Staging

Ovarian cancer staging is by the FIGO staging system and uses information obtained after surgery, which can include a total abdominal hysterectomy, removal of (usually) both ovaries and fallopian tubes, (usually) the omentum, and pelvic (peritoneal) washings for cytopathology. The AJCC stage is the same as the FIGO stage. The AJCC staging system describes the extent of the primary Tumor (T), the absence or presence of metastasis to nearby lymph Nodes (N), and the absence or presence of distant Metastasis (M).[43]    

Stage I - limited to one or both ovaries  IA - involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings  IB - involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings  IC - tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings Stage II - pelvic extension or implants  IIA - extension or implants onto uterus or fallopian tube; negative washings  IIB - extension or implants onto other pelvic structures; negative washings  IIC - pelvic extension or implants with positive peritoneal washings Stage III - microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum  IIIA - microscopic peritoneal metastases beyond pelvis  IIIB - macroscopic peritoneal metastases beyond pelvis less than 2 cm in size  IIIC - peritoneal metastases beyond pelvis > 2 cm or lymph node metastases Stage IV - distant metastases to the liver or outside the peritoneal cavity

Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC). As there is only one para-aortic lymph node

In this case. Stage T2a is used to describe a cancerous tumor that has spread to the uterus or the fallopian tubes (or both) but which is not present in the fluid taken from the pelvis. visible only under the microscope (T3a). T. Stages T2b and T2c indicate cancer that metastasized to other pelvic tissues than the uterus and fallopian tubes and which cannot be seen in the fluid taken from the pelvis. T1. N and M. This stage provides information on the size of the metastatic tumors (tumors that are located in other areas of the body. inside or outside the ovary). and which may affect one or both of them. T3 is the stage used to describe cancer that has spread to the peritoneum.intervening before the thoracic duct on the right side of the body. This staging system also uses N categories to describe cancers that have or not spread to nearby lymph nodes. The T1 category of ovarian cancer describes ovarian tumors that are confined to the ovaries. the ovarian cancer can rapidly spread to distant sites such as the lung. There are only two N categories. Cancer that has not affected the capsule. N0 which indicates that the cancerous tumors have not . respectively tumors that spread to any of the pelvic tissues (including uterus and fallopian tubes) but which can also be found in the fluid taken from the pelvis. T2 and T3. each of them being classified according to the place where the tumor has developed (in one or both ovaries. T1c category describes a type of tumor that can affect one or both ovaries. fallopian tubes or other pelvic tissues. the tumor has grown in one or both ovaries and is spread to the uterus. which has left the capsule intact and which cannot be found in the fluid taken from the pelvis. visible but not larger than 2 centimeters (T3b) and bigger than 2 centimeters (T3c). The T category contains three other subcategories. These tumors can be very small. but are caused by ovarian cancer). T2 is a more advanced stage of cancer. The AJCC/TNM staging system includes three categories for ovarian cancer. The sub-subcategory T1a is used to stage cancer that is found in only one ovary. is confined to the inside of the ovaries and cannot be found in the fluid taken from the pelvis but has affected both ovaries is staged as T1b. and which has grown through the capsule of an ovary or it is present in the fluid taken from the pelvis.

[44] Grade 1 tumors have cells that are well . the more likely for this to occur. Grade 0 is used to describe non-invasive tumors. respectively the involvement of the lymph nodes cannot be described because of the same reason. as well as any other type of cancer. The histologic grade of a tumor measures how abnormal or malignant its cells look under the microscope. M0 indicates that the cancer did not spread to distant organs and M1 category is used for cancer that has spread to other organs of the body. apart from staged.[44] There are four grades indicating the likelihood of the cancer to spread and the higher the grade. The AJCC/TNM staging system also contains a Tx and a Nx subcategory which indicates that the extent of the tumor cannot be described because of insufficient data. Grade 0 cancers are also referred to as borderline tumors.affected the lymph nodes. and N1 which indicates the involvement of lymph nodes close to the tumor. The ovarian cancer stages are made up by combining the TNM categories in the following manner:     Stage I: T1+N0+M0  IA: T1a+N0+M0  IB: T1b+N0+M0  IC: T1c+N0+M0 Stage II: T2+N0+M0  IIa: T2a+N0+M0  IIB: T2b+N0+M0  IIC: T2c+N0+M0 Stage III: T3+ N0+M0  IIIA: T3a+ N0+M0  IIIB: T3b+ N0+M0  IIIC: T3c+ N0+M0 or Any T+N1+M0 Stage IV: Any T+ Any N+M1 Ovarian cancer. is also graded. The M categories in the AJCC/TNM staging system provide information on whether the ovarian cancer has metastasized to distant organs such as liver or lungs.

TNM Clinical Classification . referred to as poorly differentiated. endoscopy. N. (TNM stages are based on clinical and/or pathological classification. There should be histological confirmation of the disease.differentiated (look very similar to the normal tissue) and are the ones with the best prognosis. Grade 2 tumors are also called moderately well differentiated and they are made up by cells that resemble the normal tissue.) 2. 3. Grade 3 tumors have the worst prognosis and their cells are abnormal. and imaging N categories. Rules for Classification The classification applies only to primary carcinomas of the vulva. Physical examination. and M categories: T categories. Regional Lymph Nodes The regional lymph nodes are the femoral and inguinal nodes. The following are the procedures for assessing T. A carcinoma of the vulva that has extended to the vagina is classified as carcinoma of the vulva. Physical examination and imaging The FIGO stages are based on surgical staging. Physical examination and imaging M categories. [edit] Vulva TNM 7 Classification TNM 6 Classification 1.

No distant metastasis M1.Regional Lymph Nodes NX.Distant Metastasis MX. Tumour confined to vulva or vulva and perineum. Tumour confined to vulva or vulva and perineum. No evidence of primary tumour Tis. Bilateral regional lymph node metastasis 3. pN. or is fixed to pubic bone 3. more than 2 cm in greatest dimension T3. N. 2 cm or less in greatest dimension and with stromal invasion no greater than 1 mm* T1b. Regional lymph nodes cannot be assessed N0.1. N .Primary Tumour TX. 2 cm or less in greatest dimension and with stromal invasion greater than 1 mm* T2. .3. Distant metastasis cannot be assessed M0. T . and pM categories correspond to the T. upper urethra. vagina.2. and M categories. Tumour confined to vulva or vulva and perineum. 2 cm or less in greatest dimension T1a. anus T4. rectal mucosa. M . Tumour invades any of the following: lower urethra. Tumour confined to vulva or vulva and perineum. pTNM Pathological Classification The pT. Unilateral regional lymph node metastasis N2.3. Primary tumour cannot be assessed T0. Distant metastasis (including pelvic lymph node metastasis) 4. Carcinoma in situ (preinvasive carcinoma) T1. Tumour invades any of the following: bladder mucosa. No regional lymph node metastasis N1.

G Histopathological Grading See definitions on . Summary TNM Vulva T1 T1a T1b T2 T3 T4 N1 N2 M1 Confined to vulva/perineum ”2 cm Stromal invasion ”1. N1 M0 M0 Stage IVA T1. 6. Stage Grouping Stage 0 Stage I Stage IA Stage IB Stage II Stage III Tis T1 T1a T1b T2 T1. Histological examination of an inguinal lymphadenectomy specimen will ordinarily include 6 or more lymph nodes.0 mm Confined to vulva/perineum >2 cm Lower urethra/vagina/anus Unilateral Bilateral Distant metastasis FIGO I IA IB II III III IVA IVB Bladder mucosa/rectal mucosa/upper urethra/bone IVA . T2. If the lymph nodes are negative. 5. T3 N2 T4 Stage IVB Any T Any N M0 Any N M1 7. T2 T3 N0 N0 N0 N0 N0 N1 M0 M0 M0 M0 M0 M0 N0.pN0.0 mm Stromal invasion >1. but the number ordinarily examined is not met. classify as pN0.

and/or distant metastases Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4) *FIGO no longer includes stage 0 (Tis) . 2] (Open Table in a new window) Primary tumor (T) TNM FIGO stages TX T0 Tis* T1 T1a T1b T2 T3a T3b I IA IB II IIIA IIIB IIIC IV T4 IVA Surgical-pathologic findings Primary tumor cannot be assessed No evidence of primary tumor Carcinoma in situ (preinvasive carcinoma) Tumor confined to corpus uteri Tumor limited to endometrium or invades less than one half of the myometrium Tumor invades one half or more of the myometrium Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus** Tumor involves serosa and/or adnexa (direct extension or metastasis) Vaginal involvement (direct extension or metastasis) or parametrial involvement Metastases to pelvic and/or para-aortic lymph nodes Tumor invades bladder mucosa and/or bowel mucosa. Chief Editor: Jules E Harris.[1. MD. MD more... 2011 TNM Classification for Endometrial Cancer The TNM classification for staging of endometrial cancer is provided below.Endometrial Cancer Staging y Author: William T Creasman. Updated: May 20.

or adnexa) Cancer. intraperitoneal disease. or bone metastases.**Endocervical glandular involvement should only be considered as stage I and no longer as stage II Regional lymph nodes (N) TNM FIGO stages NX N0 N1 N2 IIIC1 IIIC2 Surgical-pathologic findings Regional lymph nodes cannot be assessed No regional lymph node metastasis Regional lymph node metastasis to pelvic lymph nodes Regional lymph node metastasis to para-aortic lymph nodes.Net Guide Fallopian Tube Cancer Overview Statistics . vagina. it excludes metastasis to para-aortic lymph nodes. liver. pelvic serosa. with or without positive pelvic lymph nodes Distant metastasis (M) TNM FIGO stages M0 M1 IVB Surgical-pathologic findings No distant metastasis Distant metastasis (includes metastasis to inguinal lymph nodes. or lung.

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12/10 Staging Staging is a way of describing a cancer. Doctors use diagnostic tests to determine the cancer's stage.Net Editorial Board. There are five stages: stage 0 (zero) and stages I through IV (one through four). node (N). TNM is an abbreviation for tumor (T). and if the tumor has spread to other parts the body. T) Has the tumor spread to the lymph nodes? (Node. the lymph nodes around the tumor. so staging may not be complete until all of the tests are finished. One tool that doctors use to describe the stage is the TNM system. There are different stage descriptions for different types of cancer. N) . The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. The results are combined to determine the stage of cancer for each person.Questions to Ask the Doctor Patient Information Resources Fallopian Tube Cancer This section has been reviewed and approved by the Cancer. such as where it is located. This system uses three criteria to judge the stage of the cancer: the tumor itself. Doctors look at these three factors to determine the stage of cancer: y y How large is the primary tumor and where is it located?(Tumor. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). and if it is affecting the functions of other organs in the body. if or where it has spread. and metastasis (M).

a little smaller than 1 inch) or smaller is present outside the pelvis. T3: The tumor involves one or both fallopian tubes and has spread microscopically into the abdominal area outside the pelvis. T3a: Microscopic metastasis is present in the peritoneal area (the area around the organs in the abdomen) beyond the pelvis. T1c: The tumor is in one or both fallopian tubes.y Has the cancer metastasized (spread) to other parts of the body? (Metastasis. T2: The tumor involves one or both fallopian tubes and has spread to the pelvis. Specific tumor stage information is listed below: TX: The primary tumor cannot be evaluated. but no cancer cells are found in the abdominal fluid. T2c: Tumor extensions in the pelvis are present. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Tis: The tumor is carcinoma in situ (early-stage cancer that has not spread to nearby tissue). No part of the tumor has spread to the surface of the tube. This helps the doctor develop the best treatment plan for each individual. and no cancer cells are found in abdominal fluid. such as in T2a or T2b. . Nodes. T2a: Tumor extensions (areas of tumor growth also called implants) are found on the uterus and/or ovaries but no cancer cells are found in the abdominal fluid. T1: The tumor is limited to the fallopian tube(s). the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. bean-shaped organs that help fight infection. but neither tumor is touching a tube surface. M) Tumor. T2b: There is cancer in other pelvic tissue. or cancer cells are found in the abdominal fluid. No cancer cells are found in abdominal fluid. T3b: Metastasis measuring 2 centimeters (cm. T3c: Metastasis larger than 2 cm is present in areas outside the pelvis. Lymph nodes near the pelvis are called regional lymph nodes. The ³N´ in the TNM staging system stands for lymph nodes. T1b: An encapsulated (self-contained) tumor is in both fallopian tubes. T1a: The tumor is contained within one fallopian tube. T0: There is no tumor. but cancer cells are also in the abdominal fluid. but the capsule has ruptured (burst) or the tumor has spread to the tube surface. the tiny. Using the TNM system. Lymph nodes in other parts of the body are called distant lymph nodes.

Stage 0: Refers to carcinoma in situ (Tis. N0. Stage I: Cancer is located only in the fallopian tubes (T1. Stage IIB: Cancer has spread to other pelvic tissue. M0). Stage IIC: Cancer has spread into the pelvic area and is shedding cancer cells into abdominal fluid (T2c. M0). but not to lymph nodes or distant organs (T2b. N0. Stage IA: An encapsulated tumor is located in only one fallopian tube. M0). N0. with no spread to pelvic nodes or other parts of the body (T1b. N. The ³M´ in the TNM system indicates whether the cancer has spread to other parts of the body. Stage IC: Cancer is in one or both fallopian tubes with either a ruptured capsule or tumor spread to the ovarian surface. M0). M0). M0: There is no cancer beyond the peritoneal area. MX: Distant metastasis cannot be evaluated. M0). Stage IIA: Cancer has spread to the uterus or ovaries. N0: There is no cancer in the regional lymph nodes. N0. with no spread to pelvic lymph nodes or other parts of the body (T1a. Metastasis. N0. M0). N0. N0. Stage IIIA: Cancer has spread microscopically throughout the pelvis (T3a.NX: The regional lymph nodes cannot be evaluated. N0. M0). Cancer stage grouping Doctors assign the stage of the cancer by combining the T. N0. Stage II: Cancer is in one or both fallopian tubes and has grown into the pelvis but not elsewhere (T2. Stage IB: An encapsulated tumor is in both fallopian tubes. but not to the pelvic lymph nodes or distant organs (T2a. M0). N1: The cancer has spread to the pelvic lymph nodes. Stage III: Cancer is in one or both fallopian tubes and the pelvis and has spread into the peritoneum but not to distant parts of the body (T3. and M classifications. M0). or cancer cells are in the abdominal fluid (T1c. N0. N0. M1: The cancer has spread beyond the peritoneal area. M0). .

A tumor¶s grade uses the letter ³G´ and a number. but not to other parts of the body (any T. G2: The cells are somewhat different (moderately differentiated).cancerstaging. AJCC TNM staging classification1 The primary tumor (T) is staged in the following way: . M0). The two classification systems are very similar. and describes how closely the cancer cells resemble normal tissue under a microscope.Stage IIIB: Cancer has spread into the peritoneal area with implants that are 2 cm or smaller (T3b. In general. G3: The tumor cells barely resemble normal cells (poorly differentiated). MFA Content provided by Healthwise The staging system for cervical cancer depends on the size of the tumor. Used with permission of the American Joint Committee on Cancer (AJCC). Illinois. Seventh Edition (2010)published by SpringerVerlag New York.www. the extent of the tumor into cell layers (stromal invasion). the lower the grade. Stage IV: Describes any cancer that has spread to distant organs (any T. The original source for this material is the AJCC Cancer Staging Manual. N0. M1). G4: The cells do not look like normal cells (undifferentiated). Cells that look like healthy cells are low grade. N1.net. the better the prognosis. Histologic grade (G). M0). Staging of cervical cancer has been done by the American Joint Committee on Cancer (AJCC) and the Federation Internationale de Gynecologie et d'Obstetrique (FIGO). and spread to other areas of the body (metastasis). and those that look like cancer cells are high grade. 2008 Bets Davis. or the tumor has spread to lymph nodes and/or the pelvis. Chicago. G1: Describes cells that look more like normal tissue cells (well differentiated). Doctors may also assign a grade to the disease. Recurrent: Recurrent cancer is cancer that comes back after treatment. M0). Stages of cervical cancer Date updated: September 05. GX: The tumor grade cannot be identified. Stage IIIC: Describes any cancer that has spread into the peritoneal area in implants larger than 2 cm (T3c. any N. N0.

This is also called microinvasive carcinoma. Visible tumor is more than 4 cm in size. T3b. N0. T1a. Cervical carcinoma is only found in the uterus. The TNM staging system allows a health professional to recommend the most effective treatment options and discuss the long-term outcome (prognosis) based on the type of tumor. T3a. Metastasis to another part of the body has occurred. Distant metastasis cannot be assessed. The TNM system stages metastasis (M) in the following way: MX. Invasive carcinoma diagnosed by microscopy with stromal invasion is no more than 5 mm in depth and 7 mm wide. T2. M0. Visible tumor only on the cervix or microscopic tumor is larger than 5 mm in depth and 7 mm wide. T1a1. T1b1. Lymph nodes near the primary tumor cannot be evaluated. No distant metastasis is found. Lymph node involvement is staged in the following way: NX. Cancer has not spread to lymph nodes near the primary tumor. M1. and/or extends beyond the pelvis. the stage of the cancer. Tumor does not involve the connective tissue (parametrium) around the uterus. Cancer has spread to lymph nodes near the primary tumor. No primary tumor is seen. Tumor invades the lining of the bladder or rectum. or causes a nonfunctioning kidney.y y y TX. Stromal invasion is between 3 mm and 5 mm in depth and 7 mm or less in width. Distant metastasis: The cancer has spread to distant parts of the body. Tumor extends to pelvic wall and/or causes a blocked kidney or a nonfunctioning kidney. Cancer invades beyond the uterus but not to the pelvic wall or the lower third of the vagina. and the woman's age and overall health condition. T4. Stromal invasion is 3 mm or less in depth and 7 mm or less in width. and/or blocks a kidney so urine cannot flow out. the TNM system stages lymph nodeinvolvement (N) to help determine the treatment options at each stage. T3. Primary tumor cannot be assessed. T1b2. M1. N1. Tis (Carcinoma in situ). The cancer is found only in one area of the cervix and only very near surface of the cervix. The last part of staging cervical cancer is to determine whether cancer has spread to other parts of the body (metastasized). T2b. y o   o   y o o y o o y o y y y y y y . T2a. Visible tumor is 4 cm or less in size. This type of cervical cancer is called carcinoma in situ. T1a2. T1. Tumor does extend into the parametrium around the uterus. After the tumor (T) is staged. Tumor involves lower third of vagina but no extension into the pelvic wall. T1b. T0. The tumor extends to the pelvic wall and/or involves the lower third of the vagina.

Tumor involves lower third of vagina but no extension into the pelvic wall. y Stage IA.FIGO staging1 Stage I. Stage IA1. Stage IB2. Cervical carcinoma is only found in the cervix. Stage IIIA. It involves the vagina but not as far as the lower third of the vagina. Stage IVA. Visible tumor only on the cervix or by microscopy is larger than 5 mm deep and 7 mm wide. Invasive carcinoma is diagnosed by microscopy. Stage IIIB. Stage III. Visible tumor is 4 cm or less in size. Cancer has extended onto the pelvic sidewall and involves the lower third of the vagina. Tumor has spread into other pelvic structures such as the bladder or rectum. Tumor does involve the parametrium but not the pelvic sidewall. Stromal invasion is between 3 mm and 5 mm in depth and 7 mm or less in width. but does involve the upper two-thirds of the vagina. Tumor extends onto the pelvic sidewall or causes a blocked kidney or nonfunctioning kidney. Stage IA2. Stage IV. \ o o y o o y y y y y y . Visible tumor is greater than 4 cm in size. or extends beyond the pelvis. Stage III includes tumors that block urine so it cannot flow out of the kidney or that cause a nonfunctioning kidney. Cancer extends beyond the cervix but not onto the pelvic wall. Cancer has spread to distant organs. with the extent of the tumor into cell layers (stromal invasion) no more than 5 mm in depth and 7 mm wide. Stage IB. Stage IB1. Stromal invasion is 3 mm or less in depth and 7 mm or less in width. Tumor invades the lining of the bladder or rectum. Tumor does not involve the connective tissue (parametrium) around the uterus. Stage IVB. Stage IIA. Stage IIB. Stage II.

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