Germ Cell Tumor Staging 

Updated: Jan 08, 2015
  • Author: from Memorial Sloan-Kettering - Elizabeth L Jewell, MD, MHSc; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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TNM and FIGO Staging of Germ Cell Tumors

The American Joint Committee on Cancer (AJCC) TNM classification and the International Federation of Gynecology and Obstetrics (FIGO) staging system for germ cell tumors are listed below (see Tables 1 and 2). [1, 2, 3] Malignant germ cell tumors of the ovary follow the same staging system as epithelial ovarian and primary peritoneal cancers.

Table 1. TNM and FIGO Staging of Ovarian Cancer (Open Table in a new window)

Primary tumor (T)
TNM FIGO Definition
TX   Primary tumor cannot be assessed
T0   No evidence of a primary tumor
T1 I Tumor confined to the ovaries
T1a IA Tumor limited to one ovary, without capsular or surface involvement; cytology from peritoneal washings or ascites negative
T1b IB Tumor limited to both ovaries, without capsular or surface involvement; cytology from peritoneal washings or ascites negative
T1c IC Tumor limited to one of both ovaries, with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells on cytology of ascites or peritoneal washings
T2 II Tumor extends beyond ovaries but is limited to the pelvis
T2a IIA Extension and/or implants to uterus or tubes; cytology negative
T2b IIB Extension and/or implants to other pelvic tissue; cytology negative
T2c IIC Pelvic extension and/or implants; malignant cells on cytology of ascites or peritoneal washings
T3 III Tumor extends to peritoneal cavity outside the pelvis or to regional lymph nodes
T3a IIIA Microscopic peritoneal metastasis beyond the pelvis
T3b IIIB Macroscopic peritoneal metastasis beyond the pelvis but =2 cm in greatest dimension
T3c IIIC Peritoneal metastasis beyond pelvis =2 cm in greatest dimension and/or regional lymph node metastasis
Regional lymph nodes (N)
TNM FIGO  
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1 IIIC Regional (pelvic, para-aortic, inguinal) lymph node metastasis
Distant metastasis (M)
TNM FIGO  
M0   No distant metastasis
M1 IV Distant metastasis

Table 2. Anatomic Stages/Prognostic Groups for Ovarian Cancer (Open Table in a new window)

Stage TNM
IA T1a N0 M0
IB T1b N0 M0
IC T1c N0 M0
IIA T2a N0 M0
IIB T2b N0 M0
IIC T2c N0 M0
IIIA T3a N0 M0
IIIB T3b N0 M0
IIIC T3c



Any T



N0



N1



M0



M0



IV Any T Any N M1

The classification of malignant ovarian germ cell tumors is modified from the 2003 World Health Organization histologic classification of tumors of the ovary (see Table 3). [4, 5]

Table 3. Classification of Malignant Ovarian Germ Cell Tumors (Open Table in a new window)

Primitive germ cell tumors Dysgerminoma



Yolk sac tumor



Embryonal carcinoma



Polyembryoma



Nongestational choriocarcinoma



Mixed germ cell tumor, specify components



Biphasic or triphasic teratomas Immature teratoma



Mature teratoma (benign)



Monodermal teratoma and somatic-type tumors associated with mature teratoma Thyroid tumor group



Carcinoid group



Neuroectodermal tumor group



Carcinoma group



Melanocytic group



Sarcoma group



Sebaceous tumor group



Pituitary-type tumor group



Retinal anlage tumor group



Other