The latest staging of female gynaecological malignancies

1. Endometrial Cancer-FIGO Staging
2009
Stage IA No or less than half of myometrial invasion.
Endocervical gladular invasion is also stage IA.
Stage IB Invasion of half or more than half of
myometrium.
Stage II Tumor invades cervical stroma but doesnot
extend beyond the uterus.
Stage IIIA Tumor invades uterine serosa and or adnexa
Stage IIIB Vagina and parametrial spread.
Stage IIIC Metastasis to pelvic and para-aortic nodes.
Stage IVA Invasion of bladder and or rectal mucosa.
Stage IVB Distant metastases and or inguinal node
involvement.

2. Gestational Trophoblastic Neoplasia-
FIGO 2002 Staging
Stage I Disease confined to the uterus.
Stage II GTN extends outside the uterus but is limited to the genital structures
(adnexa, vagina & broad ligament).
Stage III GTN extends to the lungs ( +/- genital tract involvement).
Stage IV all other metastatic sites.

3. Cervical Cancer – FIGO staging
Stage 0 Carcinoma in situ.
Stage I Invasive carcinoma confined to the cervix.
Stage IA Diagnosed only by microscopy.
Stage IA1 Microinvasive carcinoma with stromal invasion < 3mm in depth & < 7
mm in wide.
Stage IA2 microinvasive carcinoma not exceeding 5mm in depth /7 mm in
width
Stage IB clinically visible or microscopic lesion >IA2.
Stage IB1 clinical lesion not exceeding 4cm in diameter.
Stage IB2 clinical lesion more than 4 cm in diameter.
Stage II extension beyond the cervix but not to the pelvic wall.
Stage IIA involvement of vagina but not the lower third.
Stage IIA1 clinically visible lesion not more than 4 cm.
Stage IIA2 clinically visible lesion more than 4 cm.
Stage IIB parametrial involvement not reaching the pelcvic side wall.

4. …. staging ctd
Stage III extension to the pelvic wall or lower of the vagina. Hydronephrosis
or non functioning kidney, unless due to cause other than
obstruction by the tumour.
Stage IIIA involves the lower third of the vagina
Stage IIIB extension to the pelvic wall ( includes hydronephrosis).
Stage IV extension beyond true pelvis or involving bladder or rectum
Stage IVA involvement of bladder or rectal mucosa.
Stage IVB spread outside the true pelvis or metastases to distant organs.

5. Ovarian Cancer Staging
Stage I disease confined to one or both ovaries
Stage IA involves one ovary; capsule intact; no tumour on the ovarian surface;
no malignant cells on the peritoeal washings or ascites.
Stage IIB involves both ovaries; capsule intact; no tumour on the ovarian
surface; negative washings.
Stage IIC tumour limited to the ovaries with any of the following: capsule
ruptured, tumour on the ovarian surface, positive washings
Stage II pelvic extensions or implants
Stage IIA extension onto the uterus or fallopian tubes, negative washing
Stage IIB extension or implants onto the pelvic structures; negative washings
Stage IIC pelvic extension or implants with positive peritoneal washings
Stage III microscopic peritoneal implants outside of the pelvis, or limited to
pelvis with extension to small bowel or omentum

6. …. staging ctd
Stage III A microscopic peritoneal metastases beyond pelvis
Stage IIIB macroscopic peritoneal metastases beyond pelvis < 2cm in size
Stage IIIC macroscopic peritoneal metastases beyond pelvis > 2 cm in size
or lymph node metastases including para aortic nodes.
Stage IV distant metastases to liver or outside the peritoneal cavity.

7. Vaginal Cancer-FIGO staging
Stage 0 Carcinoma in situ
Stage I Invasive carcinoma confined to the vagina.
Stage IA Tumour < 2 cm wide & < 1 mm depth of invasion.
Stage IB Tumour > 2cm wide & > 1 mm depth of invasion.
Stage II Tumour invades para-vaginal tissues but not to the pelvic wall.
Stage III Extension to the pelvic wall.
Stage IVA Extension beyond the true pelvis or invasion of bladder/rectum.
Stage IVB Pelvic or inguinal lymphadenopathy or distant metastases.

8. Vulval Carcinoma-FIGO Staging
Stage I Tumour confined to the vulva.
Stage IA </= 2 cm in size, confined to vulva or perinium, stromal invasion </=
I mm, negative nodes.
Stage IB > 2 cm size or stromal invasion > 1 mm, confined to vulva/perinium.
negative nodes.
Stage II Tumour of any size with extension to adjacent perineal structures( 1/3
lower urethra, 1/3 lower vagina, anus), negative nodes
Stage III Tumour of any size with or without extension to adjacent perineal
perineal structures( lower 1/3 anus, urethra and vagina), positive
inguinofemoral lymph nodes.
Stage IIIA (i) with one lymph node metastasis >/= 5 mm
(ii) one to two lymph node metastases <5 mm
Stage IIIB (i) with two or more lymph node metastases >/= 5 mm
(ii) Three or more lymph node metastases < 5 mm

9. …. ctd…
Stage IIIC with positive nodes with extracapsular spread
Stage IV Tumour invades other region(2/3 upper urethra, 2/3upper vagina)
or distant structures
Stage IVA Tumour invades any of the following:
(i) upper urethra and/or vaginal mucosa, bladder mucosa, rectal
mucosa, or fixed to pelvic bones, or
(ii) fixed or ulcerated inguino femoral lymph nodes.
Stage IVB Any distant metastases including pelvic lymph nodes…

10. …. ctd…
Stage IIIC with positive nodes with extracapsular spread
Stage IV Tumour invades other region(2/3 upper urethra, 2/3upper vagina)
or distant structures
Stage IVA Tumour invades any of the following:
(i) upper urethra and/or vaginal mucosa, bladder mucosa, rectal
mucosa, or fixed to pelvic bones, or
(ii) fixed or ulcerated inguino femoral lymph nodes.
Stage IVB Any distant metastases including pelvic lymph nodes…