Ovarian Epithelial Cancer Treatment - Stage Information for Ovarian Epithelial Cancer
In the absence of extra-abdominal metastatic disease, definitive staging of ovarian cancer requires laparotomy. The role of surgery in patients with stage IV disease and extra-abdominal disease is yet to be established. If disease appears to be limited to the ovaries or pelvis, it is essential at laparotomy to examine and biopsy or to obtain cytologic brushings of the diaphragm, both paracolic gutters, the pelvic peritoneum, para-aortic and pelvic nodes, and infracolic omentum, and to obtain peritoneal washings.
The serum CA 125 level is valuable in the follow-up and restaging of patients who have elevated CA 125 levels at the time of diagnosis.[2,3,4] While an elevated CA 125 level indicates a high probability of epithelial ovarian cancer, a negative CA 125 level cannot be used to exclude the presence of residual disease. CA 125 levels can also be elevated in other malignancies and benign gynecologic problems such as endometriosis, and CA 125 levels should be used with a histologic diagnosis of epithelial ovarian cancer.[6,7]
Definitions of TNM and FIGO
The American Joint Committee on Cancer (AJCC) and the F�deration Internationale de Gyn�cologie et d'Obst�trique (FIGO) have designated staging to define ovarian epithelial cancer.[8,9] The definitions of the AJCC's T, N, and M categories correspond to the stages accepted by FIGO. Both systems are included for comparison.
Table 1. Primary Tumor (T)a,b
FIGO = F�deration Internationale de Gyn�cologie et d'Obst�trique.
a Reprinted with permission from AJCC: Ovary and primary peritoneal carcinoma. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 419-28.
bLiver capsule metastasis T3/stage III; liver parenchymal metastasis M1/stage IV. Pleural effusion must have positive cytology for M1/stage IV.
|TNM Categories||FIGO Stages||�|
|TX||�||Primary tumor cannot be assessed.|
|T0||�||No evidence of primary tumor.|
|T1||�||Tumor limited to 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.|
|T2||II||Tumor involves one or both ovaries with pelvic extension.|
|T2a||IIA||Extension to and/or implants on uterus and/or tube(s). No malignant cells in ascites or peritoneal washings.|
|T2b||IIB||Extension to and/or implants on 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 pelvis (no macroscopic tumor).|
|T3b||IIIB||Macroscopic peritoneal metastasis beyond pelvis ?2 cm in greatest dimension.|
|T3c||IIIC||Peritoneal metastasis beyond pelvis >2 cm in greatest dimension and/or regional lymph node metastasis.|