TNM and FIGO Staging for Vaginal Cancer
The TNM and International Federation of Gynecology and Obstetrics (FIGO) classifications for staging vaginal cancer are provided below (see Tables 1 and 2). [1, 2]
Table 1. TNM and FIGO Staging for Vaginal 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 |
Tis* |
|
Carcinoma in situ (preinvasive) |
T1 |
I |
Tumor confined to the vagina |
T2 |
II |
Tumor invades paravaginal tissues but does not extend to pelvic wall |
T3 |
III |
Tumor extends to pelvic wall† |
T4 |
IVA |
Tumor invades mucosa of the bladder or rectum or shows direct extension beyond the true pelvis; bullous edema is not sufficient to allow classification as T4 |
Regional lymph nodes (N) |
||
TNM |
FIGO |
Definition |
NX |
|
Regional lymph nodes cannot be assessed |
N0 |
|
No regional lymph node metastasis |
N1 |
III |
Regional (pelvic or inguinal) lymph node metastasis |
Distant metastasis (M) |
||
TNM |
FIGO |
Definition |
M0 |
|
No distant metastasis |
M1 |
IVB |
Distant metastasis |
* FIGO no longer includes stage 0 (Tis). † Pelvic wall is defined as muscle, fascia, neurovascular structures, or skeletal portions of the bony pelvis. On rectal examination, there is no cancer-free space between the tumor and pelvic sidewalls. |
Table 2. Anatomic Stage/Prognostic Groups (Open Table in a new window)
Stage |
TNM |
||
0* |
Tis |
N0 |
M0 |
I |
T1 |
N0 |
M0 |
II |
T2 |
N0 |
M0 |
III |
T1-T3 T3 |
N1 N0 |
M0 |
IVA |
T4 |
Any N |
M0 |
IVB |
Any T |
Any N |
M1 |
* FIGO no longer includes stage 0. |
Rules of staging include the following:
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As with cervical cancer, FIGO uses clinical staging for vaginal cancer because many patients do not undergo surgical management for this condition; the clinical stage of vaginal cancer must not be changed because of subsequent findings once treatment has started
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In cases treated with a definitive surgical procedure, the pathology findings should not be allowed to change the clinical staging, but they may be recorded as the pathologic staging of disease; the pTNM classification of the American Joint Committee on Cancer (AJCC) is appropriate for this purpose, as described in the tables above
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All data available before the initiation of definitive treatment can and should be used to determine the clinical stage of vaginal cancer; these data include all imaging studies and the results of biopsies or fine-needle aspiration of lymph nodes
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When there is doubt about the stage to which a particular case should be allocated, the lesser stage should be used
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Suspected involvement of the bladder or rectal mucosa must be confirmed by means of biopsy
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According to FIGO, cases with clinical involvement of the cervix or the vulva should be classified as primary cervical or vulvar cancers, respectively; tumors limited to the urethra should be classified as urethral cancers