Cancer Staging Flashcards
Depth of stromal invasion and groin lymph node involvement in squamous cell carcinoma of vulva.
Figo Staging of Carcinoma of the vulva (modified 2009)
TABLE 24.3: FIGO staging of carcinoma of the vulva (modified 2009).
STAGEI
T1/2 No, Mo. Tumor confined to the vulva
IA
Tumor confined to the vulva or perineum, ≤2 cm in size with stromal invasion ≤1mm*, negative nodes
IB
Tumor confined to the vulva or perineum, >2 cm in size or with stromal invasion >1mm*, negative nodes
STAGE II
T3, No, Mo. Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus).
negative nodes
STAGE III T1-3 N1/2, Mo. Tumor of any size with or without extension to adjacent perineal structures (1/3) lower urethra, 1/3 lower vagina, anus) with positive inguinofemoral lymph nodes
Stage 3A:
Tumor of any size with positive inguinofemoral lymph nodes
■With 1 lymph node metastasis (>=5 mm) or
■With 1-2 lymph node metastasis(es) (<5mm)
Stage 3B:
■With 2 or more lymph nodes metastases (>=5 mm) or
■3 or more lymph nodes metastases (<5 mm)
Stage IIIC
With positive node(s) with extracapsular spread
STAGE IV:
Any T, any N, MI. Tumor invades other regional (2/3 upper urethra, 2/3 upper vagina), or distant structures
Stage IVA:
Tumor invades any of the following:
■2/3 upper urethra, 2/3 upper vagina, bladder mucosa, rectal mucosa, or fixed to pelvic bone or
■Fixed or ulcerated inguinofemoral lymph nodes
Stage IVB:
Any distant metastasis including pelvic lymph nodes
*The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion.
5 year survival rate of Vulval Carcinoma by Stage? And by Node Status?
Staging of Vaginal Carcinoma FIGO (1995)
Involvement of lymph nodes in different stages of Cervix cancer
Staging procedures allowed by Figo in Carcinoma of Cervix
Figo staging of Carcinoma of the Cervix uteri (2018)
TABLE 24.8: FIGO staging of carcinoma of the cervix uteri (2018).
Stage 1:
The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
IA:
Invasive carcinoma that can be diagnosed only by microscopy with maximum depth of invasion <5~mm
IA1:
Measured stromal invasion <3 mm in depth
IA2:
Measured stromal invasion >=3 mm and <5 mm in depth
IB:
Invasive carcinoma with measured deepest invasion >=5 mm (greater than stage IA), lesion limited to the cervix uteri.
IB1:
Invasive carcinoma >=5 mm depth of stromal invasion, and <2 cm in greatest dimension.
IB2:
Invasive carcinoma >=2 cm and <4 cm in greatest dimension
IB3:
Invasive carcinoma ≥4 cm in greatest dimension.
Stage 2:
The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall.
Stage IIA:
Involvement limited to the upper two-thirds of the vagina without parametrial involvement
Stage 2A1:
Invasive carcinoma <4 cm in greatest dimension
Stage IIA2:
Invasive carcinoma ≥4 cm in greatest dimension
Stage IIB:
With parametrial involvement but not up to the pelvic wall
Stage lll:
The carcinoma involves the lower third of the vagina
and/or extends to the pelvic wall
and/or causes hydronephrosis or nonfunctioning kidney
and/or involves pelvic
and/or para-aortic lymph nodes
Stage 3A:
The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall.
Stage 3B:
Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause).
Stage 3c
Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)
Stage 3C1:
Pelvic lymph node metastasis only
Stage 3C2:
Para-aortic lymph node metastasis
Stage IV:
The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to stage IV)
Stage IVA:
Spread to adjacent pelvic organs
Stage IVB:
Spread to distant organs
Management options of Carcinoma of Cervix
Endometrial Cancer Staging
Positive cytology has to be reported separately without changing the stage.
Table 27.11: FIGO 2009 staging of Carcinoma Endometrium
Stage I*
Tumor confined to the corpus uteri
IA*
No or less than half myometrial invasion
IB*
Invasion equal to or more than half of the myometrium
Stage II*
Tumor invades cervical stroma but does not extend beyond the uterus**
Stage III*
Local and/or regional spread of the tumor
IIIA*
Tumor invades the serosa of the corpus uteri and/or adnexae#
IIIB*
Vaginal and/or parametrial involvement#
IIIC*
Metastases to pelvic and/or para-aortic lymph nodes
IIIC1*
Positive pelvic nodes
IIIC2*
Positive para-aortic lymph nodes with or without positive pelvic lymph nodes.
Stage IV*
Tumor invades bladder and/or bowel mucosa, and/or distant metastases
IVA*
Tumor invasion of bladder and/or bowel mucosa
IVB*
Distant metastases including intra- abdominal metastases and/or inguinal lymph nodes
Either G1, G2 or G3.
** Endocervical glandular involvement only should be considered as Stage I and no longer as Stage II.
G1: Grade 1: ≤ 5% of a non-squamous or nonmorular solid growth pattern.
G2: Grade 2: 6-50% of a non-squamous or nonmorular solid growth pattern.
G3: Grade 3: > 50% of a non-squamous or nonmorular solid growth pattern.
- FIGO Anatomic Staging of Gestational Trophoblastic Disease (GTT)
- WHO Prognostic Scoring System of Gestational Trophoblastic disease as modified by FIGO (2000)
TABLE 24.21: FIGO anatomic staging for GTT.
Stage I
The lesion is confined to the uterus
Stage II
The lesion spreads outside the uterus but is confined to the genital organs
Stage III
The lesion metastasizes to the lungs
Stage IV
The lesion metastasizes to sites such as brain, liver or gastrointestinal tract
FIGO Staging of Carcinoma of the Ovary, tube and peritoneum
TABLE 24.29: FIGO staging of carcinoma of the ovary, tube and peritoneum (2018).
Stage l: Tumor confined to ovaries or fallopian tube(s).
T1-NO-MO
1A: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings
T1a-NO-MO
IB: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings
T1b-NO-MO
IC: Tumor limited to 1 or both ovaries or fallopian tubes, with any of the following:
IC1: Surgical spill
T1c1-NO-MO
IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
T1c2-NO-MO
IC3: Malignant cells in the ascites or peritoneal washings
T1c3-NO-MO
Stage II: Tumor involves 1 or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or peritoneal cancer
T2-NO-MO
IIA: Extension and/or implants on uterus and/or fallopian tubes and/or ovaries
T2a-NO-MO
IIB: Extension to other pelvic intraperitoneal tissues
T2b-NO-MO
Stage III: Tumor involves 1 or both ovaries or fallopian tubes, or peritoneal cancer, with cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/ or metastasis to the retroperitoneal lymph nodes
T1/T2-N1-MO
IIIA1: Positive retroperitoneal lymph nodes only (cytologically or histologically proven):
IIIA1 (i) Metastasis up to 10 mm in greatest dimension
IIIA1 (ii) Metastasis more than 10 mm in greatest dimension
IIIA2: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
T3a2-NO/N1-M0
IIIB: Macroscopic peritoneal metastasis beyond the pelvis up to 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes
T3b-NO/N1-MO
IIIC: Macroscopic peritoneal metastasis beyond the pelvis more than 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ)
T3c-NO/N1-MO
Stage IV: Distant metastasis excluding peritoneal metastases
Stage IVA: Pleural effusion with positive cytology
Stage IVB: Parenchymal metastases and metastases to extra- abdominal organs (including inguinal lymph nodes and lymph nodes outside of the abdominal cavity)
Any T, any N, M1
Regional lymph nodes (N)
- NX: Regional lymph nodes (N) cannot be assessed
- NO: No regional lymph node metastasis
- N1: Regional lymph node metastasis
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- MO: No distant metastasis
- M1: Distant metastasis (excluding peritoneal metastasis)
