Cancer staging plays a pivotal role in the battle against cancer. Although ultrasound can be used for diagnosis, it is not the imaging modality used to stage ovarian cancer. Approximately 90% of ovarian cancers are carcinomas malignant epithelial tumors and, based on histopathology, immunohistochemistry, and. The revised 2014 figo staging system for epithelial. In particular, it is now realized that cancer of ovary, fallopian tube, and peritoneum share similar.
The purpose of this study was to identify the main prognostic factors in patients with earlystage epithelial ovarian cancer. Data were extracted from 222 patients with initial stage iiia invasive. Malignant cells in the ascites or peritoneal washings. Jaime prat for the figo committee on gynecologic oncology1 article info keywords. Pathologic tnm and figo classification, staging of tumors of the ovary, fallopian tube and primary peritoneal carcinoma author. The international federation of gynecologists and obstetricians figo has revised the staging of ovarian cancer. Cancer staging is a core principle in understanding the severity of patients clinical condition, predicting the outcome, and planning adequate treatment. Another discovery that influenced the new figo staging occurred in 2001, when patients with brca mutation breastovarian cancer syndrome undergoing riskreducing salpingooophorectomy rrso were found to have highgrade serous tubal intraepithelial carcinoma stic not in the ovary but in the fallopian tube and, particularly, in the fimbria. The figo cancer report previously the figo annual report on the result of treatment in gynecologic cancer was launched at the figo world congress of gynecology and obstetrics in rome, italy, in.
In stage i ovarian cancer, histologic grad ing is the most important factor influencing diseasefree survival 69, 71, 76. Another discovery that influenced the new figo staging occurred in 2001, when patients with brca mutation breastovarian cancer syndrome undergoing riskreducing salpingooophorectomy rrso. Pdf imaging staging of ovarian cancer researchgate. Ovarian cancer stages and grades target ovarian cancer. In essence, it assigns patients to prognostic groups that require specific treatments. Approximately 90% of ovarian cancers are carcinomas malignant epithelial tumors and, based on histopathology. Tumor involves 1 or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the. The tumornodemetastasis tnm classification of the american joint committee on cancer ajcc and the international federation of gynecology and obstetrics figo classification for. Talk to your doctor if you have questions about staging. First and foremost, staging provides patients with cancer and their physicians the critical benchmark and standards for defining prognosis, the likelihood of overcoming the cancer once diagnosed, and for determining the best treatment approach for the disease.
Ovarian, fallopian tube and peritoneal cancer staging. As a rule, the lower the number, the less the cancer has spread. Staging is necessary for explaining epidemiologic changes, defining the disease at presentation, and evaluating the overall impact of new therapies. Figo committee on gynecologic oncology revised figo staging for carcinoma of the vulva, cervix, and endometrium. The revision by figo followed a series of meetings which were concluded in italy at the end of 2012. Endometrial cancer stages range from stage i 1 through iv 4. Ct is considered the best imaging modality for staging ovarian cancer. A higher number, such as stage iv, means cancer has spread to other parts of the body.
Figo committee on gynecologic oncology revised figo. The 2 systems used for staging ovarian cancer, the figo international federation of gynecology and obstetrics. Although cytoreduction is the best treatment for the management of advanced ovarian cancer, the are some factors that make it difficult to achieve. Tnm figo categories stages m0 no distant metastasis m1 ivb distant metastasis including peritoneal spread, involvement of supraclavicular, mediastinal, or paraaortic lymph nodes, lung, liver, or bone am e ric an j o int co mmit te e o n can ce r. This editorial is written to make the readership aware of the recent changes that have been made by the international federation of gynecology and obstetrics figo in the staging classification of ovarian. The number of women being diagnosed with ovarian cancer is likely to rise to 371,000 new cases a year by 2035, according to a recent study collating data from. Figo has recently revised the staging of ovarian cancer. The process of the proposed changes to the staging of ovarian, fallopian tube, and primary peritoneal cancer started three years ago under the leadership of the chair of the figo committee on. Figos staging classification for cancer of the ovary. Ffdg pet fludeoxyglucose f 18 positron emission tomography pfs progression free survival ps performance. Although each persons cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way. Each stage is further divided into substages, such as a, b, c, which indicate increasing amounts of tumour. The revised 2014 figo staging system for epithelial ovarian.
In general, ovarian cancer is a disease of the postmenopausal woman, with the highest incidence among patients ages 6574 year. Ajcc cancer staging manual 8th edition pdf free medical books. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. The updated, revised figo staging system combines the classification for ovarian, fallopian tube and peritoneum cancer and is based on findings made mainly through surgical exploration, since operative findings allow doctors to determine the precise histologic diagnosis, stage and prognosis of the patient. Figo staging, epithelial cancer of ovary definition of. Tnm figo categories stages m0 no distant metastasis m1 ivb distant metastasis including peritoneal spread, involvement of supraclavicular, mediastinal, or paraaortic lymph nodes, lung, liver, or bone am e ric an j o int co mmit te e o n can ce r financial support for ajcc 7th edition staging posters.
Imaging of ovarian cancer and the revised figo staging system ity of rmi for prediction of malignancy increases from 88% to 99% 31. We evaluated if classifying patients with eoc in figo stage iva and ivb has any prognostic implication. It includes a revision of the stage iii patients and allotment to stage iiia1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal. Data were extracted from 222 patients with initial stage iiia invasive epithelial ovarian cancer treated with primary surgery followed or not followed by adjuvant therapy, from 1 january 1980 to 31 december 2008, at the division of obstetrics and. And within a stage, an earlier letter means a lower stage. These staging codes are also used in staging fallopian tube and peritoneal cancer which are treated in a similar way to ovarian cancer. Ovarian cancer is cancer of the ovaries, the eggreleasing and hormoneproducing organs of the female reproductive tract. The role of surgery in advanced epithelial ovarian cancer. Cancerous, or malignant, cells divide and multiply in an abnormal fashion. The sensitivity of doppler ultrasound in the detection of peritoneal. Cancer of the ovary, fallopian tube, and peritoneum berek 2018. Cancer staging is a fundamental principle and one of the first and most important steps used to predict patient outcome as well as to plan the most appropriate treatment. Nov 14, 2018 the american joint committee on cancer ajcc tnm classification and the international federation of gynecology and obstetrics figo staging system for germ cell tumors are listed below see tables 1 and 2.
Updates on the staging and management guidelines on each sitespecific gynecological cancer, and. The staging system most commonly used for ovarian cancer is the international federation of gynecology and obstetrics figo system. Figos staging classification for cancer of the ovary, fallopian tube. Ovarian cancer, the revised figo staging system, and the role. Fallopian tube cancer ovarian cancer peritoneal cancer staging introduction ovarian cancer is the seventh most common cancer diagnosis.
International federation of gynaecology and obstetrics figo stage i ovarian cancer limited to the ovaries is diagnosed in approximately 20% to 33% of women with ovarian cancer in developed. Apr 11, 2018 ovarian cancer stages range from stage i 1 through iv 4. The figo and tnm staging codes for ovarian cancer are listed below. Epithelial ovarian cancer is the fifth most common cancer among women. Tumor confined to ovaries or fallopian tubes t1n0m0 ia. Ovarian cancer is the seventh most commonly occurring cancer in women and the eighth most common cause of death from cancer in women in the world. The overall 5year relative survival currently is between 30% and 40%. Figo committee on gynecologic oncology revised figo staging. A higher number, such as stage iv, means cancer has spread to other parts of. The approved, new ovarian cancer staging went into effect on jan. Ffdg pet fludeoxyglucose f 18 positron emission tomography pfs progression free survival ps performance status qoe quality of evidence qol quality of life rcog royal college of obstetricians and gynaecologists rct randomized controlled trial. Since publicationof the last figo cervical cancer staging in 2009, considerable progress has been made in the use of imaging modalities to evaluate women with cervical cancer. Impact of the new figo 20 classification on prognosis of. Nov 10, 2014 ovarian cancer is the second most common gynecologic malignancy, endometrial cancer being the most common, but is the most common cause of death among women who develop a gynecologic malignancy.
Although ultrasound can be used for diagnosis, it is not the imaging. The most common staging system for ovarian cancer is the figo system. The most commonly adopted ovarian cancer staging system is the figo staging system. The revised 2014 figo staging system for epithelial ovarian cancer eoc included many changes of the previous system, particularly dividing figo stage iv in two subgroups. Ct is considered the best imaging modality for staging ovarian. Ovarian cancer is the second most common gynecologic malignancy, endometrial cancer being the most common, but is the most common cause of death among women who develop a. Staging classification for cancer of the ovary, fallopian tube. Although cytoreduction is the best treatment for the management of advanced ovarian cancer, the are some factors that make it difficult to achieve complete cytoreduction in certain patients. The process of the proposed changes to the staging of ovarian, fallopian tube, and primary peritoneal cancer started three years ago under the leadership of the chair of the figo committee on gynecologic oncology, professor lynette denny. First, it was recognized that ovarian cancer is not a homogeneous disease, but. Pdf figos staging classification for cancer of the ovary. Laparoscopy versus laparotomy for figo stage i ovarian cancer. This editorial is written to make the readership aware of the recent changes that have been made by the international federation of gynecology and obstetrics figo in the staging classification of ovarian cancer and the reasoning behind those changes 1 x 1 prat, j.
Pathologic tnm and figo classification, staging of tumors of. Results of repeat staging in apparent stage i and ii ovarian cancer initial stage no. Malignant germ cell tumors of the ovary follow the same staging system as epithelial ovarian and primary peritoneal cancers. First, it was recognized that ovarian cancer is not a homogeneous disease, but rather a group of diseaseseach with different morphology and biological behavior. It includes a revision of the stage iii patients and allotment to stage iiia1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination, because an analysis of these patients indicates that their survival is significantly better than those who have. Generally, the higher the stage number, the more the cancer has spread. Staging is very important because ovarian cancers have different prognoses at different stages and are treated differently. Pdf on mar 3, 2018, e c nganga and others published imaging staging of ovarian cancer find, read and cite all the research you need on researchgate.
A new report from figos ijgo discusses updates to the ways in which cancers of the ovaries, fallopian tube and peritoneum are staged. On rectal examination, there is no cancer free space between the tumor and the. Ovarian cancer, the revised figo staging system, and the. Prognostic factors in earlystage ovarian cancer ecancer. A higher number, such as stage iv, means cancer has spread more.
Am e ric an j o int co mmit te e o n can ce r cervix uteri. International federation of gynaecology and obstetrics figo stage i ovarian cancer limited to the ovaries is diagnosed in approximately 20% to 33% of women with ovarian cancer in developed countries maringe 2012 and diagnosis is usually made by accidental discovery at sonography, computerised tomography ct scanning or during laparoscopy. Over the past quarter of a century, several scientific developments have challenged traditional concepts in ovarian cancer. Tumor involves 1 or both ovaries with cytologically or histologically confirmed spread to the peritoneum outside the pelvis andor metastasis to the retroperitoneal lymph nodes old new iiia microscopic metastasis beyond the pelvis. May 23, 2015 staging is very important because ovarian cancers have different prognoses at different stages and are treated differently. The tumornodemetastasis tnm and international federation of gynecology and obstetrics figo classifications for staging ovarian cancer. Committee of figo in 2014 revised the staging of ovarian cancer. The american joint committee on cancer ajcc tnm classification and the international federation of gynecology and obstetrics figo staging system for germ cell tumors are.
Tumor involves 1 or both ovaries with pelvic extension below the pelvic brim. Often the stages 1 to 4 are written as the roman numerals i, ii, iii and iv. Staging criteria for cancer of the ovary, fallopian tube, and peritoneum stage i. Patients upstaged ia 37 16% ib 10 30% ic 2 0% iia 4 100% iib 38 39% iic 9 33% total 100 31% young rc et al. Revised figo staging for carcinoma of the cervix uteri. Although each persons cancer is unique, cancers with similar stages. The revised figo staging incorporates ovarian, fallopian tube, and peritoneal cancer into the same system. Ovarian cancer stages range from stage i 1 through iv 4. Abridged republication of figos staging classification for.