Figotnm

FIGO is based on surgical staging, TNM on clinical and/or pathological classification. The TNM classification applies only to carcinomas.

pTis carcinoma in situ (= CIN III or adenocarcinoma in situ/high-grade CGIN)

pT1 carcinoma confined to the uterus (extension to the corpus is disregarded)

1a lesions detected only microscopically; maximum size 5 mm deep and 7 mm across; venous or lymphatic permeation does not alter the staging Ia1 <3mm deep, <7mm horizontal axis Ia2 3 mm <tumour depth <5 mm, <7 mm horizontal axis Ib clinically apparent lesions confined to the cervix or preclinical lesions larger than stage IA (occult carcinoma) Ib1 clinical lesions no greater than 4 cm in size Ib2 clinical lesions greater than 4 cm in size pT2 invasive carcinoma extending beyond the uterus but has not reached either lateral pelvic wall. Involvement of uppertwo-thirds of vagina, but not lower third a. without parametrial invasion b. with parametrial invasion

Tumour confined to the uterus < 4 cm

Tumour confined to the uterus < 4 cm

Figure 25.2. Cervical carcinoma. |W

Tumour confined to the uterus > 4 cm

Tumour confined to the uterus > 4 cm

Figure 25.3. Cervical carcinoma. |W

pT3 a. invasive carcinoma extending to either lower third of vagina and/or b. lateral pelvic wall and/or causes hydronephrosis/non-functioning kidney pT4 invasive carcinoma involving mucosa of urinary bladder mucosa and/or rectum* or extends beyond the true pelvis. *Bladder/rectal mucosal involvement requires confirmation by biopsy and involvement of bladder/rectal wall only is pT3a.

Figure 25.4. Cervical carcinoma. |W
Figure 25.5. Cervical carcinoma. |W

pT2b is used for grossly or histologically evident continuous invasion beyond the myometrium into the parametrium and not for parametrial lymphovascular involvement only. "Frozen pelvis" is a clinical term meaning extension to pelvic wall(s), i.e. pT3b. Positive peritoneal fluid is not considered in the TNM/FIGO classification.

Spread is typically to vagina, uterine corpus, parametria, lower urinary tract (ureters) and uterosacral ligaments. Involvement of regional nodes relates to the stage of disease with lungs, brain and bone the commonest (5-10%) sites of distant metastases.

Figure 25.6. Cervical carcinoma. |W

Distance to deep aspect of cervical stroma

Width (mm) = sum of involved serial blocks of standard thickness Tumour volume (mm3) can be estimated by length x depth x width

D = tumour distance (mm) to the Circumferential Radial Margin (CRM) of excision of the parametrium

Figure 25.7. Cervical carcinoma. [QA

Figure 25.8. Cervical carcinoma: regional lymph nodes. ^W

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