A 62-year-old woman presents with a 5 cm right adnexal mass, bilateral pleural effusions, and massive ascites. CA-125 is 980 U/mL. Omentum biopsy reveals papillary serous adenocarcinoma. Peritoneal deposits are noted on CT in the upper abdomen. What is the FIGO stage and the cornerstone of management?

• A Stage II; primary surgery followed by chemotherapy
• B Stage IV; palliative chemotherapy only
• C Stage IIIA; neoadjuvant chemotherapy then surgery
• D Stage IIIC; debulking surgery (cytoreduction) followed by platinum-taxane chemotherapy ✓

Explanation

FIGO stage IIIC ovarian carcinoma is defined by peritoneal metastases beyond the pelvis with retroperitoneal lymph node involvement or macroscopic peritoneal deposits >2 cm. This patient has upper abdominal peritoneal deposits and omental involvement, consistent with Stage IIIC. The standard of care is optimal cytoreductive surgery (residual disease <1 cm) followed by platinum (carboplatin) and taxane (paclitaxel) chemotherapy. Bilateral pleural effusions without cytological confirmation do not automatically upgrade to Stage IV.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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