Ovarian germ cell tumor staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]
Overview
According to the FIGO and TNM cancer staging system, there are 4 stages of ovarian germ cell tumor. Surgery is the mainstay of staging for ovarian germ cell tumors.
Staging
Ovarian germ cell tumor is surgically staged using the FIGO and TNM cancer staging system:[1][2] During the surgical staging, the followings must be evaluated:[3]
- Peritoneal fluid cytology
- Biopsy of any suspicious areas on the peritoneal surfaces
- Retroperitoneal lymph node sampling such as:
- Pelvic
- High para-aortic
- Infracolic
| Primary tumor | ||
|---|---|---|
| Tumor size | FIGO stage | Finding |
| T1 | I | Growth limited to one or both ovaries, |
| T1a | Ia | Growth limited to one ovary; no ascites present containing malignant cells. No tumor on the external surface; capsule intact |
| T1b | Ib | Growth limited to one or both ovaries; no ascites present containing malignant cells. No tumor on the external surfaces; capsules intact |
| T1c | Ic | Tumor either stage Ia or Ib, but with the tumor on surface of one or both ovaries, or with capsule ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings |
| T2 | II | Growth involving one or both ovaries with pelvic extension |
| T2a | IIa | Extension and/or metastases to the uterus and/or tubes |
| T2b | IIb | Extension to other pelvic tissues |
| T2c | IIc | Tumor either stage IIa or IIb, but with the tumor on surface of one or both ovaries, or with capsule(s) ruptured, or with ascites present containing malignant cells, or with positive peritoneal washings |
| T3 | III | Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastases equal stage III. The tumor is limited to the true pelvis, but with histologically proven malignant extension to small bowel or omentum |
| T3a | IIIa2 | Tumor grossly limited to the true pelvis with histologically confirmed microscopic seeding of abdominal peritoneal surfaces, or histologic proven extension to small bowel or mesentery with or without positive retroperitoneal lymph nodes |
| T3b | IIIb | Tumor of one or both ovaries with histologically confirmed implants, peritoneal metastasis of abdominal peritoneal surfaces, none exceeding 2 cm in diameter with or without extension metastasis to the retroperitoneal lymph nodes |
| T3c | IIIc | Peritoneal metastasis beyond the pelvis >2 cm in diameter with or without metastasis to the retroperitoneal lymph nodes (includes the extension of tumor to the capsule of liver and spleen without parenchymal involvement of either organ) |
| AnyT | IV | Growth involving one or both ovaries with distant metastases. If pleural effusion is present, there must be positive cytology to allow a case to stage IV. Parenchymal liver metastasis equals stage IV. |
| Regional lymph node involvement | ||
| Node involvement | FIGO stage | Finding |
| N0 | No lymph node involvement | |
| N0(i+) | Tumor cells are present in regional lymph node(s), no greater than 0.2 mm | |
| N1 | IIIA1 | Histologically confirmed retroperitoneal lymph nodes |
| N1a | IIIA1i | Metastasis <and= 10 mm in greatest dimension |
| N1b | IIIA1ii | Metastasis more than 10 mm in greatest dimension |
| Distant metastasis | ||
| Presence of metastasis | FIGO stage | Finding |
| M0 | No distant metastasis | |
| M1 | IV | Distant metastasis, including positive cytology of pleural effusion; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); and transmural involvement of intestine |
| M1a | IVa | Pleural effusion with positive cytology |
| M1b | IVb | Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine |
- TNM staging of ovarian germ cell tumor:
- M1: Distant metastasis, M1a: Pleural effusion with cytology, M1b: Liver or splenic parenchymal metastases; extra-abdominal metastases; transmural involvement of intestine
| FIGO stage | T | N | M |
| I | T1 | N0 | M0 |
| Ia | T1a | N0 | M0 |
| Ib | T1b | N0 | M0 |
| Ic | T1c | N0 | M0 |
| II | T2 | N0 | M0 |
| IIa | T2a | N0 | M0 |
| IIb | T2b | N0 | M0 |
| IIc | T2c | N0 | M0 |
| III | T3 | N0 | M0 |
| IIIa | T3a | N0/N1 | M0 |
| IIIb | T3b | N0/N1 | M0 |
| IIIc | T3c | N0/N1 | M0 |
| IV | AnyT | AnyN | M1 |
| IVa | AnyT | AnyN | M1a |
| IVb | AnyT | AnyN | M1b |
References
- ↑ Stage Information for Ovarian Germ Cell Tumors. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_8. URL Accessed on November 5, 2015
- ↑ Prat, Jaime (2014). "Staging classification for cancer of the ovary, fallopian tube, and peritoneum". International Journal of Gynecology & Obstetrics. 124 (1): 1–5. doi:10.1016/j.ijgo.2013.10.001. ISSN 0020-7292.
- ↑ Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). "Malignant ovarian germ-cell tumours". Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.