Updated FIGO Staging for Ovarian Cancer

Introduction to Updated Staging

The 2014 FIGO staging system for ovarian, fallopian tube, and primary peritoneal cancer introduced critical subdivisions that improve prognostic stratification and guide treatment decisions, with the most significant changes being the subdivision of stages IC, IIIA, IIIC, and IV, while eliminating stage IIC 1, 2

Comprehensive surgical staging remains essential and should include bilateral salpingo-oophorectomy 1, hysterectomy 4, omentectomy 1, peritoneal biopsies 4, pelvic and para-aortic lymph node assessment 3, and peritoneal washings (results recorded but no longer affect staging) 1, 3

The American College of Radiology recommends the use of imaging modalities (CT, MRI, PET/CT) for preoperative assessment of disease extent, predicting optimal cytoreduction feasibility, detecting supradiaphragmatic disease (stage IVA), and identifying parenchymal metastases (stage IVB) 4, 5
The National Comprehensive Cancer Network suggests that the revised staging adequately reflects survival with clear statistical separation between stages, including stage IIIC2, which has para-aortic lymph node involvement (with or without pelvic nodes), reflecting worse survival 1, 3