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Intro. | Anatomy | | Treat. | Exercise || Go to Cervical Cancer || | |||||||||
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| ICD-O Codes | Morphology & Grade | Extent of Disease Evaluation | | Abstracting Keys | Unit Review | | |||||||||||
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Intro. | Anatomy | | Treat. | Exercise || Go to Cervical Cancer || | |||||||||
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| ICD-O Codes | Morphology & Grade | Extent of Disease Evaluation | | Abstracting Keys | Unit Review | | |||||||||||
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 |
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.
| T1 | Confined to uterus | Stage I | Stages are subdivided |
| T2 | Other genital structures | Stage II | A without risk factors |
| M1a | Metastasis to lung(s) | Stage III | B with one risk factor |
| M1b | Other distan t metastasis | Stage IV | C with two risk factors |
HCG > 100,000 IU/24 h urine
detection of disease > 6 months from pregnancy
Fore more details on Collaborative Stage, see the CS module.
