A 55-year-old post-menopausal woman is staged surgically for ovarian cancer. Histology confirms high-grade serous carcinoma. Intraoperative findings: bilateral ovarian involvement, omental cake, no extraperitoneal spread, with ascites cytology positive. According to FIGO 2014 staging, this is:

• A Stage IIIA1
• B Stage IIIB
• C Stage IVA
• D Stage IIIC ✓

Explanation

FIGO 2014 ovarian cancer staging: Stage III involves peritoneal spread beyond the pelvis and/or retroperitoneal lymph node metastases. Stage IIIA1 = retroperitoneal LN only; IIIA2 = microscopic extra-pelvic peritoneal mets; IIIB = macroscopic peritoneal mets ≤2 cm; IIIC = macroscopic peritoneal mets >2 cm (including omental spread). An omental cake (large omental mass) constitutes macroscopic peritoneal metastases >2 cm, classifying this as Stage IIIC.

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

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