Stage Information
In the absence of obvious metastatic disease, accurate staging of germ cell
tumors of the ovary requires laparotomy with careful examination of the entire
diaphragm, both paracolic gutters, pelvic nodes on the side of the ovarian
tumor, the para-aortic lymph nodes, and the omentum. The contralateral ovary
should be carefully examined and biopsied if necessary. Ascitic fluid should
be examined cytologically. If ascites is not present, it is important to
obtain peritoneal washings before the tumor is manipulated. In patients with
dysgerminoma, lymphangiography or computed tomography is indicated if the
pelvic and para-aortic lymph nodes were not carefully examined at surgery.
Although not required for formal staging, it is desirable to obtain serum
levels of alpha fetoprotein (AFP) and human chorionic gonadotropin (HCG) as
soon as the diagnosis is established since persistence of these markers in the
serum after surgery indicates unresected tumor.
The Federation Internationale de Gynecologie et d’Obstetrique (FIGO) and the
American Joint Committee on Cancer (AJCC) have designated staging.[1,2]
Stage I
Stage I ovarian germ cell cancer is growth limited to the ovaries.
- Stage IA: Tumor is limited to 1 ovary; capsule is intact, and no tumor is present on the ovarian surface. No malignant cells are present in ascites or peritoneal washings.*
- Stage IB: Tumor is limited to both ovaries; capsules are intact, no tumor is present on the ovarian surface. No malignant cells are present in ascites or peritoneal washings.*
- Stage IC: Tumor is limited to 1 or both ovaries with any of the following: capsule is ruptured, tumor is present on the ovarian surface, malignant cells are present in ascites or peritoneal washings.[1]
* [Note: Malignant ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.]
Stage II
Stage II ovarian germ cell cancer is growth involving 1 or both ovaries with
pelvic extension and/or implants.
- Stage IIA: Extension and/or implants are present on the uterus and/or fallopian tubes.
No malignant cells are present in ascites or peritoneal washings.
- Stage IIB: Extension to and/or implants are present on other pelvic tissues. No malignant cells are present in ascites or peritoneal washings.
- Stage IIC: Pelvic extension and/or implants (stage IIA or stage IIB) with malignant cells are present in ascites or peritoneal washings.
Different criteria for designating cases to stages IC and IIC have an impact on
the diagnoses. To evaluate the impact, determine if
rupture of the capsule was (1) spontaneous or (2) caused by the surgeon, and if
the source of the malignant cells detected was (1) peritoneal washings or (2)
ascites.
Stage III
Stage III ovarian germ cell cancer is growth involving 1 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 the small bowel or omentum.
- Stage IIIA: Microscopic peritoneal metastasis is present beyond the pelvis (no macroscopic tumor).
- Stage IIIB: Macroscopic peritoneal metastasis is present beyond the pelvis and ≤2 cm in greatest dimension.
- Stage IIIC: Peritoneal metastasis is present beyond the pelvis and is >2 cm in greatest dimension, and/or regional lymph node metastasis is present.
Stage IV
Stage IV ovarian germ cell cancer is growth involving 1 or both ovaries with
distant metastasis. If pleural effusion is present, there must be positive
cytologic test results to designate a case to stage IV. Parenchymal liver
metastasis equals stage IV.
References
-
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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