Abstracting Keys

The organs of the true pelvis are the bladder, ureters, urethra, uterus, fallopian tubes, ovaries, vagina and rectum.

The adnexa are the fallopian tubes, ovaries and the supporting ligaments of the internal genitalia.

Involvement of the corpus and cervix is Stage II, sometimes referred to as "corpus et collum."

Metastases to the vagina or ovary are Stage III.

Bullous edema is a blister-like appearance of the interior surface of the bladder or rectum, which is not to be considered evidence of a T4 lesion.

There must be evidence of actual tumor on the interior (mucosal) surface of the bladder or rectum in order for the tumor to be assigned to the T4 (Stage IVA) category.

Seeding, implants, and tumor nodules in the omentum, peritoneum or on the diaphragm are considered distant disease (Stage IV).

Occasionally, it is not possible to determine whether the primary is in the corpus or cervix. In such cases, after all diagnostic workup is complete, assign adenocarcinomas to a corpus primary and epidermal (squamous) carcinomas to a cervical p rimary.

If the operative report states that the adnexa were palpated but gives no mention of nodes, assume that the lymph nodes are negative.

If exploratory or definitive surgery is performed and lymph nodes are not mentioned in the operative report, assume that the lymph nodes are negative.

Postmenopausal bleeding can be assumed to be due to malignancy until proven otherwise.

"Sounding" of the uterus is accomplished by inserting a probe and measuring the distance from the back of the uterine cavity to the external os. The depth may be measured in inches or centimeters. A D & C may also give this information.

The size and depth of the uterus has prognostic significance, but uterine enlargement may also be caused by figroids or adenomyosis. A desciption that the uterus is "the size of xx weeks pregnancy" is not adequate to differentiate stage I tumors.

Both pleural effusion and ascites must be cytologically proven to have an effect on TNM staging.

Endometrioid carcinoma may be primary in the ovary. It should not be coded as metastatic from the endometrium. Review the case carefully for a description of the primary site.

FIGO is the acronym for the French term that means International Federation for Gynecology and Obstetrics. The American Joint Committee on Cancer has developed the tumor (T) component of the TNM staging system to correspond to FIGO staging.