A 55-year-old post-menopausal woman is found to have a stage IIIC epithelial ovarian carcinoma at staging laparotomy — bilateral ovarian masses with omental cake and peritoneal deposits ≤2 cm after optimal cytoreduction. According to FIGO 2014 staging, what distinguishes stage IIIC from IIIB in epithelial ovarian cancer?

• A Any involvement of the retroperitoneal lymph nodes regardless of tumor size
• B Peritoneal metastases >2 cm and/or retroperitoneal (pelvic or para-aortic) lymph node involvement ✓
• C Extension to pelvic peritoneum only
• D Macroscopic peritoneal metastases beyond pelvis ≤2 cm

Explanation

Under FIGO 2014 ovarian cancer staging: Stage IIIB = macroscopic peritoneal metastases beyond pelvis ≤2 cm ± retroperitoneal nodes; Stage IIIC = macroscopic peritoneal metastases beyond pelvis >2 cm AND/OR regional lymph node metastasis (pelvic or para-aortic). Positive retroperitoneal nodes alone upstage to IIIA1 (new 2014 category) or IIIC depending on nodal size. The distinguishing feature for IIIC is deposits >2 cm or positive lymph nodes.

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

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