Radiology Tutor

by Jonathan Colledge

Ovarian cancer TNM staging (UICC/AJCC 7th edition)

N.B. This uses FIGO 2104, but AJCC/UICC 7th edition. The 8th edition is due 2016, effective 2017. There are differences! e.g. there will no longer be T2c, but there is already no IIc. Currently in beta testing stage. Manual verification of results is required.

T

Are one or both ovaries involved?
One ovary Both ovaries

Has there been surgical spill?

Is there pre-surgical capsule rupture or tumour on the ovarian surface?

Are there malignant cells in the ascites or peritoneal washings?

Is there extension to or are there deposits on the uterus or fallopian tubes?

Is there extension to or are there deposits on other pelvic tissues?

Are there microscopic peritoneal metastases beyond the pelvis?

Are there macroscopic peritoneal/capsular metastases beyond the pelvis with a maximum diameter ≤2 cm?

Are there macroscopic peritoneal/capsular metastases beyond the pelvis >2 cm in maximum diameter?

N

Are regional lymph nodes involved? (External iliac, internal iliac, obturator, common iliac, para-aortic, inguinal, and pelvic and retroperitoneal nodes not otherwise specified)

Are there positive retoperitoneal lymph nodes <10 mm?

Are there positive retoperitoneal lymph nodes >10 mm?

M

Is there positive cytology of pleural effusion?

Are there metastases (includes parenchymal but not capsular (IIIb/c) spleen and liver, distant nodes, does not include peritoneal metastases)?

TNM staging =

FIGO staging =

T1 tumours contains three subdivisions. T1a and T1b depend on whether one or both ovaries are involved. If there is capsular rupture, tumour on the ovarian surface or if malignant cells are found in ascites or peritoneal washings, then the tumour is T1c regardless of whether one or both ovaries are involved.
T2 tumours are those that extend beyond the ovary either to the uterus and fallopian tubes (T2a) or to other structures within the pelvis (T2b). Once again, malignant cells in ascites or peritoneal washings give T2c, though there is no longer a IIc in FIGO and T2c will disappear with the 8th edition TNM.
T3 tumours are those with peritoneal deposits (including liver capsule) which are either microscopic (T3a), macroscopic ≤2 cm (T3b) or macroscopic >2 cm (T3c).

The regional lymph nodes of ovary are defined in the AJCC Cancer Staging Manual(1) as:

External iliac, internal iliac, obturator, common iliac, para-aortic, inguinal, pelvic and retroperitoneal (not otherwise specified).

FIGO staging

The FIGO staging roughly corresponds to the T staging unless there is lymph node involvement or metastases (IV) and will correspond more exactly on release of the 8th edition of AJCC and UICC staging.

References

AJCC Cancer Staging Manual. (Springer, 2011).
2014 FIGO staging for ovarian, fallopian tube and peritoneal cancer. Mutch, David G. et al. Gynecologic Oncology , Volume 133 , Issue 3 , 401 - 404

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