ABSTRACT
Impact of Residual Disease Theoretical Rationale for Maximal Cytoreduction The following theoretical example conceptualizes the effect that debulking surgery may have on a 1-kg stage III ovarian cancer. Such a mass contains an estimated 1012 cells, a size that takes
Table 1 International Federation of Obstetrics and Gynecology Staging for Ovarian Cancer
Stage
I Growth limited to the ovaries IA Growth limited to one ovary; no tumor on external surface; capsule intact; no malignant ascites IB Growth limited to both ovaries; no tumor on external surfaces; capsules intact; no malignant ascites ICa Growth limited to one or both ovaries; tumor on external surfaces or; capsule ruptured or with cytologically malignant ascites or
washings II Growth involving one or both ovaries with pelvic extension
IIA Extension and/or metastases to the uterus and/or tubes IIB Extension to other pelvic tissue IICa Extension to uterus and/or tubes and/or other pelvic tissue with tumor on the surface of one or both ovaries; or with capsule
ruptured or with cytologically malignant ascites or washings III Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive
retroperitoneal or inguinal lymph nodes; metastases to the liver surface equal stage III IIIA Tumor is grossly limited to the true pelvis, with histologically confirmed microscopic seeding to abdominal peritoneal surfaces;
lymph nodes are negative IIIB Abdominal peritoneal implants not exceeding 2 cm in diameter; lymph nodes are negative IIIC Abdominal peritoneal implants exceeding 2 cm in diameter and/or positive retroperitoneal or inguinal lymph nodes
IV Presence of distant metastases including parenchymal liver metastases; if pleural effusions are present, there must be positive cytology to allot the case to stage IV
aFIGO recommends for stages IC and IIC to document if (i) source of the malignant cells was ascites or peritoneal washings and (ii) if rupture of the
capsule was spontaneous or iatrogenic.
