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) |
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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) |
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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 |
Polyembryoma Nongestational choriocarcinoma Mixed germ cell tumor, specify components |
Biphasic or triphasic teratomas |
|
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 |