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Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®)

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Stage Information for Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer

In the absence of extra-abdominal metastatic disease, definitive staging of ovarian cancer requires surgery. 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]

Definitions: FIGO

The Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define ovarian epithelial cancer. FIGO recently approved a new staging system for ovarian, fallopian tube, and primary peritoneal cancer (see Table 1). The FIGO system is most commonly used.[8,9]

Table 1. 2014 FIGO Ovarian, Fallopian Tube, and Peritoneal Cancer Staging System and Corresponding TNMc
Stage Definition
aIncludes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ.
bParenchymal metastases are Stage IVB.
cAdapted from the Féderation Internationale de Gynécologie et d’Obstétrique.[8]
I Tumor confined to ovaries or fallopian tube(s).
IA Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings.
IB Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings.
IC Tumor limited to one or both ovaries or fallopian tubes, with any of the following:
IC1: Surgical spill intraoperatively.
IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface.
IC3: Malignant cells present in the ascites or peritoneal washings.
II Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer (Tp).
IIA Extension and/or implants on the uterus and/or fallopian tubes and/or ovaries.
IIB Extension to other pelvic intraperitoneal tissues.
III Tumor involves one or both ovaries, or fallopian tubes, or primary peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside of the pelvis and/or metastasis to the retroperitoneal lymph nodes.
IIIA Metastasis to the retroperitoneal lymph nodes with or without microscopic peritoneal involvement beyond the pelvis.
IIIA(i) Positive retroperitoneal lymph nodes only (cytologically or histologically proven).
IIIA(ii) Metastasis >10 mm in greatest dimension.
IIIA2 Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes.
IIIB Macroscopic peritoneal metastases beyond the pelvic brim ≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes.
IIIC Macroscopic peritoneal metastases beyond the pelvic brim >2 cm in greatest dimension, with or without metastases to the retroperitoneal nodes.a
IV Distant metastasis excluding peritoneal metastases.
IVA Pleural effusion with positive cytology.
IVB Metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity).b

References

  1. Hoskins WJ: Surgical staging and cytoreductive surgery of epithelial ovarian cancer. Cancer 71 (4 Suppl): 1534-40, 1993. [PUBMED Abstract]
  2. Mogensen O: Prognostic value of CA 125 in advanced ovarian cancer. Gynecol Oncol 44 (3): 207-12, 1992. [PUBMED Abstract]
  3. 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]
  4. 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]
  5. 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]
  6. 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]
  7. 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]
  8. Mutch DG, Prat J: 2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer. Gynecol Oncol 133 (3): 401-4, 2014. [PUBMED Abstract]
  9. 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.
  • Updated: March 27, 2015