- George L. Mutter
- Jaime Prat
The purpose of tumor staging is two-fold: to provide standardized terminology that allows comparison of patients between centers; and to distribute patients and their tumors into prognostic groups requiring specific treatments. Thus, as new data become available diagnostic methods improve and therapeutic options change, staging systems evolve over time. This appendix lists anatomic staging criteria by primary site effective at the time of publication.
The most widely used staging system for gynecologic malignancies, as presented here, is that of the International Federation of Gynecology and Obstetrics (FIGO). FIGO staging recommendations are endorsed by the American Joint Committee on Cancer (AJCC), the International Union against Cancer (UICC), and the World Health Organization (WHO), who promote concordance with FIGO by incorporating parallel staging elements into their own published systems.
Staging is based upon a variety of information sources including clinical, imaging, surgical-pathological, and biomarker parameters. Individual pathologic specimens are often inadequate for comprehensive staging, either because they lack the full repertoire of required samples or because the pathologist does not have access to relevant ancillary information. In all cases of primary tumor excision, the pathologist should clearly indicate in the pathology report involvement of included anatomic structures that define different disease stages.
| Stage | Anatomic Distribution |
|---|---|
| Stage I | Tumor confined to ovaries or fallopian tube(s). |
| IA | Tumor limited to 1 ovary (capsule intact) or fallopian tube. Surface free of tumor and washings negative. |
| IB | Tumor limited to both ovaries (capsules intact) or fallopian tubes. Surface free of tumor and washings negative. |
| IC | Tumor limited to 1 or both ovaries or fallopian tubes, with any of the following: |
| IC1 | Surgical spill. |
| IC2 | Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface. |
| IC3 | Malignant cells in the ascites or peritoneal washings. |
| Stage II | Tumor involves 1 or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or primary peritoneal cancer. |
| IIA | Extension and/or implants on the uterus and/or fallopian tubes and/or ovaries. |
| IIB | Extension to other pelvic intraperitoneal tissues. |
| Stage III | Cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or metastasis to the retroperitoneal lymph nodes. |
| IIIA | Positive retroperitoneal lymph nodes (cytologically or histologically proven). |
| IIIA1 | |
| IIIA1 (i) | Nodal metastasis ≤10 mm in greatest dimension. |
| IIIA1 (ii) | Nodal metastasis >10 mm in greatest dimension. |
| IIIA2 | Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes. |
| IIIB | Macroscopic peritoneal metastases beyond the pelvic brim ≤2 cm in greatest dimension with or without positive retroperitoneal lymph nodes. |
| IIIC | Macroscopic peritoneal metastases beyond the pelvic brim >2 cm in greatest dimension with or without positive retroperitoneal lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ). |
| Stage IV | Distant metastasis excluding peritoneal metastases. |
| IVA | Pleural effusion with positive cytology. |
| IVB | Metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of abdominal cavity). |
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The primary site should be designated as ovary (OV), fallopian tube (FT), peritoneum (P), or cannot be assessed (“undesignated”).
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Involvement of abdominal organs such as spleen and liver must be distinguished as surface peritoneal spread (Stage III) compared with isolated parenchymal metastases (Stage IVB).
| Stage | Anatomic Distribution |
|---|---|
| Stage I | Tumor confined to the corpus uteri. |
| IA | No myometrial invasion or invasion ≤50% of myometrium thickness. |
| IB | Tumor invades >50% of myometrium thickness. |
| 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 adnexa. * |
| 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. |
* In Stage III disease, positive peritoneal cytology should to be reported separately without changing the stage.
| Stage | Anatomic Distribution |
|---|---|
| Stage I | Tumor limited to uterus. |
| IA | Tumor ≤5 cm. |
| IB | Tumor >5 cm. |
| Stage II | Tumor extends to the pelvis. |
| IIA | Adnexal involvement. |
| IIB | Tumor extends to extrauterine pelvic tissue. |
| Stage III | Tumor invades abdominal tissues. |
| IIIA | One site. |
| IIIB | More than one site. |
| IIIC | Metastasis to pelvic and/or para-aortic lymph nodes. |
| Stage IV | Tumor invades bladder and/or rectum and/or distant metastasis. |
| IVA | Tumor invades bladder and/or rectum. |
| IVB | Distant metastasis. |
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