Stage Information
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.[1]
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.[2-4] 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.[5] 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]
The Federation Internationale de Gynecologie et d’Obstetrique and the
American Joint Committee on Cancer have designated staging.[8,9]
Stage I
Stage I ovarian cancer is limited to the ovaries.
- Stage IA: Tumor limited to one ovary; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings.*
- Stage IB: Tumor limited to both ovaries; capsules intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings.*
- Stage 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.[8]
* [Note: The term, malignant ascites, is not classified. The presence of ascites does not affect staging unless malignant cells are present.]
Stage II
Stage II ovarian cancer is tumor involving one or both ovaries with
pelvic extension and/or implants.
- Stage IIA: Extension and/or implants on the uterus and/or fallopian tubes.
No malignant cells in ascites or peritoneal washings.
- Stage IIB: Extension to and/or implants on other pelvic tissues. No malignant cells in ascites or peritoneal washings.
- Stage IIC: Pelvic extension and/or implants (stage IIA or stage IIB) with malignant cells in ascites or peritoneal washings.
Different criteria for allotting cases to stage IC and stage IIC have an impact on
diagnosis. To assess this impact, of value would be to know if
rupture of the capsule was (1) spontaneous or (2) caused by the surgeon; and, if
the source of malignant cells detected was (1) peritoneal washings or (2)
ascites.
Stage III
Stage III ovarian cancer is tumor involving one or both ovaries with
microscopically confirmed peritoneal implants outside the pelvis. Superficial liver metastasis equals stage III. Tumor is
limited to the true pelvis but with histologically verified malignant
extension to small bowel or omentum.
- Stage IIIA: Microscopic peritoneal metastasis beyond pelvis (no macroscopic tumor).
- Stage IIIB: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension.
- Stage IIIC: Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis.
Stage IV
Stage IV ovarian cancer is tumor involving one or both ovaries with distant
metastasis. If pleural effusion is present, positive cytologic
test results must exist to designate a case to stage IV. Parenchymal liver metastasis equals
stage IV.
References
-
Hoskins WJ: Surgical staging and cytoreductive surgery of epithelial ovarian cancer. Cancer 71 (4 Suppl): 1534-40, 1993.
[PUBMED Abstract]
-
Mogensen O: Prognostic value of CA 125 in advanced ovarian cancer. Gynecol Oncol 44 (3): 207-12, 1992.
[PUBMED Abstract]
-
Högberg T, Kågedal B: Long-term follow-up of ovarian cancer with monthly determinations of serum CA 125. Gynecol Oncol 46 (2): 191-8, 1992.
[PUBMED Abstract]
-
Rustin GJ, Nelstrop AE, Tuxen MK, et al.: Defining progression of ovarian carcinoma during follow-up according to CA 125: a North Thames Ovary Group Study. Ann Oncol 7 (4): 361-4, 1996.
[PUBMED Abstract]
-
Makar AP, Kristensen GB, Børmer OP, et al.: CA 125 measured before second-look laparotomy is an independent prognostic factor for survival in patients with epithelial ovarian cancer. Gynecol Oncol 45 (3): 323-8, 1992.
[PUBMED Abstract]
-
Berek JS, Knapp RC, Malkasian GD, et al.: CA 125 serum levels correlated with second-look operations among ovarian cancer patients. Obstet Gynecol 67 (5): 685-9, 1986.
[PUBMED Abstract]
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Atack DB, Nisker JA, Allen HH, et al.: CA 125 surveillance and second-look laparotomy in ovarian carcinoma. Am J Obstet Gynecol 154 (2): 287-9, 1986.
[PUBMED Abstract]
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Shepherd JH: Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 96 (8): 889-92, 1989.
[PUBMED Abstract]
-
Ovary. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 275-284.
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