Routine clinical, laboratory, and radiological examinations for gynaecological malignancies are performed for the purpose of tumor detection, diagnosis, and accurate staging, so as to enable optimal treatment planning. Specific radiologic examinations for each malignancy depend on the site, histology, grade, and pattern and extent of spread based on clinical evaluation.
Pre- treatment evaluation / Investigations
Pre-invasive carcinoma/ carcinoma in situ
Tumour confined to cervix.
Micro-invasive (diagnosed only under microscopy), no greater than 3 mmdepth and no wider than 7 mm.
5mm below the basement membrane (BM) and > 7mm in transverse dimension.
5mm below BM and >7mm wide invasive lesion but limited to cervix only.
4 cm in size
4 cm in size
Tumour beyond uterus but not the lower 1/3 of vagina or up to the pelvic side walls.
without Parametrial invasion.
with Parametrial invasion.
Tumour extending upto pelvic wall, lower 1/3 vagina, hydro-nephrosis or non-functioning kidney.
No extension to pelvic wall but involved lower 3rd vagina.
Extension to pelvic side wall, hydronephrosis or non-functioning kidney.
Invasion of bladder and/or rectum.
Disease outside pelvis. Para-aortic nodes are regarded as distant metastasis.
Investigations and Work-up for Ovarian Cancer
Staging: Ovarian carcinoma is a surgico-pathologically staged cancer. It requires a laparotomy with a thorough examination of the abdominal cavity. If disease appears confined to the ovary, biopsy of the diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum, para-aortic and pelvic nodes, infracolicomentum are required in addition to peritoneal washings. In the event the patient receives chemotherapy prior to surgery, clinical staging is followed. However, every effort must be made to stage the disease as accurately as possible by imaging studies or laparoscopic evaluation.
Stage I: Growth limited to the ovaries
1A: Growth limited to one ovary; no tumour on the external surface; capsule intact; no ascites.
1B: Growth limited to both ovaries; no tumour on the external surface; capsule intact; no ascites
IC: IA or IB but with tumour on the surface of one or both ovaries; rupture of capsule; malignant ascites or positive peritoneal washings
Stage II: Growth involving ovaries with pelvic extension
IIA: Extension/metastases to uterus and or tubes
IIB: Extension to the pelvis.
IIC: IIa or lIb but with tumour on the surface of one or both ovaries; rupture of capsule; malignant ascites or positive peritoneal washings
Stage III: Tumour involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal lymph nodes. Superficial liver metastases equals stage
III. Tumour is limited to true pelvis but with histologically verified malignant extension to small bowel or omentum
IlIA: Tumour grossly limited to the true pelvis with negative nodes but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces"
IIIB: Tumour of one or both ovaries with histologically confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter. Nodes negative.
IIIC: Abdominal implants greater than 2 cm in diameter and/or positive retroperitoneal or inguinal nodes
Stage IV: Growth involving one or both ovaries with distant metastases. If pleural effusion is present, cytological test results must be positive to allot a case to stage IV. Parenchymal liver metastases equals stage IV.