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» Gynecological Tumours Fallopian Tube
Introduction
The following classification for carcinoma of the fallopian tube
is based on that of FIGO adopted in 1992. The definitions of the
T, N, and M categories correspond to the FIGO stages. Both systems
are included for comparison.
1. Rules for Classification
The classification applies only to carcinoma. There should be histological
confirmation of the disease.
The following are the procedures for assessing T, N, and M categories:
T categories. examination, imaging, laparoscopy, and/or surgical exploration
N categories. Physical examination, imaging, laparoscopy, and/or surgical exploration
M categories. Physical examination, imaging, laparoscopy, and/or surgical exploration
The FIGO stages are based on surgical staging. (TNM stages are based on clinical
and/or pathological staging.)
2. Regional Lymph Nodes
The regional lymph nodes are the hypogastric (obturator), common
iliac, external iliac, lateral sacral, para-aortic, and inguinal
nodes.
3. TNM Clinical Classification
3.1. 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 |
Tumour confined to fallopian tube(s) |
T1a |
IA |
Tumour limited to one tube, without penetrating the serosal surface |
T1b |
IB |
Tumour limited to both tubes, without penetrating the serosal surface |
T1c |
IC |
Tumour
limited to one or both tube(s) with extension onto or through the tubal
serosa, or with malignant cells in ascites or peritoneal washings |
T2 |
II |
Tumour involves one or both fallopian tube(s) with pelvic extension |
T2a |
IIA |
Extension and/or metastasis to uterus and/or ovaries |
T2b |
IIB |
Extension to other pelvic structures |
T2c |
IIC |
Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings |
T3 and/or N1 |
III |
Tumour involves one or both fallopian tube(s) with peritoneal implants outside the pelvis and/or positive regional lymph nodes |
T3a |
IIIA |
Microscopic peritoneal metastasis outside the pelvis |
T3b |
IIIB |
Macroscopic peritoneal metastasis outside the pelvis 2 cm or less in greatest dimension |
T3c and/or N1 |
IIIC |
Peritoneal metastasis more than 2 cm in greatest dimension and/or positive regional lymph nodes |
M1 |
IV |
Distant metastasis (excludes peritoneal metastasis) |
|
Note: Liver capsule metastasis is T3/stage III,
liver parenchymal metastasis, M1/ stage IV. Pleural effusion must have
positive cytology for M1/stage IV.
3.2. N - Regional Lymph Nodes
NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis
3.3. M - Distant Metastasis
MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis
4. 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 examined
lymph nodes are negative, but the number ordinarily examined is
not met, classify as pN0.
5. G Histopathological Grading
GX. Grade of differentiation cannot be assessed
G1. Well differentiated
G2. Moderately differentiated
G3. Poorly differentiated
G4. Undifferentiated
6. Stage Grouping
Stage 0 |
Tis |
N0 |
M0 |
Stage IA |
T1a |
N0 |
M0 |
Stage IB |
T1b |
N0 |
M0 |
Stage IC |
T1c |
N0 |
M0 |
Stage IIA |
T2a |
N0 |
M0 |
Stage IIB |
T2b |
N0 |
M0 |
Stage IIC |
T2c |
N0 |
M0 |
Stage IIIA |
T3a |
N0 |
M0 |
Stage IIIB |
T3b |
N0 |
M0 |
Stage IIIC |
T3c |
N0 |
M0 |
Any T |
N1 |
M0 |
Stage IV |
Any T |
Any N |
M1 |
|
7. Summary
TNM |
Fallopian Tube |
FIGO |
T1 |
Limited to tube(s) |
I |
T1a |
One tube; serosa intact |
IA |
T1b |
Both tubes; serosa intact |
IB |
T1c |
Serosa involved; malignant cells in ascites or peritoneal washings |
IC |
T2 |
Pelvic extension |
II |
T2a |
Uterus and/or ovaries |
IIA |
T2b |
Other pelvic structures |
IIB |
T2c |
Malignant cells in ascites or peritoneal washings |
IIC |
T3 and/or N1 |
Peritoneal metastasis outside the pelvis and/or regional lymph node metastasis |
III |
T3a |
Microscopic peritoneal metastasis |
IIIA |
T3b |
Macroscopic peritoneal metastasis ≤2 cm |
IIIB |
T3c and/or N1 |
Peritoneal metastasis >2 cm and/or regional lymph node metastasis |
IIIC |
M1 |
Distant metastasis (excludes peritoneal metastasis) |
IV |
|
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