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» Gynecological Tumours Ovary
1. Rules for Classification
The classification applies to malignant surface epithelial-stromal
tumours including those of borderline malignancy or of low
malignant potential (WHO histological classification, 2nd edition,
Scully 1999) corresponding to "common epithelial tumours" of the
earlier terminology. Non-epithelial ovarian cancers may also be
classified using this scheme. There should be histological
confirmation of the disease and division of cases by histological
type.
The following are the procedures for assessing T, N, and M categories:
T categories. Physical 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 classification.)
The definitions of the T, N, and M categories correspond to the FIGO stages.
Both systems are included for comparison.
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 |
T1 |
I |
Tumour limited to the ovaries |
T1a |
IA |
Tumour
limited to one ovary; capsule intact, no tumour on ovarian surface; no
malignant cells in ascites or perito-neal washings |
T1b |
IB |
Tumour limited to both ovaries; capsule intact, no tumour on ovarian surface; no malignant cells in ascites or perito-neal
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 uterus and/or tube(s); no malignant cells in ascites or peritoneal washings |
T2b |
IIB |
Extension to other pelvic tissues; no malignant cells in ascites or peritoneal washings |
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 ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional
lymph node metastasis |
T3a |
IIIA |
Microscopic peritoneal metastasis beyond pelvis |
T3b |
IIIB |
Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension |
T3 and/or N1 |
IIIC |
Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis |
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 lymph nodes are negative, but
the number ordinarily examined is not met, classify as pN0.
5. G Histopathological Grading
See definitions on .
6. Stage Grouping
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 |
Ovary |
FIGO |
T1 |
Limited to the ovaries |
I |
T1a |
One ovary, capsule intact |
IA |
T1b |
Both ovaries, capsule intact |
IB |
T1c |
Capsule ruptured, tumour on surface, malignant cells in ascites or peritoneal washings |
IC |
T2 |
Pelvic extension |
II |
T2a |
Uterus, tube(s) |
IIA |
T2b |
Other pelvic tissues |
IIB |
T2c |
Malignant cells in ascites or peritoneal washings |
IIC |
T3 and/or N1 |
Peritoneal metastasis beyond pelvis and/or regional lymph node metastasis |
III |
T3a |
Microscopic peritoneal metastasis |
IIIA |
T3b |
Macroscopic peritoneal metastasis ≤2 cm |
IIIB |
T3 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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