# Radiation Oncology/Ovary/Staging

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Ovarian Cancer Staging

## FIGO (2014)

2014 FIGO staging
* Ovarian cancer staging is by FIGO staging system and uses information obtained after surgery, which should include a total abdominal hysterectomy, removal of (usually) both ovaries, pelvic (peritoneal) washings for cytology, and biopsies (omentum, mesentery, diaphragm, peritoneal surfaces, pelvic and para-aortic nodes)
* Also includes primary peritoneal carcinoma
Primary Tumor: (FIGO stage in parentheses)
* I - limited to one or both ovaries
** IA - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
** IB - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
** IC - tumor limited to ovaries with any of the following: surgical spill (IC1), capsule ruptured or tumor on ovarian surface (IC2), positive washings (IC3)
* II - pelvic extension or primary peritoneal cancer
** IIA - extension or implants onto uterus or fallopian tube
** IIB - extension or implants onto other pelvic structures
* III - microscopic peritoneal implants outside of the pelvis or positive LN
** IIIA
*** IIIA1 - retroperitoneal lymph nodes; IIIA1(i) - ≤ 10 mm; IIIA1(ii) - > 10 mm
*** IIIA2 - microscopic peritoneal metastases beyond pelvis (w/ or w/o positive LN)
** IIIB - macroscopic peritoneal metastases beyond pelvis ≤ 2cm (w/ or w/o positive LN). Includes extension to capsule of liver or spleen.
** IIIC - peritoneal metastases beyond pelvis > 2 cm (w/ or w/o positive LN). Includes extension to capsule of liver or spleen.
* IV - distant metastases
** IVA - pleural effusion with positive cytology
** IVB - hepatic or splenic parenchymal metastases, extra-abdominal metastases, or distant LNs (inguinal LN, or LNs outside of abdominal cavity)
Changes from AJCC 7th Edition:
    Substaging of IC into IC1-3. Removed stage IIC. Positive lymph nodes are IIIA (previously IIIC). IIIA subdivided into IIIA1(i-ii) and IIIA2. IV subdivided into IVA and B. Inguinal lymph nodes are Stage IV (all LNs previously IIIC).

## AJCC 7th Edition (2009)

* Ovarian cancer staging is by FIGO staging system and uses information obtained after surgery, which should include a total abdominal hysterectomy, removal of (usually) both ovaries, pelvic (peritoneal) washings for cytology, and biopsies (omentum, mesentery, diaphragm, peritoneal surfaces, pelvic and para-aortic nodes)
* The AJCC stage is the same as the FIGO stage
* Also includes primary peritoneal carcinoma
Primary Tumor: (FIGO stage in parentheses)
* T1 (I) - limited to one or both ovaries
** T1a (IA) - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
** T1b (IB) - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
** T1c (IC) - tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
* T2 (II) - pelvic extension or implants
** T2a (IIA) - extension or implants onto uterus or fallopian tube; negative washings
** T2b (IIB) - extension or implants onto other pelvic structures; negative washings
** T2c (IIC) - pelvic extension or implants (T2a or T2b) with positive peritoneal washings
* T3 (III) - microscopic peritoneal implants outside of the pelvis
** T3a (IIIA) - microscopic peritoneal metastases beyond pelvis
** T3b (IIIB) - macroscopic peritoneal metastases beyond pelvis less than 2cm in size
** T3c (IIIC) - peritoneal metastases beyond pelvis > 2 cm. (lymph node metastasis is also IIIC for FIGO)
Regional Lymph Nodes: includes pelvic, para-aortic, inguinal, retroperitoneal
* N0 - no
* N1 (IIIC) - yes
Distant Metastases:
* M0 - no
* M1 (IV) - yes
Stage Grouping:
    Follows FIGO staging above (in parentheses). T3c and N1 are both IIIC.
    Note: primary peritoneal tumors are usually either Stage III or IV
    Note: seeding of the liver capsule is Stage III but liver parenchymal mets are Stage IV.

### Older staging systems

AJCC 6th Edition (2002)
    Same as 7th Edition, except primary peritoneal carcinoma is always metastatic (M1) at diagnosis