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:

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
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
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
When there is doubt about the stage to which a particular case should be allocated, the lesser stage should be used
Suspected involvement of the bladder or rectal mucosa must be confirmed by means of biopsy
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

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Table 1. TNM and FIGO Staging for Vaginal Cancer

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.