GYN Staging

What is this?

Vulva

• Complete vulvectomy

What type of specimen is this?

Partial vulvectomy

What type of specimen is this?

Vulvectomy

What defines pT1 vulva specimens?

Tumor is confined to the vulva

What are the two subtypes of pT1 vulva specimens?

pT1a — Tumor size ≤2 cm, stromal invasion ≤1 mm

pT1b — Tumor size >2 cm, stromal invasion >1 mm

How is depth of invasion measured for vulva specimens?

Measured from the basement membrane of the deepest adjacent tumor-free rete ridge to the deepest point of invasion

What defines pT2 vulva specimens?

Any size w/ extension to:

• Lower 1/3 of urethra

• Lower 1/3 of vagina, or

• Anus

What defines pT3 vulva specimens?

Any size w/ extension with any of the following:

• Upper 2/3 of urethra

• Upper 2/3 of vagina

• Bladder mucosa

• Rectal mucosa

What defines pT4 vulva specimens?

Tumor fixed to pelvic bone

What defines pN0(i+) vulva specimens?

Isolated tumor cells in regional LN(s) ≤0.3 mm, OR

Single cells or clusters of cells ≤200 cells in a single LN cross-section

What defines pN1 vulva specimens and the subcategories?

Tumor involved of non-fixed, non-ulcerated regional LNs

• pN1mi

• pN1a

• pN1b

• pN1c

What FIGO stage do the pN1 determine for vulva specimens?

pN1 — III

• pN1mi — IIIA

• pN1a — IIIA

• pN1b — IIIB

• pN1c — IIIC

What defines pN1mi vulva specimens?

Involvement >0.2 mm BUT ≤2.0 mm in diameter

What defines pN1a vulva specimens?

Involvement >2 mm BUT ≤5 mm of regional LNs

What defines pN1b vulva specimens?

Involvement >5 mm of regional LNs

What defines pN1c vulva specimens?

Involvement of regional LNs w/ ENE

What defines pN2 vulva specimens and FIGO stage?

Involvement of fixed or ulcerated regional LNs

FIGO stage — IVA

What is the minimum number of lymph nodes commonly expected in an inguinofemoral lymphadenectomy?

6 or more lymph nodes are usually included

• If fewer are identified and all are negative, the pN category may not be assigned

What defines cM1 and pM1 for vulva specimens, including the FIGO stage?

cM1 — Distant mets

pM1 — Microscopic confirmation of distant mets

FIGO stage — IVB

Which lymph nodes are considered sites of regional spread for vulva specimens?

Femoral LNs

Inguinal LNs

What is this?

Vaginal carcinoma

Where do vulva specimens spread towards?

Up towards the vagina, urethra, and rectum

(SIZE MATTERS)

What is the FIGO stage for pT1 vulva specimens?

pT1 — I

• pT1a — IA

• pT1b — IB

What is the FIGO stage for pT2 vulva specimens?

Stage II

What is the FIGO stage for pT3 vulva specimens?

Stage IIIA

What is the FIGO stage for pT4 vulva specimens?

Stage IVA

What defines pT1 vaginal tumors?

Confined to the vagina

• pT1a — ≤2.0 cm

• pT1b — >2.0 cm

What defines pT2 vaginal tumors?

Invades paravaginal tissues but NOT the pelvic sidewall

• pT2a — ≤2.0 cm

• pT2b — >2.0 cm

What is considered the pelvic sidewall?

Defined as the:

• Muscle

• Fascia

• Neurovascular structures, or

• Skeletal portions

of the bony pelvis

What defines pT3 vaginal tumors?

Extends to the pelvis sidewall and/or causes:

• Hydronephrosis, or

• Nonfunctioning kidney

What defines pT4 vaginal tumors?

Invades the mucosa of the bladder or rectum and/or extending beyond the true pelvis

What defines pN0(i+) vaginal tumors?

Isolated tumor cells in regional LN(s) <0.2 mm

What defines pN1 vaginal tumor?

Pelvic or inguinal LN mets

What defines pM1 vaginal tumor?

Distant mets

What regional LNs are considered for upper two-thirds of the vagina?

Pelvic NOS

Parametrial

Obturator

Internal iliac (hypogastric)

External iliac

Common iliac

Sacral

Presacral

Para-aortic

What regional LNs are considered for lower one-thirds of the vagina?

Femoral

Inguinal

What defines a FIGO stage I for vaginal tumor?

Any size confined to the vagina

What defines a FIGO stage II for vaginal tumor?

Any size that invades paravaginal tissue but NOT the pelvic sidewall

What defines a FIGO stage III for vaginal tumor?

Extends to the pelvic sidewall and/or

Involve the lower third of the vagina and/or

Causes hydronephrosis or non-functioning kidney or

T1-T3 tumor involving pelvic or inguinal LNs (N1) but NOT distant mets

What defines a FIGO stage IV for vaginal tumor?

Extends beyond the true pelvis, or

Involves the bladder and rectal mucosa

What defines a FIGO stage IVA for vaginal tumor?

Invades:

• Bladder and/or

• Rectal mucosa and/or

• Extend beyond the true pelvis

Regardless of LN involvement (any N)

What defines a FIGO stage IVB for vaginal tumor?

Any size with spread of distant mets (M1)

Any T

Any N

What is this?

Cervix carcinoma

What defines pT1 cervical carcinoma and FIGO stage?

Strictly confined to the cervix

• Extension to the corpus should be disregarded

Stage I

What defines pT1a cervical carcinoma and FIGO stage?

Able to be diagnosed ONLY by microscopy w/ max depth of invasion ≤5 mm

Stage IA

What defines pT1a1 cervical carcinoma and FIGO stage?

Measured stromal invasion ≤3 mm in depth

Stage IA1

What defines pT1a2 cervical carcinoma and FIGO stage?

3 mm < X ≤ 5 mm

Stage IA2

What defines pT1b cervical carcinoma and FIGO stage?

Deepest invasion >5 mm

• Lesion limited to the cervix

• Involved of vascular/lymphatics spaces does NOT change the staging

• Lateral extent is NOT considered

Stage IB

What defines pT1b1 cervical carcinoma and FIGO stage?

5 mm < X ≤ 2 cm

Stage IB1

What defines pT1b2 cervical carcinoma and FIGO stage?

2 cm < X ≤ 4 cm

Stage IB2

What defines pT1b3 cervical carcinoma and FIGO stage?

X > 4 cm

Stage IB3

What defines pT2 cervical carcinoma and FIGO stage?

Invades beyond the uterus

• Does NOT extend to lower third of the vagina or the pelvic wall

Stage II

What defines pT2a cervical carcinoma and FIGO stage?

Limited to upper two-thirds of the vagina WITHOUT parametrial invasion

Stage IIA

What defines pT2a1 cervical carcinoma and FIGO stage?

≤ 4 cm

Stage IIA1

What defines pT2a2 cervical carcinoma and FIGO stage?

> 4 cm

Stage IIA2

What defines pT2b cervical carcinoma and FIGO stage?

WITH parametrial invasion but NOT to the pelvic wall

Stage IIB

What defines pT3 cervical carcinoma and FIGO stage?

Involves the lower third of the vagina and/or

Extends to the pelvic wall and/or

Causes hydronephrosis or nonfunctioning kidney

Stage III

What defines pT3a cervical carcinoma and FIGO stage?

Involves lower third of the vagina WITHOUT extension to pelvic wall

Stage IIIA

What defines pT3b cervical carcinoma and FIGO stage?

Extension to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney

Stage IIIB

What defines pT4 cervical carcinoma and FIGO stage?

Involves the:

• Mucosa of the bladder

• Rectum, or

• Spread to adjacent organs

Stage IV

What defines pN0(i+) cervical carcinoma?

Isolated tumor cells in regional LN(s)

• ≤ 0.2 mm

• Single cells or clusters of cells ≤ 200 cells in a single LN cross section

What defines pN1 cervical carcinoma and FIGO stage?

Mets to pelvic LNs ONLY

Stage IIIC1

What defines pN1mi cervical carcinoma and FIGO stage?

Mets 0.2 mm < X ≤ 2.0 mm

• To pelvic LNs

Stage IIIC1

What defines pN1a cervical carcinoma and FIGO stage?

Mets > 2.0 mm to pelvic LNs

Stage IIIC

What defines pN2 cervical carcinoma and FIGO stage?

Mets to para-aortic LNs

• With or without positive pelvic LNs

Stage IIIC2

What defines pN2mi cervical carcinoma and FIGO stage?

Mets 0.2 mm < X ≤ 2.0 mm

• To para-aortic LNs

  • With or without positive pelvic LNs

Stage IIIC2

What defines pN2a cervical carcinoma and FIGO stage?

Mets > 0.2 mm to para-aortic LNs

• With or without positive pelvic LNs

Stage IIIC2

What are classified as regional LNs for cervical carcinoma staging?

Parametrial

Obturator

Internal iliac (hypogastric)

External iliac

Common iliac

Sacral

Presacral

Para-aortic

What defines pM1 cervical carcinoma and FIGO score?

Microscopic confirmation of distant mets

• Excludes pelvic, para-aortic, or vagina

Stage IVB

What is this?

An endometrial mass in the uterine cavity

Attached leiomyomata in the myometrium

What is this showing?

A tumor in the myometrium

What is this?

ESS

What defines pT1 uterine tumors and FIGO stage?

Confined to the corpus uteri

• Includes endocervical glandular involvement

Stage I

What defines pT1a uterine tumors and FIGO stage?

Limited to the endometrium OR

Invading less than half of the myometrium

Stage IA

What defines pT1b uterine tumors and FIGO stage?

Invades half or more myometrium

Stage IB

What defines pT2 uterine tumors and FIGO stage?

Invades stromal connective tissue of the cervix

• Does NOT extend beyond the uterus

• Does NOT include endocervical glandular involvement

Stage II

What defines pT3 uterine tumors and FIGO stage?

Can involve:

• Serosa

• Adnexa

• Vagina

• Parametrium

Stage III

What defines pT3a uterine tumors and FIGO stage?

Involves the serosa and/or adnexa

Stage IIIA

What defines pT3b uterine tumors and FIGO stage?

Vaginal or parametrial involvement

Stage IIIB

What defines pT4 uterine tumors and FIGO stage?

Invades the bladder mucosa and/or bowel mucosa

Stage IVA

What are important criteria/questions for uterine FIGO scores?

Histological type?

Does it invade the cervix?

Any lympho-vascular invasion?

How can you distinguish a stage III uretine tumors?

Distinguished by where it spreads

• Evidence of spread = Stage III

  • Ex. Stage IIIC — Mets to pelvic or para-aortic LNs (or BOTH)

What classifies a stage IVC uterine tumor?

Distant mets to any extra- or intra-abdominal LNs above the:

• Renal vessels

• Lungs

• Liver

• Brain

• Bone

What defines pN0(i+) uterine tumors?

Isolated tumor cells in regional LN(s) no greater than 0.2 mm

What defines pN1 uterine tumors and FIGO stage?

Regional LN mets to pelvic

Stage IIIC1

What defines pN1mi uterine tumors and FIGO stage?

Regional LN mets 0.2 mm < X ≤ 2.0 mm to pelvic LNs

Stage IIIC1

What defines pN1a uterine tumors and FIGO stage?

> 2 mm in diameter to pelvic LNs

Stage IIIC1

What defines pN2 uterine tumors and FIGO stage?

Mets to para-aotic LNs

• With or without positive pelvic LNs

Stage IIIC2

What defines pN2mi uterine tumors and FIGO stage?

0.2 mm < X ≤ 2.0 mm, mets to para-aotic LNs

• With or without positive pelvic LNs

Stage IIIC2

What defines pN2a uterine tumors and FIGO stage?

> 2 mm in diameter, mets to para-aotic LNs

• With or without positive pelvic LNs

Stage IIIC2

What defines pM1 uterine tumors and FIGO stage?

Distant mets

• Excludes:

  • Pelvic or para-aortic LNs

  • Vagina

  • Uterine serosa

  • Adnexa

Stage IVB

What is this?

Uterine sarcoma

What defines pT1 uterine sarcoma and FIGO stage?

Limited to the uterus

Stage I

What defines pT1a uterine sarcoma and FIGO stage?

≤ 5 cm

Stage IA

What defines pT1b uterine sarcoma and FIGO stage?

> 5 cm

Stage IB

What defines pT2 uterine sarcoma and FIGO stage?

Extends beyond the uterus

• Within the pelvis

Stage II

What defines pT2a uterine sarcoma and FIGO stage?

Involves adnexa

Stage IIA

What defines pT2b uterine sarcoma and FIGO stage?

Involves other pelvic tissues

Stage IIB

What defines pT3 uterine sarcoma and FIGO stage?

Infiltrates abdominal tissues

Stage III

What defines pT3a uterine sarcoma and FIGO stage?

Infiltrates one site of abdominal tissue

Stage IIIA