TNM and FIGO Staging of Fallopian Tube Cancer

Because the fallopian tube is an open lumen, fallopian tube carcinoma has the ability to spread within the peritoneal cavity; consequently, surgical staging is required.^[1]The tumor-node-metastasis (TNM) classification of the American Joint Committee on Cancer (AJCC) and the International Federation of Gynecology and Obstetrics (FIGO) classification for staging fallopian tube cancer are listed below (see Table 1), as well as the AJCC prognostic groups (see Table 2).^{[1, 2, 3, 4]}

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

Primary tumor (T)
TNM	FIGO	Definition
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
T1	I	Tumor limited to the fallopian tube(s)
T1a	IA	Tumor limited to 1 tube; no tumor on tube surface; no malignant cells in ascites or peritoneal washings
T1b	IB	Tumor limited to both tubes; no tumor on tube surface; no malignant cells in ascites or peritoneal washings
T1c	IC	Tumor limited to 1 or both tubes, with any of the following:
T1c1	IC1	Surgical spill
T1c2	IC2	Capsule ruptured before surgery or tumor on tube surface
T1c3	IC3	Malignant cells in ascites or peritoneal washings
T2	II	Tumor involves 1 or both fallopian tubes, with pelvic extension below pelvic brim or primary peritoneal cancer
T2a	IIA	Extension to and/or implants on the uterus or the ovaries
T2b	IIB	Extension to and/or implants on other pelvic tissues
T3	III	Tumor involves 1 or both fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastasis to the retroperitoneal (pelvic and/or para-aortic) lymph nodes
T3a	IIIA	Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
T3b	IIIB	Macroscopic peritoneal metastasis beyond the pelvis ≤2 cm in greatest diameter, with or without positive retroperitoneal lymph nodes
T3c	IIIC	Macroscopic peritoneal metastasis outside the pelvis and > 2 cm in diameter, with or without positive retroperitoneal lymph nodes (includes extension of tumor to capsule, but not parenchyma, of liver and spleen)
Regional lymph nodes (N)
TNM	FIGO	Definition
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	IIIA1	Positive retroperitoneal lymph nodes only (histologically confirmed)
N1a	IIIA2	Metastasis ≤10 mm in greatest dimension
N1b	IIIA3	Metastasis > 10 mm in greatest dimension
Distant metastasis (M)
TNM	FIGO	Definition
M0		No distant metastasis
M1	IV	Distant metastasis, including pleural effusion with positive cytology; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); and transmural involvement of intestine
M1a	IVA	Pleural effusion with positive cytolog
M1b	IVB	Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine

Table 2. AJCC Prognostic Groups of Fallopian Tube Cancer (Open Table in a new window)

Stage	T	N	M
I	T1	N0	M0
IA	T1a	N0	M0
IB	T1b	N0	M0
IC	T1c	N0	M0
II	T2	N0	M0
IIA	T2a	N0	M0
IIB	T2b	N0	M0
IIIA1	T1/T2	N0	M0
IIIA2	T3a	NX/N0/N1	M0
IIIB	T3b	NX/N0/N1	M0
IIIC	T3c	NX/N0/N1	M0
IV	Any T	Any N	M1
IVA	Any T	Any N	M1a
IVB	Any T	Any N	M1b

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Table 1. TNM and FIGO Staging of Fallopian Tube Cancer

Primary tumor (T)
TNM	FIGO	Definition
TX		Primary tumor cannot be assessed
T0		No evidence of primary tumor
T1	I	Tumor limited to the fallopian tube(s)
T1a	IA	Tumor limited to 1 tube; no tumor on tube surface; no malignant cells in ascites or peritoneal washings
T1b	IB	Tumor limited to both tubes; no tumor on tube surface; no malignant cells in ascites or peritoneal washings
T1c	IC	Tumor limited to 1 or both tubes, with any of the following:
T1c1	IC1	Surgical spill
T1c2	IC2	Capsule ruptured before surgery or tumor on tube surface
T1c3	IC3	Malignant cells in ascites or peritoneal washings
T2	II	Tumor involves 1 or both fallopian tubes, with pelvic extension below pelvic brim or primary peritoneal cancer
T2a	IIA	Extension to and/or implants on the uterus or the ovaries
T2b	IIB	Extension to and/or implants on other pelvic tissues
T3	III	Tumor involves 1 or both fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastasis to the retroperitoneal (pelvic and/or para-aortic) lymph nodes
T3a	IIIA	Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
T3b	IIIB	Macroscopic peritoneal metastasis beyond the pelvis ≤2 cm in greatest diameter, with or without positive retroperitoneal lymph nodes
T3c	IIIC	Macroscopic peritoneal metastasis outside the pelvis and > 2 cm in diameter, with or without positive retroperitoneal lymph nodes (includes extension of tumor to capsule, but not parenchyma, of liver and spleen)
Regional lymph nodes (N)
TNM	FIGO	Definition
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	IIIA1	Positive retroperitoneal lymph nodes only (histologically confirmed)
N1a	IIIA2	Metastasis ≤10 mm in greatest dimension
N1b	IIIA3	Metastasis > 10 mm in greatest dimension
Distant metastasis (M)
TNM	FIGO	Definition
M0		No distant metastasis
M1	IV	Distant metastasis, including pleural effusion with positive cytology; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); and transmural involvement of intestine
M1a	IVA	Pleural effusion with positive cytolog
M1b	IVB	Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal cavity); transmural involvement of intestine

Table 2. AJCC Prognostic Groups of Fallopian Tube Cancer

Stage	T	N	M
I	T1	N0	M0
IA	T1a	N0	M0
IB	T1b	N0	M0
IC	T1c	N0	M0
II	T2	N0	M0
IIA	T2a	N0	M0
IIB	T2b	N0	M0
IIIA1	T1/T2	N0	M0
IIIA2	T3a	NX/N0/N1	M0
IIIB	T3b	NX/N0/N1	M0
IIIC	T3c	NX/N0/N1	M0
IV	Any T	Any N	M1
IVA	Any T	Any N	M1a
IVB	Any T	Any N	M1b