International Journal of Gynecology and Obstetrics 105 (2009) 3–4

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International Journal of Gynecology and Obstetrics
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / i j g o

FIGO COMMITTEE ON GYNECOLOGIC ONCOLOGY

Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia
The FIGO Committee on Gynecologic Oncology, in collaboration with various international societies and agencies, has developed and approved new staging for uterine sarcomas— published in the March issue of IJGO [1]. Updated staging for cancer of the vulvar, cervix, and endometrium are also to be published in a forthcoming issue. The current staging for vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia have been included in the April issue so that the most up-to-date FIGO stagings are published consecutively.

Table 1. Carcinoma of the vagina
Carcinoma of the vagina: FIGO nomenclature Stage I Stage II Stage III Stage IV The carcinoma is limited to the vaginal wall The carcinoma has involved the subvaginal tissue but has not extended to the pelvic wall The carcinoma has extended to the pelvic wall The carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edema as such does not permit a case to be allotted to Stage IV. IVa Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis IVb Spread to distant organs FIGO Annual Report, FIGO 26 Vol. Annual Report, Vol. 26

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Table 2. Carcinoma of the fallopian tube
Carcinoma of the Fallopian tube: FIGO nomenclature (Singapore, 1991) Stage 0 Stage I Carcinoma in situ (limited to tubal mucosa) Growth limited to the Fallopian tubes Ia Growth is limited to one tube, with extension into the submucosa and/or muscularis, but not penetrating the serosal surface; no ascites Ib Growth is limited to both tubes, with extension into the submucosa and/or muscularis, but not penetrating the serosal surface; no ascites Ic Tumor either Stage Ia or Ib, but with tumor extension through or onto the tubal serosa, or with ascites present containing malignant cells, or with positive peritoneal washings Growth involving one or both Fallopian tubes with pelvic extension IIa Extension and/or metastasis to the uterus and/or ovaries IIb Extension to other pelvic tissues IIc Tumor either Stage IIa or IIb and with ascites present containing malignant cells or with positive peritoneal washings Tumor involves one or both Fallopian tubes, with peritoneal implants outside the pelvis and/or positive regional lymph nodes. Superficial liver metastasis equals Stage III. Tumor appears limited to the true pelvis, but with histologically-proven malignant extension to the small bowel or omentum IIIa Tumor is grossly limited to the true pelvis, with negative nodes, but with histologically-confirmed microscopic seeding of abdominal peritoneal surfaces IIIb Tumor involving one or both tubes, with histologically-confirmed implants of abdominal peritoneal surfaces, none exceeding 2 cm in diameter. Lymph nodes are negative IIIc Abdominal implants N 2 cm in diameter and/or positive retroperitoneal or inguinal nodes Growth involving one or both Fallopian tubes with distant metastases. If pleural effusion is present, there must be positive cytology to be Stage IV. Parenchymal liver metastases equals Stage IV FIGO Annual Report, Vol. 26 FIGO Annual Report, Vol. 26

Stage II

Stage III

Stage IV

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capsules intact Ica Tumor either Stage Ia or Ib. brain N8 2 or more drugs IJGO Vol. Vol. If pleural effusion is present. Stage IV:9. FIGO staging for uterine sarcomas. or with capsule ruptured. but with histologically confirmed microscopic seeding of abdominal peritoneal surfaces. Suppl. 1 Table 4. or with positive peritoneal washings Tumor involving one or both ovaries with histologically confirmed peritoneal implants outside the pelvis and/or positive regional lymph nodes. or with capsule(s) ruptured. 2000a) FIGO Anatomical Staging Stage I Disease confined to the uterus Stage II GTN extends outside of the uterus. Int J Gynecol Obstet 2009. no ascites present containing malignant cells. 26 IJGO Vol. Carcinoma of the ovary Carcinoma of the ovary: FIGO nomenclature (Rio de Janeiro 1988) Stage I Growth limited to the ovaries Ia Growth limited to one ovary.104(3):179. a patient's diagnosis is allocated to a stage as represented by a Roman numeral I. 26 To stage and allot a risk factor score. with negative nodes. II. Stage II:4. FIGO Annual Report. or ascites. Superficial liver metastases equals Stage III. 26 FIGO Annual Report. This is then separated by a colon from the sum of all the actual risk factor scores expressed in Arabic numerals. Parenchymal liver metastasis equals Stage IV Stage II Stage III Stage IV a In order to evaluate the impact on prognosis of the different criteria for allotting cases to Stage Ic or IIc. or with ascites present containing malignant cells. III. or with positive peritoneal washings Growth involving one or both ovaries with pelvic extension IIa Extension and/or metastases to the uterus and/or tubes IIb Extension to other pelvic tissues IIca Tumor either Stage IIa or IIb. and IV.4 FIGO COMMITTEE ON GYNECOLOGIC ONCOLOGY Table 3. there must be positive cytology to allot a case to Stage IV. No tumor on the external surface. or caused by the surgeon. No tumor on the external surfaces. broad ligament) Stage III GTN extends to the lungs. Gestational trophoblastic neoplasia GTN: FIGO staging and classification (Washington. 95. or histologic proven extension to small bowel or mesentery IIIb Tumor of one or both ovaries with histologically confirmed implants. Tumor is limited to the true pelvis. Suppl. e. 1 FIGO Annual Report. peritoneal metastasis of abdominal peritoneal surfaces. Reference [1] FIGO Committee on Gynecologic Oncology. This stage and score will be alloted for each patient. but with tumor on surface of one or both ovaries. capsule intact Ib Growth limited to both ovaries. 1 IJGO Vol. but with tumor on surface of one or both ovaries. none exceeding 2 cm in diameter. Vol. Suppl. no ascites present containing malignant cells. it would be of value to know if rupture of the capsule was spontaneous. Vol. or with ascites present containing malignant cells. with or without known genital tract involvement Stage IV All other metastatic sites Modified WHO Prognostic Scoring System as Adapted by FIGO Scores Age Antecedent pregnancy Interval months from index pregnancy Pretreatment serum hCG (iu/l) Largest tumor size (including uterus) Site of metastases Number of metastases Previous failed chemotherapy 0 b 40 mole b4 b 103 b3 lung – – 1 ≥ 40 abortion 4–6 103–104 3–4 cm spleen. vagina. . nodes are negative IIIc Peritoneal metastasis beyond the pelvis N2 cm in diameter and/or positive regional lymph nodes Growth involving one or both ovaries with distant metastases.g. kidney 1–4 – 2 – term 7–12 104–105 ≥5 cm gastro-intestinal 5–8 single drug 4 – – N12 N105 – liver. 95. and if the source of malignant cells detected was peritoneal washings. but is limited to the genital structures (adnexa. 95. but with histologically proven malignant extension to small bowel or omentum IIIa Tumor grossly limited to the true pelvis.

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