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 TNM and International Federation of Gynecology and Obstetrics (FIGO) classifications for staging fallopian tube cancer are listed below (see Table 1) [2] ; however, modified FIGO staging (see Table 2) has been recommended as better reflecting tumor histology and patient outcome. [3]
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 |
Tis* |
|
Carcinoma in situ (limited to tubal mucosa) |
T1 |
I |
Tumor limited to the fallopian tube(s) |
T1a |
IA |
Tumor limited to 1 tube, without penetrating the serosal surface; no ascites |
T1b |
IB |
Tumor limited to both tubes, without penetrating the serosal surface; no ascites |
T1c |
IC |
Tumor limited to 1 or both tubes, with extension onto or through the tubal serosa or with malignant cells in ascites or peritoneal washings |
T2 |
II |
Tumor involves 1 or both fallopian tubes, with pelvic extensions |
T2a |
IIA |
Extension or metastasis to the uterus or the ovaries |
T2b |
IIB |
Extension to other pelvic structures |
T2c |
IIC |
Pelvic extension, with malignant cells in ascites or peritoneal washings |
T3 |
III |
Tumor involves 1 or both fallopian tubes, with peritoneal implants outside the pelvis |
T3a |
IIIA |
Microscopic peritoneal metastasis outside the pelvis |
T3b |
IIIB |
Macroscopic peritoneal metastasis outside the pelvis ≤2 cm in greatest diameter |
T3c |
IIIC |
Macroscopic peritoneal metastasis outside the pelvis and >2 cm in diameter |
Regional lymph nodes (N) |
||
TNM |
FIGO |
Definition |
NX |
|
Regional lymph nodes cannot be assessed |
N0 |
|
No regional lymph node metastasis |
N1 |
IIIC |
Regional lymph node metastasis |
Distant metastasis (M) |
||
TNM |
FIGO |
Definition |
M0 |
|
No distant metastasis |
M1† |
IV |
Distant metastasis (excluding metastasis with the peritoneal cavity) |
* FIGO no longer considers stage 0 (Tis). † Metastasis to the liver surface (capsule) is considered T3, stage III; metastasis to the liver parenchyma is M1, stage IV. A pleural effusion with positive cytology results is M1, stage IV. |
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Table 2. Modified FIGO Staging of Fallopian Tube Cancer (Open Table in a new window)
Modified FIGO |
Definition |
I |
Tumor limited to the fallopian tube(s) |
IA |
Tumor limited to 1 tube, without penetrating the serosal surface; no ascites |
IA-0 |
Tumor limited to 1 tube, with no extension into the lamina propria |
IA-1 |
Tumor limited to 1 tube, with extension into the lamina propria but no extension into the muscularis |
IA-2 |
Tumor limited to 1 tube, with extension into the muscularis |
IB |
Tumor limited to both tubes, without penetrating the serosal surface; no ascites |
IB-0 |
Tumor limited to both tubes, with no extension into the lamina propria |
IB-1 |
Tumor limited to both tubes, with extension into the lamina propria but no extension into the muscularis |
IB-2 |
Tumor limited to both tubes, with extension into the muscularis |
IC |
Tumor limited to 1 or both tubes, with extension onto or through the tubal serosa or with malignant cells in ascites or peritoneal washings |
IF |
Tumor limited to 1 or both tubes at the fimbriated ends, without invasion of tubal wall |
II |
Tumor involves 1 or both fallopian tubes, with pelvic extension |
IIA |
Extension or metastasis to the uterus or the ovaries |
IIB |
Extension to other pelvic structures |
IIC |
Pelvic extension, with malignant cells in ascites or peritoneal washings |
III |
Tumor involves 1 or both fallopian tubes, with peritoneal implants outside the pelvis; included are superficial liver implants, retroperitoneal lymph nodes, or inguinal lymph nodes |
IIIA |
Microscopic peritoneal metastasis outside the pelvis; negative lymph nodes |
IIIB |
Macroscopic peritoneal metastasis outside the pelvis ≤2 cm in greatest diameter; negative lymph nodes |
IIIC |
Macroscopic peritoneal metastasis outside the pelvis and >2 cm in diameter or positive retroperitoneal or inguinal lymph nodes |
IV |
Distant metastasis, including liver parenchyma or positive pleural cytology |
Tables
Primary tumor (T) |
||
TNM |
FIGO |
Definition |
TX |
|
Primary tumor cannot be assessed |
T0 |
|
No evidence of primary tumor |
Tis* |
|
Carcinoma in situ (limited to tubal mucosa) |
T1 |
I |
Tumor limited to the fallopian tube(s) |
T1a |
IA |
Tumor limited to 1 tube, without penetrating the serosal surface; no ascites |
T1b |
IB |
Tumor limited to both tubes, without penetrating the serosal surface; no ascites |
T1c |
IC |
Tumor limited to 1 or both tubes, with extension onto or through the tubal serosa or with malignant cells in ascites or peritoneal washings |
T2 |
II |
Tumor involves 1 or both fallopian tubes, with pelvic extensions |
T2a |
IIA |
Extension or metastasis to the uterus or the ovaries |
T2b |
IIB |
Extension to other pelvic structures |
T2c |
IIC |
Pelvic extension, with malignant cells in ascites or peritoneal washings |
T3 |
III |
Tumor involves 1 or both fallopian tubes, with peritoneal implants outside the pelvis |
T3a |
IIIA |
Microscopic peritoneal metastasis outside the pelvis |
T3b |
IIIB |
Macroscopic peritoneal metastasis outside the pelvis ≤2 cm in greatest diameter |
T3c |
IIIC |
Macroscopic peritoneal metastasis outside the pelvis and >2 cm in diameter |
Regional lymph nodes (N) |
||
TNM |
FIGO |
Definition |
NX |
|
Regional lymph nodes cannot be assessed |
N0 |
|
No regional lymph node metastasis |
N1 |
IIIC |
Regional lymph node metastasis |
Distant metastasis (M) |
||
TNM |
FIGO |
Definition |
M0 |
|
No distant metastasis |
M1† |
IV |
Distant metastasis (excluding metastasis with the peritoneal cavity) |
* FIGO no longer considers stage 0 (Tis). † Metastasis to the liver surface (capsule) is considered T3, stage III; metastasis to the liver parenchyma is M1, stage IV. A pleural effusion with positive cytology results is M1, stage IV. |
||
Modified FIGO |
Definition |
I |
Tumor limited to the fallopian tube(s) |
IA |
Tumor limited to 1 tube, without penetrating the serosal surface; no ascites |
IA-0 |
Tumor limited to 1 tube, with no extension into the lamina propria |
IA-1 |
Tumor limited to 1 tube, with extension into the lamina propria but no extension into the muscularis |
IA-2 |
Tumor limited to 1 tube, with extension into the muscularis |
IB |
Tumor limited to both tubes, without penetrating the serosal surface; no ascites |
IB-0 |
Tumor limited to both tubes, with no extension into the lamina propria |
IB-1 |
Tumor limited to both tubes, with extension into the lamina propria but no extension into the muscularis |
IB-2 |
Tumor limited to both tubes, with extension into the muscularis |
IC |
Tumor limited to 1 or both tubes, with extension onto or through the tubal serosa or with malignant cells in ascites or peritoneal washings |
IF |
Tumor limited to 1 or both tubes at the fimbriated ends, without invasion of tubal wall |
II |
Tumor involves 1 or both fallopian tubes, with pelvic extension |
IIA |
Extension or metastasis to the uterus or the ovaries |
IIB |
Extension to other pelvic structures |
IIC |
Pelvic extension, with malignant cells in ascites or peritoneal washings |
III |
Tumor involves 1 or both fallopian tubes, with peritoneal implants outside the pelvis; included are superficial liver implants, retroperitoneal lymph nodes, or inguinal lymph nodes |
IIIA |
Microscopic peritoneal metastasis outside the pelvis; negative lymph nodes |
IIIB |
Macroscopic peritoneal metastasis outside the pelvis ≤2 cm in greatest diameter; negative lymph nodes |
IIIC |
Macroscopic peritoneal metastasis outside the pelvis and >2 cm in diameter or positive retroperitoneal or inguinal lymph nodes |
IV |
Distant metastasis, including liver parenchyma or positive pleural cytology |
