Wednesday, December 24, 2014

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