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

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

affected the lymph nodes, and N1 which indicates the involvement of lymph nodes close to the tumor. 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. 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. 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, respectively the involvement of the lymph nodes cannot be described because of the same reason. 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, as well as any other type of cancer, is also graded, apart from staged. The histologic grade of a tumor measures how abnormal or malignant its cells look under the microscope.[44] There are four grades indicating the likelihood of the cancer to spread and the higher the grade, the more likely for this to occur. Grade 0 is used to describe non-invasive tumors. Grade 0 cancers are also referred to as borderline tumors.[44] Grade 1 tumors have cells that are well

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. Grade 3 tumors have the worst prognosis and their cells are abnormal, referred to as poorly differentiated.
[edit]

Vulva TNM 7 Classification TNM 6 Classification 1. Rules for Classification

The classification applies only to primary carcinomas of the vulva. There should be histological confirmation of the disease. A carcinoma of the vulva that has extended to the vagina is classified as carcinoma of the vulva. The following are the procedures for assessing T, N, and M categories: T categories. Physical examination, endoscopy, and imaging N categories. Physical examination and imaging M categories. Physical examination and imaging The FIGO stages are based on surgical staging. (TNM stages are based on clinical and/or pathological classification.)

2. Regional Lymph Nodes

The regional lymph nodes are the femoral and inguinal nodes.

3. TNM Clinical Classification

3.1. T - Primary Tumour TX. Primary tumour cannot be assessed T0. No evidence of primary tumour Tis. Carcinoma in situ (preinvasive carcinoma) T1. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension T1a. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension and with stromal invasion no greater than 1 mm* T1b. Tumour confined to vulva or vulva and perineum, 2 cm or less in greatest dimension and with stromal invasion greater than 1 mm* T2. Tumour confined to vulva or vulva and perineum, more than 2 cm in greatest dimension T3. Tumour invades any of the following: lower urethra, vagina, anus T4. Tumour invades any of the following: bladder mucosa, rectal mucosa, upper urethra; or is fixed to pubic bone 3.2. N - Regional Lymph Nodes NX. Regional lymph nodes cannot be assessed N0. No regional lymph node metastasis N1. Unilateral regional lymph node metastasis N2. Bilateral regional lymph node metastasis 3.3. M - Distant Metastasis MX. Distant metastasis cannot be assessed M0. No distant metastasis M1. Distant metastasis (including pelvic lymph node metastasis)

4. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of an inguinal lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.

5. G Histopathological Grading
See definitions on .

6. Stage Grouping
Stage 0 Stage I Stage IA Stage IB Stage II Stage III Tis T1 T1a T1b T2 T1. T2 T3 N0 N0 N0 N0 N0 N1 M0 M0 M0 M0 M0 M0

N0. N1 M0 M0

Stage IVA T1. T2. T3 N2 T4 Stage IVB Any T

Any N M0 Any N M1

7. Summary
TNM Vulva T1 T1a T1b T2 T3 T4 N1 N2 M1 Confined to vulva/perineum 2 cm Stromal invasion 1.0 mm Stromal invasion >1.0 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

Endometrial Cancer Staging

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Author: William T Creasman, MD; Chief Editor: Jules E Harris, MD more...
Updated: May 20, 2011

TNM Classification for Endometrial Cancer

The TNM classification for staging of endometrial cancer is provided below.[1, 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, 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)

**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, 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, intraperitoneal disease, or lung, liver, or bone metastases; it excludes metastasis to para-aortic lymph nodes, vagina, pelvic serosa, or adnexa)

Cancer.Net Guide Fallopian Tube Cancer

Overview

Statistics

Medical Illustrations

Risk Factors and Prevention

Symptoms

Diagnosis

Staging

Treatment

Clinical Trials Resources

Side Effects

After Treatment

Current Research

Questions to Ask the Doctor

Patient Information Resources

Fallopian Tube Cancer

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/10

Staging

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. 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). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
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How large is the primary tumor and where is it located?(Tumor, T) Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized (spread) to other parts of the body? (Metastasis, M)

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

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

Stage IIIB: Cancer has spread into the peritoneal area with implants that are 2 cm or smaller (T3b, N0, M0). Stage IIIC: Describes any cancer that has spread into the peritoneal area in implants larger than 2 cm (T3c, N0, M0), or the tumor has spread to lymph nodes and/or the pelvis, but not to other parts of the body (any T, N1, M0). Stage IV: Describes any cancer that has spread to distant organs (any T, any N, M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. Histologic grade (G). Doctors may also assign a grade to the disease. A tumors grade uses the letter G and a number, and describes how closely the cancer cells resemble normal tissue under a microscope. Cells that look like healthy cells are low grade, and those that look like cancer cells are high grade. In general, the lower the grade, the better the prognosis. GX: The tumor grade cannot be identified. G1: Describes cells that look more like normal tissue cells (well differentiated). G2: The cells are somewhat different (moderately differentiated). G3: The tumor cells barely resemble normal cells (poorly differentiated). G4: The cells do not look like normal cells (undifferentiated).
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010)published by SpringerVerlag New York,www.cancerstaging.net.

Stages of cervical cancer

Date updated: September 05, 2008 Bets Davis, MFA Content provided by Healthwise

The staging system for cervical cancer depends on the size of the tumor, the extent of the tumor into cell layers (stromal invasion), and spread to other areas of the body (metastasis). 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). The two classification systems are very similar.

AJCC TNM staging classification1

The primary tumor (T) is staged in the following way:

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

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

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