Wednesday, December 24, 2014

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