T1 I Tumour limited to ovaries
T1a IA Tumour limited to one ovary; capsule intact, no tumour on ovarian surface; no malignant cells in ascites or peritoneal washings
T1b IB Tumour limited to both ovaries; capsule intake, no tumour on ovarian surface; no malignant cells in ascites or peritoneal washings
T1c IC Tumour limited to one or both ovaries with any of the following: capsule ruptured, tumour on ovarian surface;
malignant cells in ascites or peritoneal washings
T2 II Tumour involves one or both ovaries with pelvic extension
T2a IIA Extension and/or implants on the uterus and/or tubes; no malignant cells in ascites or peritoneal washings
T2b IIB Extension to other pelvic tissue; no malignant cells in ascites or peritoneal washings
T2c IIC Pelvic extension (2a or 2b); malignant cells in ascites or peritoneal washings
T3 III Tumour limited to one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional lymph node metastasis
T3a: N1 IIIA Microscopic peritoneal metastasis beyond pelvis
T3b IIIB Macroscopic peritoneal metastasis beyond pelvis 2.0 cm or less in greatest dimension
T3c IIIC Peritoneal metastasis beyond pelvis more than 2.0 cm in greatest dimension and/or lymph node metastasis
N0 No regional lymph node metastases
N1 IIIC Regional lymph node metastases
M0 No distant metastasis
M1 IV Distant metastasis (excludes peritoneal metastasis)
Note: There is discontinuity in the TNM staging progression with respect to malignant ascites as Stage T1c indicates the presence of malignant ascites but It is absent in Stages T2a and T2b.
and other features include thick walls, septations and papillary projections. For example, papillary projections are seen in 92% of malignant ovarian tumours. Pelvic organ invasion, implants, ascites and enlarged lymph nodes increase the diagnostic confidence of malignancy.
The cystic components of malignant ovarian tumours have a variable signal intensity but are usually low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images.
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