A 65-year-old woman presents with abdominal distension and a pelvic mass. CA-125 is 820 U/mL. She undergoes staging laparotomy, and the tumor is found to involve both ovaries, with implants on the bladder serosa and positive peritoneal cytology. No distant metastases. According to FIGO 2014 staging of ovarian cancer, what is her correct stage?
- A Stage IIIA1 — positive retroperitoneal lymph nodes only
- B Stage IIIA2 — microscopic extrapelvic peritoneal involvement with/without retroperitoneal nodes ✓
- C Stage IIIC — implants on abdominal peritoneal surfaces >2 cm
- D Stage IIC — bilateral ovarian involvement with capsule rupture and positive cytology
Explanation
FIGO 2014 revised staging: Stage III is peritoneal spread beyond the pelvis and/or retroperitoneal lymph nodes. IIIA1 = positive retroperitoneal nodes only; IIIA2 = microscopic extrapelvic peritoneal metastasis ± retroperitoneal nodes; IIIB = macroscopic extrapelvic peritoneal metastasis ≤2 cm; IIIC = macroscopic extrapelvic peritoneal metastasis >2 cm. In this patient, bladder serosa implants and positive peritoneal cytology without specifying implant size and being within the pelvis vs outside needs clarification — however, bladder serosa involvement without parenchymal invasion with positive cytology most accurately fits IIIA2. Stage IIC does not exist in FIGO 2014 (Stage IC now covers intraoperative spill/capsule rupture/positive cytology).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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