Die neue FIGO-Klassifikation

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Ivo Meinhold-Heerlein, Aachen

AGO State of the Art 2013

22. Juni 2013
Berlin

Cancer of Ovary, Fallopian Tube and

Peritoneum: FIGO staging
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Deliberations on October 7th, 2012 in Roma at Fieri

Di Roma
FIGO GYNAECOLOGY ONCOLOGY COMMITTEE in
collaboration with ESGO, UICC, AJCC, SGO, GCIG,
IGCS

Cancer of Ovary, Fallopian Tube and

Peritoneum: FIGO staging
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The process of the proposed changes to staging of Ovarian Cancer

(OV), Fallopian Tube (FT) and Primary Peritoneal Cancer (PPC)
started 3 years ago with a proposal that was sent to all relevant
gynaecology oncology organisations and societies throughout the
world and input was collated, evaluated and formulated into the
staging that is presented below.
All suggestions are based on the best AVAILABLE evidence. The
committee acknowledges that there are areas that are not
supported by strong evidence and have been careful to ensure that
changes are not made without quality evidence.
The new staging below was reached by consensus of all participating
in the meeting on October 7th, 2012, some of whom were
representatives of their organisations. The new staging was
presented to the FIGO EXCECUTIVE BOARD on Friday 12th October
2012 and approved two weeks later.
The proposal will now be presented to the boards of UICC and AJCC.
Only once approval has been given from these organisations will
FIGO be able to publish the new staging globally.

Cancer of Ovary, Fallopian Tube and

Peritoneum: FIGO staging
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FIGO
OV
FT
P
X

TNM
Primary tumor, ovary
Tov
Primary tumor, fallopian tube
Tft
Primary tumor, peritoneum
Tp
Primary tumor cannot be assessed Tx

Molecular similarity of
SBOT/SCA-G1 and SCA-G2/3 tumors
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Meinhold-Heerlein et al., 2005:

Molecular and prognostic distinction between serous ovarian tumors of varying grade and malignant potential.
Oncogene 24 (6), 1053-65

Pathogenesis of serous ovarian cancer:

Progression Model
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Type I tumors
Genetically stable
KRAS/BRAF, -Catenin,
PTEN, ErbB2 mutations
LOH Ch1p+Ch19q
Unique gene expression
Type II tumors
De novo
Aggressive
Genetically unstable
TP53 mutations
Unique gene expression
Shih and Kurman, 2005:
Ovarian Tumorigenesis A Proposed Model Based on Morphological and Molecular Genetic Analysis
American Journal of Pathology 164 (5), 1511-18

Fallopian tube:
Origin of high grade ovarian cancer?
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Serous tubal intraepithelial cancers (STICs):

Origin of Type II cancer?
Ovarian cancer is of Mllerian, not mesothelial cell type!
STICs are concomitant and molecular identical
with ovarian cancer.
p53 Mutations in normal tubal tissue identical
with concomitant ovarian cancer.
Peritoneal washings of patients without cancer
showed STIC cells.

Kurman and Shih, 2010:

The Origin and Pathogenesis of Epithelial Ovarian Cancer A Proposed Unifying Theory
American Journal of Surgical Pathology 34 (3), 433-443

Paradigm of serous ovarian cancer development

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Kurman and Shih, 2010:

The Origin and Pathogenesis of Epithelial Ovarian Cancer A Proposed Unifying Theory
American Journal of Surgical Pathology 34 (3), 433-443

Histological subtype
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High Grade Serous (HGS)

Endometrioid (E)
Clear Cell (CC)
Mucinous (M)

Low Grade Serous (LG)

Other or cannot be classified (O)
Germ Cell (GC)
Sex-Cord Stromal Cell Tumor (SC)

FIGO Stage I
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FIGO
I
Tumor confined to ovaries or fallopian tube(s)
Tumor limited to the ovaries (one or both)

TNM
T1

IA

Tumor limited to one ovary (capsule intact) or fallopian tube

No tumor on ovarian or fallopian tube surface
No malignant cells in the ascites or peritoneal washings
Tumour limited to one ovary; capsule intact
No tumour on ovarian surface
No malignant cells in ascites or peritoneal washings

T1a

IB

Tumor limited to both ovaries (capsules intact) or fallopian tubes T1b

No tumor on ovarian or fallopian tube surface
No malignant cells in the ascites or peritoneal washings
Tumour limited to both ovaries; capsule intact
No tumour on ovarian surface
No malignant cells in ascites or peritoneal washings

FIGO Stage I
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New
Old
FIGO
IC Tumor limited to one or both ovaries or fallopian tubes,
with any of the following:
Tumour limited to one or both ovaries with any of the following:
Capsule ruptured, tumour on ovarian surface, malignant cells in
ascites or peritoneal washings
IC1 Surgical spill intraoperatively

IC2 Capsule ruptured before surgery or tumor on ovarian or fallopian

tube surface
IC3 Malignant cells in the ascites or peritoneal washings

TNM
T1c

FIGO Stage II
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New
Old
FIGO
TNM
II Tumor involves one or both ovaries or fallopian tubes with pelvic T2
extension (below pelvic brim) or primary peritoneal cancer (Tp)
Tumour involves one or both ovaries with pelvic extension
IIA Extension and/or implants on the uterus
and/or fallopian tubes/and/or ovaries
Extension and/or implants on uterus and/or tube(s);
no malignant cells in ascites or peritoneal washings

T2a

IIB Extension to other pelvic intraperitoneal tissues

Extension to other pelvic tissues
No malignant cells in ascites or peritoneal washings

T2b

IIC Pelvic extension (IIa or IIb) with malignant cells

in ascites or peritoneal washings

T2c

FIGO Stage III

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New
Old
FIGO
III Tumor involves one or both ovaries, fallopian tubes, or primary
peritoneal cancer, with cytologically or histologically confirmed
spread to the peritoneum outside the pelvis
and/or metastasis to the retroperitoneal lymph nodes
Tumour involves one or both ovaries with microscopically
Confirmed peritoneal metastasis outside the pelvis and / or
regional lymph node metastasis

TNM
T3

FIGO Stage III

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New
Old
FIGO
IIIA

IIIA1

Metastasis to the retroperitoneal lymph nodes with

or without microscopic peritoneal involvement
beyond the pelvis
Microscopic peritoneal metastasis beyond pelvis

TNM
T1, T2,
T3aN1

Positive retroperitoneal lymph nodes only

(cytologically or histologically proven)
IIIA1 (i) Metastasis 10 mm in greatest dimension
IIIA1 (ii) Metastasis > 10 mm in greatest dimension

IIIA2

Microscopic extrapelvic (above the pelvic brim)

peritoneal involvement with or without positive
retroperitoneal lymph nodes

T3a,
T3aN1

FIGO Stage III

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New
Old

IIIB Macroscopic peritoneal metastases beyond the pelvic brim

2 cms in greatest dimension, with or without metastasis
to the retroperitoneal lymph nodes
Macroscopic peritoneal metastasis beyond the pelvis,
2 cm or less in greatest dimension.

T3b/T3bN1

IIIC Macroscopic peritoneal metastases beyond the pelvic brim

T3c/T3cN1

> 2 cms in greatest dimension, with or without metastases

to the retroperitoneal nodes
(includes extension of tumor to capsule of liver and spleen
without parenchymal involvement of either organ)
Peritoneal metastasis beyond pelvis, more than 2 cm in
greatest dimension and / or regional lymph node metastasis

FIGO Stage IV
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IV

Distant metastasis excluding peritoneal metastases

Distant metastasis (excludes peritoneal metastasis)

IVA: Pleural effusion with positive cytology

IVB:

Note:

Metastases to extra-abdominal organs

(including inguinal lymph nodes and
lymph nodes outside of abdominal cavity)
Parenchymal metastases are Stage IV B

Any T, Any N, M1

Stage Grouping
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FIGO
IA
IB
IC
IIA
IIB
IIC
IIIA

IIIB
IIIC
IV

T
T1a
T1b
T1c
T2a
T2b
T2c
T3a
T3a
T3b
T3b
T3c
T3c
Any T

N
N0
N0
N0
N0
N0
N0
N0
N1
N0
N1
N0
N1
Any N

M
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M0
M1

Notes
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1. The primary site - i.e. ovary, fallopian tube or peritoneum

should be designated where possible.
In some cases, it may not be possible to clearly delineate the primary site,
and these should be listed as undesignated.
2. The histologic type of should be recorded.
3. The staging 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 intraperitoneal dissemination.
4. Involvement of retroperitoneal lymph nodes must be proven
cytologically or histologically.
5. Extension of tumor from omentum to spleen or liver (Stage III C)
should be differentiated from isolated parenchymal splenic
or liver metastases (Stage IVB)

Vielen Dank fr die Aufmerksamkeit!

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