Carcinoma Cervix
The TNM staging system for cervical cancer is analogous to the FIGO stage.
- Stage 0 – full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
- Stage I – limited to the cervix
- IA – diagnosed only by microscopy; no visible lesions
- IA1 – stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
- IA2 – stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
- IB – visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
- IB1 – visible lesion 4 cm or less in greatest dimension
- IB2 – visible lesion more than 4 cm
- IA – diagnosed only by microscopy; no visible lesions
- Stage II – invades beyond cervix
- IIA – without parametrial invasion, but involve upper 2/3 of vagina
- IIB – with parametrial invasion
- Stage III – extends to pelvic wall or lower third of the vagina
- IIIA – involves lower third of vagina
- IIIB – extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney
Stage IV-Distant spread
- IVA – invades mucosa of bladder or rectum and/or extends beyond true pelvis
- IVB – distant metastasis
Key Points:4stages, each having two subdivisions A and B.No mention of LN status,Ascites.
Treatment
Tumour <5mm-Conization(to preserve fertility)or hysterectomy
Invasive lesions not extending to abdominal viscera or distal vagina-Hysterectomy+Chemotherapy+Radiotherapy
Recurrent disease- Radiotherapy.
Carcinoma Endometrium.
Stage I-Tumour limited to uterine corpus
- Stage IA: tumor limited to the endometrium
- Stage IB: invasion of less than half the myometrium
- Stage IC: invasion of more than half the myometrium
Stage II-Tumour confined to uterus and cervix
- Stage IIA: endocervical glandular involvement only
- Stage IIB: cervical stromal invasion
Stage III-Local spread confined to the pelvis
- Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
- Stage IIIB: vaginal metastasis
- Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
Stage IV-Distant spread/organ invasion
- Stage IVA: invasion of the bladder or bowel
- Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes
Key Points:4 stages Stage I and III has 3 subdivisions A,B,C.LN spread mentioned only in STAGE III AND IV
FIGO staging of Ca endometrium
- IA Tumor confined to the uterus, no or < ½ myometrial invasion
- IB Tumor confined to the uterus, > ½ myometrial invasion
- II Cervical stromal invasion, but not beyond uterus
- IIIA Tumor invades serosa or adnexa
- IIIB Vaginal and/or parametrial involvement
- IIIC1 Pelvic node involvement
- IIIC2 Para-aortic involvement
- IVA Tumor invasion bladder and/or bowel mucosa
- IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes
Treatment
Stage I and II-TAH+BSO,stage II may also need adjuvant radiotherapy.
Stage III and IV-TAH+BSO+postoperative radiotherapy
Carcinoma Ovary
- Stage I – limited to one or both ovaries
- IA – involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
- IB – involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
- IC – tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
- Stage II – pelvic extension or implants
- IIA – extension or implants onto uterus or fallopian tube; negative washings
- IIB – extension or implants onto other pelvic structures; negative washings
- IIC – pelvic extension or implants with positive peritoneal washings
- Stage III – microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum
- IIIA – microscopic peritoneal metastases beyond pelvis
- IIIB – macroscopic peritoneal metastases beyond pelvis less than 2 cm in size
- IIIC – peritoneal metastases beyond pelvis > 2 cm or lymph node metastases
- Stage IV – distant metastases to the liver or outside the peritoneal cavity
Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC).
Key Points:4 stages, First 3 stages have subdivisions A,B,C.IVth stage has no sudivisions.
The ovarian cancer stages are made up by combining the TNM categories in the following manner:
- Stage I: T1+N0+M0
- IA: T1a+N0+M0
- IB: T1b+N0+M0
- IC: T1c+N0+M0
- Stage II: T2+N0+M0
- IIa: T2a+N0+M0
- IIB: T2b+N0+M0
- IIC: T2c+N0+M0
- Stage III: T3+ N0+M0
- IIIA: T3a+ N0+M0
- IIIB: T3b+ N0+M0
- IIIC: T3c+ N0+M0 or Any T+N1+M0
- Stage IV: Any T+ Any N+M1
Treatment
TAH+BSO+OMENTECTOMY
Postoperative chemotherapy
Neoadjuvant chemo
Radiotherapy
Immunotherapy.
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