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Staging

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.

AJCC FIGO Definition
Tis 0 In situ
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
T2b IIB Cervical stroma
T3 III Local and/or regional as specified below
T3a IIIA Serosa/adnexa/positive peritoneal cytology
T3b IIIB Vaginal involvement
T1/2/3-N1 IIIC Regional lymphnode metastasis
T4 IVA Mucosa of bladder or bowel
M1 IVB Distant metastasis

Placental Tumors

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

AJCC Description Stage
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

Risk Factors

  • 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.