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» Gynecological Tumours Cervix Uteri
1. Rules for Classification
The classification applies only to carcinomas. There should be
histological confirmation of the disease.
The following are the procedures for assessing T, N, and M
categories:
T categories. Physical examination, cystoscopy,* and imaging
including urography
N categories. Physical examination and imaging
including urography
M categories. Physical examination and imaging
The FIGO stages are based on clinical staging. This includes
histological examination of a cone or amputation of the cervix.
(TNM stages are based on clinical and/or pathological
classification.)
The definitions of the T and M categories correspond to the FIGO
stages. Both systems are included for comparison.
2. Anatomical Subsites
1. Endocervix (C53.0)
2. Exocervix (C53.1)
3. Regional Lymph Nodes
The regional lymph nodes are the paracervical, parametrial,
hypogastric (internal iliac, obturator), common and external iliac,
presacral, and lateral sacral nodes.
4. TNM Clinical Classification
4.1.T - Primary Tumour
TNM Categories |
FIGO Stages |
|
TX |
|
Primary tumour cannot be assessed |
T0 |
|
No evidence of primary tumour |
Tis |
0 |
Carcinoma in situ (preinvasive carcinoma) |
T1 |
I |
Cervical carcinoma confined to uterus (extension to corpus should be disregarded) |
T1a |
IA |
Invasive
carcinoma diagnosed only by microscopy. All macroscopically visible
lesions-even with superficial invasion-are T1b/Stage
IB |
T1a1 |
IA1 |
Stromal invasion no greater than 3.0 mm in depth and 7.0 mm or less in horizontal spread |
T1a2 |
IA2 |
Stromal invasion more than 3.0 mm and not more than 5.0 mm with a horizontal spread 7.0 mm or less Note:
The depth of invasion should not be more than 5 mm taken from the base
of the epithelium, either surface or glandular, from
which it originates. The depth of invasion
is defined as the measurement of the tumour from the epithelial-stromal
junction
of the adjacent most superficial
epithelial papilla to the deepest point of invasion. Vascular space involvement, venous or lymphatic, does not affect classification. |
T1b |
IB |
Clinically visible lesion confined to cervix or microscopic lesion greater than T1a2/IA2 |
T1b1 |
IB1 |
Clinically visible lesion 4.0 cm or less in greatest dimension |
T1b2 |
IB2 |
Clinically visible lesion more than 4 cm in greatest dimension |
T2 |
II |
Tumour invades beyond uterus but not to pelvic wall or to lower third of vagina |
T2a |
IIA |
Without parametrial invasion |
T2b |
IIB |
With parametrial invasion |
T3 |
III |
Tumour extends to pelvic wall, involves lower third of vagina, or causes hydronephrosis or non-functioning kidney |
T3a |
IIIA |
Tumour involves lower third of vagina, no extension to pelvic wall |
T3b |
IIIB |
Tumour extends to pelvic wall or causes hydronephrosis or non-functioning kidney |
T4 |
IVA |
Tumour invades mucosa of bladder or rectum or extends beyond true pelvis Note: The presence of bullous oedema is not sufficient to classify a tumour as T4. The lesion should be confirmed by biopsy. |
M1 |
IVB |
Distant metastasis |
|
4.2. N - Regional Lymph Nodes
NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis
4.3. M - Distant Metastasis
MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis
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5. pTNM Pathological Classification
The pT, pN, and pM categories correspond to the T, N, and M categories.
pN0. Histological examination of a pelvic lymphadenectomy specimen
will ordinarily include 10 or more lymph nodes. If the lymph nodes
are negative, but the number ordinarily examined is not met,
classify as pN0.
6. G Histopathological Grading
GX. Grade of differentiation cannot be assessed
G1. Well differentiated
G2. Moderately differentiated
G3. Poorly differentiated
G4. Undifferentiated
7. Stage Grouping
Stage 0 |
Tis |
N0 |
M0 |
Stage IA |
T1a |
N0 |
M0 |
Stage IA1 |
T1a1 |
N0 |
M0 |
Stage IA2 |
T1a2 |
N0 |
M0 |
Stage IB |
T1b |
N0 |
M0 |
Stage IB1 |
T1b1 |
N0 |
M0 |
Stage IB2 |
T1b2 |
N0 |
M0 |
Stage IIA |
T2a |
N0 |
M0 |
Stage IIB |
T2b |
N0 |
M0 |
Stage IIIA |
T3a |
N0 |
M0 |
Stage IIIB |
T1, T2, T3a |
N1 |
M0 |
T3b |
Any N |
M0 |
Stage IVA |
T4 |
Any N |
M0 |
Stage IVB |
Any T |
Any N |
M1 |
|
8. Summary
TNM |
Cervix Uteri |
FIGO |
Tis |
In situ |
0 |
T1 |
Confined to uterus |
I |
T1a |
Diagnosed only by microscopy |
IA |
T1a1 |
Depth ≤3 mm, horizontal spread ≤7 mm |
IA1 |
T1a2 |
Depth >3-5 mm, horizontal spread ≤7 mm |
IA2 |
T1b |
Clinically visible or microscopic lesion, greater than T1a2 |
IB |
T1b1 |
≤4 cm |
IB1 |
T1b2 |
>4 cm |
IB2 |
T2 |
Beyond uterus but not pelvic wall or lower third vagina |
II |
T2a |
No parametrium |
IIA |
T2b |
Parametrium |
IIB |
T3 |
Lower third vagina/pelvic wall/hydronephrosis |
III |
T3a |
Lower third vagina |
IIIA |
T3b |
Pelvic wall/hydronephrosis |
IIIB |
T4 |
Mucosa of bladder/rectum; beyond true pelvis |
IVA |
N1 |
Regional |
- |
M1 |
Distant metastasis |
IVB |
|
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