TNM and FIGO Classifications for Cervical Cancer

The American Joint Committee on Cancer (AJCC) TNM classification and the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer are provided below.^{[1, 2, 3]}

Table 1. TNM and FIGO Classifications for Cervical Cancer (Open Table in a new window)

Primary tumor (T)
TNM	FIGO	Surgical-Pathologic Findings
Categories	Stages
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
Tis		Carcinoma in situ (preinvasive carcinoma)
T1	I	Cervical carcinoma confined to the cervix (disregard extension to the corpus)
T1a	IA	Invasive carcinoma diagnosed only by microscopy; stromal invasion with a maximum depth of < 5.0 mm, measured from the base of the epithelium; vascular space involvement, venous or lymphatic, does not affect classification
T1a1	IA1	Measured stromal invasion < 3.0 mm in depth
T1a2	IA2	Measured stromal invasion ≥ 3.0 mm and < 5.0 mm
T1b	IB	Invasive carcinoma with measured deepest invasion ≥ 5 mm (greater than stage IA), lesion limited to the cervix
T1b1	IB1	Invasive carcinoma with ≥ 5 mm depth of stromal invasion and < 2 cm in greatest dimension
T1b2	IB2	Invasive carcinoma, 2 cm to < 4 cm in greatest dimension
T1b3	IB3	Invasive carcinoma, ≥ 4 cm in greatest dimension
T2	II	Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina
T2a	IIA	Involvement limited to the upper two-thirds of the vagina, without parametrial invasion
T2a1	IIA1	Invasive carcinoma < 4 cm in greatest dimension
T2a2	IIA2	Invasive carcinoma ≥ 4 cm in greatest dimension
T2b	IIB	Tumor with parametrial invasion but not up to the pelvic wall
T3	III	Carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes
T3a	IIIA	Tumor involves lower third of vagina, with no extension to pelvic wall
T3b	IIIB	Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctional kidney
T3c	IIIC	Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r [imaging] and p [pathology] notations)
T3c1	IIIC1	Pelvic lymph node metastasis only
T3c2	IIIC2	Para-aortic lymph node metastasis
T4	IV	The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to stage IV.)
	IVA	Spread to adjacent pelvic organs
	IVB	Spread to distant organs
Regional lymph nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N0 (i+)	Isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
N1	Regional lymph node metastasis
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis (including peritoneal spread; involvement of supraclavicular, mediastinal, or distant lymph nodes; and lung, liver, or bone)

Table 2. AJCC Prognostic Groups (Open Table in a new window)

Stage	Tumor	Node	Metastasis
I	T1	Any N	M0
IAI	T1a	Any N	M0
IA2	T1a1	Any N	M0
IB	T1b	Any N	M0
IB1	T1b1	Any N	M0
IB2	T1b2	Any N	M0
II	T2	Any N	M0
IIA	T2a	Any N	M0
IIA1	T2a1	Any N	M0
IIA2	T2a2	Any N	M0
IIB	T2b	Any N	M0
III	T3	Any N	M0
IIIA	T3a	Any N	M0
IIIB	T3b	Any N	M0
IVA	T4	Any N	M0
IVB	Any T	Any N	M1

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Table 1. TNM and FIGO Classifications for Cervical Cancer

Primary tumor (T)
TNM	FIGO	Surgical-Pathologic Findings
Categories	Stages
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
Tis		Carcinoma in situ (preinvasive carcinoma)
T1	I	Cervical carcinoma confined to the cervix (disregard extension to the corpus)
T1a	IA	Invasive carcinoma diagnosed only by microscopy; stromal invasion with a maximum depth of < 5.0 mm, measured from the base of the epithelium; vascular space involvement, venous or lymphatic, does not affect classification
T1a1	IA1	Measured stromal invasion < 3.0 mm in depth
T1a2	IA2	Measured stromal invasion ≥ 3.0 mm and < 5.0 mm
T1b	IB	Invasive carcinoma with measured deepest invasion ≥ 5 mm (greater than stage IA), lesion limited to the cervix
T1b1	IB1	Invasive carcinoma with ≥ 5 mm depth of stromal invasion and < 2 cm in greatest dimension
T1b2	IB2	Invasive carcinoma, 2 cm to < 4 cm in greatest dimension
T1b3	IB3	Invasive carcinoma, ≥ 4 cm in greatest dimension
T2	II	Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina
T2a	IIA	Involvement limited to the upper two-thirds of the vagina, without parametrial invasion
T2a1	IIA1	Invasive carcinoma < 4 cm in greatest dimension
T2a2	IIA2	Invasive carcinoma ≥ 4 cm in greatest dimension
T2b	IIB	Tumor with parametrial invasion but not up to the pelvic wall
T3	III	Carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes
T3a	IIIA	Tumor involves lower third of vagina, with no extension to pelvic wall
T3b	IIIB	Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctional kidney
T3c	IIIC	Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r [imaging] and p [pathology] notations)
T3c1	IIIC1	Pelvic lymph node metastasis only
T3c2	IIIC2	Para-aortic lymph node metastasis
T4	IV	The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to stage IV.)
	IVA	Spread to adjacent pelvic organs
	IVB	Spread to distant organs
Regional lymph nodes (N)
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N0 (i+)	Isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
N1	Regional lymph node metastasis
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis (including peritoneal spread; involvement of supraclavicular, mediastinal, or distant lymph nodes; and lung, liver, or bone)

Table 2. AJCC Prognostic Groups

Stage	Tumor	Node	Metastasis
I	T1	Any N	M0
IAI	T1a	Any N	M0
IA2	T1a1	Any N	M0
IB	T1b	Any N	M0
IB1	T1b1	Any N	M0
IB2	T1b2	Any N	M0
II	T2	Any N	M0
IIA	T2a	Any N	M0
IIA1	T2a1	Any N	M0
IIA2	T2a2	Any N	M0
IIB	T2b	Any N	M0
III	T3	Any N	M0
IIIA	T3a	Any N	M0
IIIB	T3b	Any N	M0
IVA	T4	Any N	M0
IVB	Any T	Any N	M1