FIGO Stage IV Disease
This patient has FIGO Stage IVB ovarian cancer. The pathologic designation pT3cN0M1 directly translates to Stage IVB in the 2014 FIGO staging system because the M1 component indicates distant metastases beyond the peritoneal cavity 1, 2.
Understanding the TNM to FIGO Translation
The pathologic staging breaks down as follows:
- pT3c: Indicates tumor extending beyond the pelvis with peritoneal implants >2 cm in greatest dimension and/or regional lymph node metastasis 1
- N0: No regional lymph node involvement 1
- M1: Distant metastases present 1, 2
Critical Distinction: Stage IVA vs IVB
The 2014 FIGO revision fundamentally subdivided Stage IV disease into two prognostically distinct categories 1, 2:
- Stage IVA: Malignant pleural effusion with positive cytology only 1, 2
- Stage IVB: Parenchymal metastases to extra-abdominal organs (including liver or spleen parenchyma), extra-abdominal metastases (including inguinal or extra-abdominal lymph nodes), transmural bowel involvement with mucosal involvement, or umbilical metastasis 1, 2
Since M1 designation indicates distant metastatic disease and the patient does not have isolated pleural effusion (which would be the only scenario for Stage IVA), this automatically classifies as Stage IVB 1, 2.
Prognostic Implications
High-grade serous carcinomas account for approximately 80-85% of all ovarian carcinomas, and up to 95% of patients with FIGO Stage III-IV disease have this histologic subtype 3. The presence of distant metastases (M1) represents the most advanced stage of disease with the poorest prognosis 4.
Complete macroscopic resection remains the single most important modifiable prognostic factor even in Stage IV disease 4. Patients achieving R0 resection (no visible residual tumor) demonstrate statistically significant improved survival compared to those with any residual disease, regardless of whether residual tumor is 0.1-1 cm or >1 cm 4.
Documentation Requirements
The 2014 FIGO system requires documentation of 1, 2:
- Primary site: ov (ovarian), ft (fallopian tube), or p (peritoneal)
- Histologic subtype: HGSC (high-grade serous carcinoma) in this case
The complete staging notation should read: Stage IVB (ov, HGSC) 1, 2.