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

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Table 1. TNM and FIGO Staging of Ovarian and Fallopian Tube Cancer

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

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