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Ovarian Cancer Staging

Ovarian / Fallopian / Peritoneal

FIGO 2014 Revised Staging

I

Confined to Ovaries/Tubes

IA (1 side) | IB (Both sides) | IC (Capsule rupture/Washings +ve)

II

Pelvic Extension

IIA (Uterus/Tubes/Ovaries) | IIB (Other pelvic tissues)

III

Extra-Pelvic Peritoneal / Nodes

IIIA (Retroperitoneal nodes) | IIIB (Microscopic peritoneal) | IIIC (Macroscopic >2cm)

IV

Distant Metastasis

IVA (Pleural effusion +ve cytology) | IVB (Parenchymal metastasis)

Surgical staging is mandatory for ovarian cancer including omentectomy and lymphadenectomy.

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Primary Clinical Uses

  • Surgical staging of primary carcinoma of the ovary, fallopian tube, and peritoneum
  • Predicting overall survival and recurrence risk
  • Determining the obligite need for adjuvant platinum-based chemotherapy

The Fallopian Paradigm

The 2014 FIGO update unified Ovarian, Fallopian Tube, and Primary Peritoneal cancers under one identical staging classification. This reflects the modern oncological consensus that high-grade serous "ovarian" carcinoma predominantly originates in the fimbriated end of the fallopian tube.

CLINICAL INSIGHT

How it Works

Stage I — Confined to Ovaries/Tubes

IA
IB
IC1
IC2
IC3

Stage II — Pelvic Extension (below pelvic brim)

IIA
IIB

Stage III — Peritoneal/Nodal Spread

IIIA1
IIIA2
IIIB
IIIC

Stage IV — Distant Metastasis

IVA
IVB
CLINICAL INSIGHT

Practical Pearls

Surgical Spillage Alert

  • Puncturing or forcefully tearing an intact malignant cyst during surgery immediately catapults an IA patient to IC1.
  • This iatrogenic mistake subjects the patient to harsh but necessary heavy-metal chemotherapy (carboplatin) that they could have otherwise avoided.
  • Never aspirate or morsellate a massive adnexal mass if malignancy is a realistic possibility on preoperative imaging.
CLINICAL INSIGHT

Next Steps

Adjuvant Chemotherapy Triggers

  • Stage IA/IB (Low Grade OR Grade 1): Observation is acceptable; surgery was curative.
  • Stage IA/IB (High Grade, Clear Cell, Grade 3): Chemotherapy required.
  • Stage IC and above: Universal requirement for adjuvant chemotherapy (typically 6 cycles Carboplatin + Paclitaxel).
  • Stage III/IV: Evaluate for primary cytoreductive surgery versus neoadjuvant chemotherapy initially, followed by interval debulking.
CLINICAL INSIGHT

Evidence Base

The 2014 Unification

FIGO 2014 Ovarian cancer staging update.

Berek JS, Ravanbakhsh C.Int J Gynaecol Obstet.2014
CLINICAL INSIGHT

Background

A Modern Understanding

The fundamental recognition by pathologists like Dr. Robert Kurman that pelvic serous cancers originate in the fallopian tube epithelium (STIC lesions) drove FIGO to entirely restructure how these diseases are tracked.