Staging for Carcinoma of the Ovary
Staging of ovarian carcinoma is based on findings at clinical examination and by surgical exploration. The histologic findings are to be considered in the staging, as are the cytologic findings as far as effusions are concerned. It is desirable that a biopsy be taken from suspicious areas outside of the pelvis.
Stage I Growth is limited to the ovaries.
Stage IA Growth is limited to one ovary; no ascites present containing malignant cells. There is no tumor on the external surface; capsule is intact.
Stage lB Growth is limited to both ovaries; no ascites present containing malignant cells. There is no tumor on the external surfaces; capsules are intact.
Stage IC* Tumor is classified as either stage IA or lB but with tumor on the surface of one or both ovaries; or with ruptured capsule(s); or with ascites containing malignant cells present or with positive peritoneal washings.
Stage II Growth involves one or both ovaries, with pelvic extension.
Stage IIA There is extension and/or metastases to the uterus and/or tubes.
Stage lIB There is extension to other pelvic tissues.
Stage IIC* Tumor is either stage IIA or lib but with tumor on the surface of one or both ovaries; or with capsule(s) ruptured; or with ascites containing malignant cells present or with positive peritoneal washings.
Stage Ill Tumor involves 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 proven malignant extension to small bowel or overturn.
Stage IlIA Tumor is grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces.
Stage IIIB Tumor involves one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter; nodes are negative.
Stage IIIC There are abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes.
Stage IV Growth involves one or both ovaries, with distant metastases. If pleural effusion is present, there must be positive cytologic findings to assign a case to stage IV. Parenchymal liver metastasis equals stage IV.
*To evaluate the impact on prognosis of the different criteria for assigning cases to stage IC or IIC, it would be of value to know whether the rupture of the capsule was spontaneous or caused by the surgeon and if the source of malignant cells detected was peritoneal washings or ascites.
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