Germ Cell Tumor Staging 

Updated: Nov 14, 2018
  • Author: from Memorial Sloan-Kettering - Elizabeth L Jewell, MD, MHSc; Chief Editor: from Memorial Sloan-Kettering - Yukio Sonoda, MD  more...
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TNM and FIGO Staging of Germ Cell Tumors

The American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) classification and the International Federation of Gynecology and Obstetrics (FIGO) staging system for germ cell tumors are listed below (see Tables 1 and 2). [1, 2, 3] Malignant germ cell tumors of the ovary follow the same staging system as epithelial ovarian and primary peritoneal cancers.

Table 1. TNM and FIGO Staging of Ovarian and 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 a primary tumor

T1

I

Tumor confined to the ovaries (one or both) or fallopian tubes

T1a

IA

Tumor limited to one ovary, with capsule intact, or fallopian tube; no tumor on ovarian or fallopian tube surface; cytology from peritoneal washings or ascites negative

T1b

IB

Tumor limited to both ovaries, with capsules intact, or fallopian tubes; no tumor on ovarian or fallopian tube surface; cytology from peritoneal washings or ascites negative

T1c

IC

Tumor limited to one or both ovaries or fallopian tubes, with any of the following: surgical spill (T1c1; IC1), capsule ruptured before surgery or tumor on ovarian or fallopian tube surface (T1c2; IC2); malignant cells on cytology of ascites or peritoneal washings (T1c3; IC3)

T2

II

Tumor involves one or both ovaries or fallopian tubes with pelvic extension below pelvic brim 

T2a

IIA

Extension and/or implants on the uterus and/or fallopian tube(s) and/or ovaries

T2b

IIB

Extension and/or implants on other pelvic tissue

T3

III

Tumor involves one or both ovaries or fallopian tubes, with microscopically confirmed peritoneal metastasis outside the pelvis and/or metastasis to the retroperitoneal (pelvic and/or para-aortic) lymph nodes

T3a

IIIA2

Microscopic peritoneal metastasis above the pelvic brim; peritoneal involvement with or without positive retroperitoneal lymph nodes

T3b

IIIB

Macroscopic peritoneal metastasis beyond the pelvis but ≤2 cm in greatest dimension, with or without positive retroperitoneal lymph nodes

T3c

IIIC

Macroscopic peritoneal metastasis beyond the pelvis > 2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ)

Regional lymph nodes (N)

TNM

FIGO

 

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

IIIAIi

Metastasis ≤10 mm in greatest dimension

N1b

IIIAIii

Metastasis > 10 mm in greatest dimension

Distant metastasis (M)

TNM

FIGO

 

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. Anatomic Stages/Prognostic Groups for Ovarian Cancer (Open Table in a new window)

Stage

TNM

I

T1

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

IC

T1c

N0

M0

IIA

T2a

N0

M0

IIB

T2b

N0

M0

IIIA1

T1/T2

N1

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

The classification of malignant ovarian germ cell tumors is modified from the 2003 World Health Organization histologic classification of tumors of the ovary (see Table 3). [4, 5]

Table 3. Classification of Malignant Ovarian Germ Cell Tumors (Open Table in a new window)

Primitive germ cell tumors

Dysgerminoma

Yolk sac tumor

Embryonal carcinoma

Polyembryoma

Nongestational choriocarcinoma

Mixed germ cell tumor, specify components

Biphasic or triphasic teratomas

Immature teratoma

Mature teratoma (benign)

Monodermal teratoma and somatic-type tumors associated with mature teratoma

Thyroid tumor group

Carcinoid group

Neuroectodermal tumor group

Carcinoma group

Melanocytic group

Sarcoma group

Sebaceous tumor group

Pituitary-type tumor group

Retinal anlage tumor group

Other