Criteria for TNM Clinical Staging: Physical examination and history, palpation of abdomen, abdominal imaging, endoscopy, colposcopy, endocervical curettage, fractional curettage, sounding of uterine cavity, intravenous urography, imaging for distant metastases, and histologic confirmation of malignancy
Criteria for TNM Pathologic Staging: Hysterectomy with or without dissection of pelvic lymph nodes.
Staging for uterine tumors applies only to carcinomas.
|T1||I||Confined to corpus|
|T1a||IA||Limited to endometrium|
|T1b||IB||= < half of myometrium|
|T1c||IC||> half of myometrium|
|T2||II||Extension to cervix|
|T2a||IIA||Endocervical glandular only|
|T3||III||Local and/or regional as specified below|
|T3a||IIIA||Serosa/adnexa/positive peritoneal cytology|
|T1/2/3-N1||IIIC||Regional lymphnode metastasis|
|T4||IVA||Mucosa of bladder or bowel|
The US Trophoblastic Disease Centers have developed a clinical staging system based on the following criteria:
- Duration of disease
- Presence of liver or brain metastases
- HCG titer level
- Treatment with chemotherapy
- Occurrence after a full-term pregnancy
Cases are grouped into nonmetastatic and metastatic, which is further subdivided into low risk and high risk.
- Nonmetastatic: tumor confined to the uterus
- Metastatic, good prognosis: last pregnancy less than 4 months
- prior;HCG titer low; no liver or brain metastases; no prior chemotherapy
- Metastatic, poor prognosis: last pregnancy more than
- 4 months prior; high HCG titer; liver or brain metastases;
- prior chemotherapy; occurrence after a full-term pregnancy
A second system proposed by the World Health Organization is a scoring system that determines low-, medium- and high-risk patients, based on such factors as age, previous pregnancy, HCG titer, blood group, size of tumor, metastatic sites, number of metastases, interval between end of previous pregnancy and start of chemotherapy, and history of chemotherapy.
The TNM staging system for Gestational Trophoblastic Tumors is new in the fifth edition.
Brief Summaries of 5th Edition Categories
|T1||Confined to uterus||Stage I|
|T2||Other genital structures||Stage II|
|M1a||Metastasis to lung(s)||Stage III|
|M1b||Other distant metastasis||Stage IV|
- HCG > 100,000 IU/24 h urine
- detection of disease > 6 months from pregnancy
Collaborative Stage Elements
For more details on Collaborative Stage, see the Intro to Collaborative Staging module.