The following entities are distinguished according to histologic criteria:
- Borderline and epithelial tumors (60-80% of all ovarian cancers, age-dependent: Increase with increasing age)
- Endometrioid carcinoma
- De-differentiated carcinoma
- Mixed carcinoma
- Clear cell carcinoma
- Mucinous carcinoma
- Squamous epithelial
- Low-grade serous carcinoma – when low-grade serous carcinoma (LGSC) is indicated, additional subclassification should be made between carcinoma and invasive implants of a borderline serous tumor (WHO 2004)
- Undifferentiated/unclassified carcinoma.
- Transitional cell carcinoma
- Germline stromal carcinomas (about 5% of all ovarian carcinomas, 2/3 are hormone active (estrogen, progesterone, testosterone and others, no age dependence)).
- Granulosa stromal cell tumors
- Granulosa cell tumor
- Adult type
- Juvenile type
- Tumor of the thekom fibroma group
- Thekom
- Fibroma
- Fibrosarcoma
- Granulosa cell tumor
- Sertoli stromal cell tumors
- Sertoli stromal cell tumor
- Leydig cell tumor
- Sertoli-Leydig cell tumor
- Gynandroblastoma
- Steroid cell tumor
- Granulosa stromal cell tumors
- Germ cell tumors (approximately 3-5% of all ovarian cancers, peak age: 18-23 years).
- Chorionic carcinoma
- Dysgerminoma
- Endodermal sinus tumor (yolk sac tumor, yolk sac tumor = YST).
- Glandular
- Hepatoid
- Embryonal carcinoma
- Mixed germ cell tumors
- Polyembryoma
- Teratoma
- mature
- Fetiform (homunculus)
- Solid
- Cystic(dermoid cyst)
- Immature
- monodermal specialized
- Carcinoid
- Struma ovarii
- mature
- Metastases (about 15%)
- Endometrial carcinoma (cancer of the uterus)
- Gastrointestinal carcinoma (cancer of the gastrointestinal tract).
- Mammary carcinoma (breast cancer)
WHO classification (2003): staging.
TNM | Criteria | |
T1 | Tumor limited to the ovaries (ovaries) | |
1a |
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1b |
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1c |
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T2 | Tumor affects one or both ovaries and spreads to the lesser pelvis | |
2a | Spread to and/or implants on the uterus and/or fallopian tubes | |
2b | Spread to other tissues of the lesser pelvis | |
2c |
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T3 |
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3a | Microscopic peritoneal metastases outside the pelvis | |
3b |
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3c |
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Nx | No statement can be made about regional lymph node metastases | |
N0 | No metastases in the regional lymph nodes | |
N1 | Metastases in the regional lymph nodes | |
M0 | no distant metastases | |
M1 | Distant metastases |
It is expected that the TNM classification will be aligned with the FIGO classification in the near future. FIGO classification (2014): staging.
FIGO stage | Criteria | |||
I | Tumor confined to the ovaries (ovaries) | |||
A |
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B | Tumor confined to both ovaries, otherwise as IA. | |||
C | Tumor confined to one or both ovaries | |||
1 | iatrogenic capsular rupture | |||
2 | Perioperative capsular rupture or tumor on ovarian surface | |||
3 | Malignant (malignant) cells in ascites or in flush cytology | |||
II |
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A | Spread to and/or implants on the uterus and/or fallopian tubes | |||
B | Spread to other pelvic tissues | |||
III |
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A | Retroperitoneal lymph node metastases and/or microscopic metastases outside the pelvis | |||
1 | Retroperitoneal lymph node metastases only. | |||
i | Metastases ≤ 10 mm | |||
ii | Metastases > 10 mm | |||
2 | Microscopically detectable spread to the peritoneum (abdominal cavity) outside the lesser pelvis with or without retroperitoneal lymph node metastases | |||
B | Macroscopic spread to the peritoneum outside the lesser pelvis ≤ 2 cm with or without retroperitoneal lymph node metastases (includes spread to the liver capsule and spleen) | |||
C | Macroscopic spread to the peritoneum outside the lesser pelvis > 2 cm with or without retroperitoneal lymph node metastases (includes spread to the liver capsule and spleen) | |||
IV | Distant metastases with the exception of peritoneal metastases. | |||
A | Pleural effusion with positive cytology | |||
B |
FIGO: International Federation of Gynecology and ObstetricsNote: Stage II C of the old FIGO classification is omitted. The following grading (assessment of the degree of differentiation of tumor tissue) is performed for ovarian cancer:
- G1 – well-differentiated tissue
- G2 – moderately differentiated tissue.
- G3 – poorly differentiated tissue
- G4 – undifferentiated tissue
TNM classification (2017) and FIGO classification.
TNM | FIGO | Definition |
TX | Primary tumor not known, no information available | |
T0 | No evidence of tumor | |
T1 | I | Tumor confined to the ovaries (ovary) or tubes (fallopian tubes) |
T1a | IA | Tumor confined to one ovary (capsule intact) or one tube (serosa intact), ovarian or tubal surface tumor-free, negative purge cytology |
T1b | IB | Tumor involvement of both ovaries (capsule intact) or both tubes (serosa intact), ovarian or tubal surface tumor-free, negative purge cytology |
T1c | IC | Tumor affecting one or both ovaries or tubes with evidence of any of the following: |
T1c1 | IC1 | Iatrogenic capsular (serous) rupture |
T1c2 | IC2 | Preoperative capsular (serous) rupture or tumor on ovarian or tubal surface |
T1c3 | IC3 | Malignant cells detectable in ascites (abdominal dropsy) or on irrigation cytology |
T2 | II | Tumor affecting one or both ovaries or tubes with cytologically or histologically proven spread to the lesser pelvis or primary peritoneal carcinoma |
T2a | IIA | Spread and/or tumor implants to uterus (womb) and/or tubes and/or ovaries |
T2b | IIB | Spread to other intraperitoneal structures in the area of the small pelvis |
Summary of the graduation of carcinomas according to the 2014 World Health Organization (WHO) classification.
Graduation | Explanation/Remark | |
Serious | “Low-grade” (G 1) | – – |
“High-grade” (G3) | – – | |
Mucinous | No uniform graduation according to WHO | In practice, often graduation based on endometrioid carcinomas |
Seromucinous | Not yet established | – – |
Endometrioid | G1, G2, G3 | – – |
Clear cell | Always G3 | – – |
Malignant Brenner tumor | No graduation | – – |
Undifferentiated carcinomas and carcinosarcomas. | No graduation, considered highly malignant | – – |