Extent Of Local Tumour Spread

Border: pushing/infiltrative. Lymphocytic reaction: prominent/sparse.

FIGO/TNM

FIGO is based on clinical staging, TNM on clinical and/or pathological classification. It applies to primary carcinoma of the vagina only excluding secondary growths either by metastasis or direct extension, e.g. from cervix or vulva.

Category of microinvasive carcinoma is not established, although superficial tumours invading <3 mm with no lymphovascular invasion have a low incidence of nodal metastases.

Figure 26.1. Vaginal carcinoma. |W
Figure 26.2. Vaginal carcinoma. |W

pTis carcinoma in situ pT1 tumour confined to the vagina pT2 tumour invades paravaginal tissues but does not extend to pelvic wall pT3 tumour extends to pelvic wall*

pT4 tumour invades mucosa of bladder or rectum, and/or extends beyond the true pelvis.

*The pelvic wall is defined as muscle, fascia, neurovascular structures or skeletal elements of the bony pelvis.

Figure 26.4. Vaginal carcinoma. |W

Invasion of the rectal or bladder wall is pT2, while mucosal involvement is pT4. "Frozen pelvis" is a clinical term meaning tumour extension to the pelvic wall(s) and is classified as pT3.

Spread is mainly by early direct invasion and lymph node metastases, with 50% beyond the vagina (pT2) at presentation and 25% in the rectum or bladder (pT4).

Ml disease is either an upper two-thirds vaginal tumour with inguinal node metastases, or a lower third vaginal tumour with pelvic node metastases. Other distant sites include lung, liver and brain.

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