Wednesday, December 24, 2014

Gynecological Tumours Vagina

1. Rules for Classification

The classification applies to primary carcinomas only. Tumours present in the vagina as secondary growths from either genital or extragenital sites are excluded. A tumour that has extended to the portio and reached the external os (orifice of uterus) is classified as carcinoma of the cervix. A tumour involving the vulva is classified as carcinoma of the vulva. There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories:

T categories. Physical examination, endoscopy, and imaging
N categories. Physical examination and imaging
M categories. Physical examination and imaging

The FIGO stages are based on surgical staging. (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. Regional Lymph Nodes

Upper two-thirds of vagina: the pelvic nodes including obturator, internal iliac (hypogastric), external iliac, and pelvic nodes, NOS.

Lower third of vagina: the inguinal and femoral 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 vagina
T2 II Tumour invades paravaginal tissues but does not extend to pelvic wall
T3 III Tumour extends to pelvic wall
T4 IVA Tumour invades mucosa of bladder or rectum, and/or extends beyond the true pelvis
Note: The presence of bullous oedema is not sufficient evidence to classify a tumour as T4.
M1 IVB Distant metastasis

3.2. - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis

3.3. - 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 an inguinal lymphadenectomy specimen will ordinarily include 6 or more lymph nodes; 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





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6. Stage Grouping


Stage 0 Tis N0 M0
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
T1. T2. T3 N1 M0
Stage IVA T4 Any N M0
Stage IVB Any T Any N M1

7. Summary


TNM Vagina FIGO
T1 Vaginal wall I
T2 Paravaginal tissue II
T3 Extends to pelvic wall III
T4 Mucosa of bladder/rectum, beyond pelvis IVA
N1 Regional -
M1 Distant metastasis IVB