Ovarian Cancer 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 remains to be established. If disease appears to be limited to the ovaries or pelvis, it is essential at laparotomy to examine and biopsy the diaphragm, both paracolic gutters, the pelvic peritoneum, para-aortic and pelvic nodes, and infracolic omentum, and to obtain peritoneal washings.

In addition, invasion of the bladder and bowel needs to be taken into consideration, and a preoperative intravenous pyelogram and barium enema may be useful to evaluate the urinary tract and large bowel.

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.

The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging.

Stage I

Stage I ovarian cancer is growth limited to the ovaries.

Stage IA: growth limited to one ovary; no ascites. No tumor on the external surface; capsule intact.

Stage IB: growth limited to both ovaries; no ascites. No tumor on the external surfaces; capsules intact.

Stage IC: tumor either stage IA or IB, but with tumor on the surface of one or both ovaries; or with capsule ruptured; or with ascites present containing malignant cells or with positive peritoneal washings.

Stage II

Stage II ovarian cancer is growth involving one or both ovaries with pelvic extension.

Stage IIA: extension and/or metastases to the uterus and/or tubes.

Stage IIB: extension to other pelvic tissues. 

Stage IIC: tumor either stage IIA or stage IIB, but with tumor on the surface of one or both ovaries; or with capsule(s) ruptured; or with ascites present containing malignant cells or with positive peritoneal washings.

Different criteria for allotting cases to stages IC and IIC have an impact on diagnosis. In order to evaluate this impact, it would be of value 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 peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. 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: tumor grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces.

Stage IIIB: tumor of one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 centimeters in diameter. Nodes negative.

Stage IIIC: abdominal implants greater than 2 centimeters in diameter and/or positive retroperitoneal or inguinal nodes.

Stage IV

Stage IV ovarian cancer is growth involving one or both ovaries with distant metastasis. If pleural effusion is present, there must be positive cytologic test results to allot a case to stage IV. Parenchymal liver metastasis equals stage IV.

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