Wednesday, December 24, 2014

Gynecological Tumours Vulva

1. Rules for Classification


The classification applies only to primary carcinomas of the vulva. There should be histological confirmation of the disease.

A carcinoma of the vulva that has extended to the vagina is classified as carcinoma of the vulva.

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.)


2. Regional Lymph Nodes

The regional lymph nodes are the femoral and inguinal nodes.


3. TNM Clinical Classification

3.1. T - Primary Tumour

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ (preinvasive carcinoma)
T1. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension
T1a. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension and with stromal invasion no greater than 1 mm*
T1b. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension and with stromal invasion greater than 1 mm*
T2. Tumour confined to vulva or vulva and perineum, more than 2 cm in greatest dimension
T3. Tumour invades any of the following: lower urethra, vagina, anus
T4. Tumour invades any of the following: bladder mucosa, rectal mucosa, upper urethra; or is fixed to pubic bone

3.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Unilateral regional lymph node metastasis
N2. Bilateral regional lymph node metastasis

3.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis (including pelvic lymph node 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. 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 0 Tis N0 M0
Stage I T1 N0 M0
Stage IA T1a N0 M0
Stage IB T1b N0 M0
Stage II T2 N0 M0
Stage III T1. T2 N1 M0
T3 N0. N1 M0
Stage IVA T1. T2. T3 N2 M0
T4 Any N M0
Stage IVB Any T Any N M1


7. Summary


TNM Vulva FIGO
T1 Confined to vulva/perineum ≤2 cm I
T1a Stromal invasion ≤1.0 mm IA
T1b Stromal invasion >1.0 mm IB
T2 Confined to vulva/perineum >2 cm II
T3 Lower urethra/vagina/anus III
T4 Bladder mucosa/rectal mucosa/upper urethra/bone IVA
N1 Unilateral III
N2 Bilateral IVA
M1 Distant metastasis IVB




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