nodes.

Stage IIIB – Tumor involves one or both ovaries/fallopian tubes with macroscopic peritoneal deposits (</=2 cm) with/without spread to retroperitoneal lymph nodes.

Stage IIIC – Tumor involves one or both ovaries/fallopian tubes with macroscopic peritoneal deposits (>2 cm) with/without spread to retroperitoneal lymph nodes. The cancer cells might have invaded the capsule of the liver or the spleen without parenchymal involvement.

Stage IVA – Tumor spread to the fluid in pleural cavity (pleural effusion) with positive cytology.

Stage IVB – Tumor spread to the spleen/liver parenchyma, to the lymph nodes other than the retroperitoneal lymph nodes, and/or to other organs outside the abdomen such as the lungs, bones, etc.

ovarian cancer staging - III and IV
Ovary Cancer – Stage III and IV
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Watch the video below where CancerBro explains the anatomy of ovary and nearby structures.

Video Transcript:

First, we will discuss the normal anatomy of the female reproductive system.

This pear-shaped structure called the uterus is lined by endometrial lining from inside.

The menstrual cycles in females are due to the regular shedding of this endometrial lining.

It is also called the womb, as it enlarges during pregnancy to accommodate the child.

This structure, which is present below the uterus is called the cervix. This global structure present lateral to the uterus on both sides is called an ovary.

The fallopian tube is the tubular structure which carries the ovum produced from the ovaries to the uterus.

 

After understanding the anatomy, we will look at a video explaining the staging of ovarian cancer.

Video Transcript:

Now, we come to the ovarian cancer staging.

Stage 1A is when the tumor is localised to one ovary with intact capsule, that is when the tumor has not spread to the surface of ovary or anywhere else.

Stage 1B when the tumor is localized to both the ovaries but with an intact capsule, with no spread of the tumor to the surface of ovary or anywhere else.

Stage 1C is when there is a capsule rupture either spontaneously or during surgery, with the presence of tumor cells on the surface of ovary or in ascitis fluid, but there is no extension of tumor to the adjacent structures.

To understand the stage 2 better, we will discuss the normal anatomy of the female pelvis. Imagine we are seeing from the top, on both side of the uterus are ovaries which are connected to the uterus with fallopian tube. In front of the uterus is the urinary bladder, and these tube-like structures joining the bladder on both sides are called as ureters. This tube-like structure present behind the uterus is called as the rectum.

 

In stage 2A, cancer spreads to the fallopian tube or uterus. In this figure, it has spread to the fallopian tube.

And here, it extends to the fallopian tube and the uterus.

Here it extends anteriorly to infiltrate the urinary bladder.

And here it extends posteriorly to involve the rectum.

In stage 3, cancer extends outside the pelvis into the abdominal cavity. Let’s have a look at abdominal structures first. This is the large intestine. And this is the liver, behind which is the stomach. And these are the lungs, which are present in the thoracic cavity, separated from the abdomen by the diaphragm.

In stage 3 ovarian cancer, there may be involvement of these nodular structures present inside the abdomen, called as retroperitoneal lymph nodes.

Stage 3 may also present as surface deposits inside the abdomen, called peritoneal deposits.

Now we come to the stage 4 ovarian cancer. It may spread to the lungs, which may present as a fluid collection around the lung, called a pleural effusion.

Stage 4 may also present as nodular deposits in the parenchymal of the lung, or in liver or spleen

It may also present as the involvement of inguinal lymph nodes.

So this was the ovarian cancer staging.

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