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]

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
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

  1. 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
  2. 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.
  3. 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.



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