atypia with mitotic rate used as a secondary fea-
ture. The benefit would be to provide better repro-
ducibility in the grading of serous ovarian tumors.80
Treatment for IA and IB, grade 1 is surgical staging followed by observation. This group is considered potentially curable with surgery alone, with
cure rates exceeding 90%.75 For patients with grade
2 stage IA or IB disease, observation may be a
consideration depending on the subtype as per the
For stage IA and IB, grade 2, adjuvant che-
Two large, randomized prospective phase 3 tri-
motherapy with a platinum and taxane doublet is
recommended following optimal cytoreduction. In
stage IA and IB, grade 3, stage IC or clear cell
type, adjuvant chemotherapy is recommended
after optimal surgical staging.
Early Gynecologic Oncology Group (GOG) tri-
als validated the use of cisplatin-based chemo-
therapy.81 European groups also pursued this
research, including Gruppo Interregionale Coop-
erative Oncologico Gynecological (GICOG) which
compared cisplatin with a cisplatin-based regimen
in advanced ovarian cancer; their finding sug-
gested that cisplatin by itself was as effective as a
als have demonstrated a benefit of using platinum-
based regimens for adjuvant chemotherapy, the
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 IIIC Regional lymph node metastasis
M0 No distant metastasis
M1 IV Distant metastasis (excluding peritoneal metastasis)
IVA Pleural effusion with positive cytology
IVB Hepatic and/or splenic parenchymal metastasis, metastasis to extra-abdominal organs (including inguinal
lymph nodes and lymph nodes outside of the abdominal cavity)
• The presence of nonmalignant ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.
• Liver capsule metastasis is T3/stage III; liver parenchymal metastasis, M1/stage IV. Pleural effusion must have positive cytology for M1/stage IV.
Other major recommendations for FIGO staging are as follows:
Histologic type including grading should be designated at staging.
Primary site (ovary, fallopian tube or peritoneum) should be designated where possible.
Tumors that may otherwise qualify for stage I but are involved with dense adhesions justify upgrading to stage II if tumor cells are histologically
proven to be present in the adhesions.
Adapted with permission from Ovary and primary peritoneal carcinoma. In: Edge SB, Byrd DR, Compton CC, et al, eds. AJCC cancer staging
manual. 7th ed. New York: Springer-Verlag; 2010:493–506; and Prat J; FIGO Committee on Gynecologic Oncology. Staging classification for cancer
of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014;124: 15.