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]
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 |
Tables
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 |
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 |
