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Staging:

The actual staging system that is used in ovarian cancer has traditionally been the FIGO system. However the T, N and M system is also used.

Primary Tumor, (T):

TNM

FIGO

Description

Primary tumor cannot be assessed

No evidence of primary tumor

Tumor limited to ovaries (one or both)

T1a

Tumor limited to one ovary; capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings*

T1b

Tumor limited to both ovaries; capsules intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings*

T1c

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

Tumor involves one or both ovaries with pelvic extension

T2a

IIA

Extension and/or implants on uterus and/or tube(s). No malignant cells in ascites or peritoneal washings

T2b

IIB

Extension to other pelvic tissues. No malignant cells in ascites or peritoneal washings

T2c

IIC

Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings

T3 &/or N1

III

Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional lymph node metastasis.

T3a

IIIA

Microscopic peritoneal metastasis beyond pelvis

T3b

IIIB

Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension

T3c &/or N1

IIIC

Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis

Distant metastasis (excludes peritoneal metastasis)

Regional Lymph Nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis

Distant Metastasis (M)
MX	Distant metastasis cannot be assessed
M0	No distant metastasis
M1	Distant metastasis (excludes peritoneal metastasis)

STAGE GROUPING
FIGO/TNM Stage	T	N	M
Stage IA	T1a	N0	M0
Stage IB	T1b	N0	M0
Stage IC	T1c	N0	M0
Stage IIA	T2a	N0	M0
Stage IIB	T2b	N0	M0
Stage IIC	T2c	N0	M0
Stage IIIA	T3a	N0	M0
Stage IIIB	T3b	N0	M0
Stage IIIC	T3c	N0	M0
	Any T	N1	M0
Stage IV	Any T	Any N	M1

*Note: The presence of nonmalignant ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.

Note: Liver capsule metastasis are T3/Stage III; liver parenchymal metastasis, M1/Stage IV. Pleural effusion must have positive cytology for M1/Stage IV.