4/4/2017 www.medscape.

com/viewarticle/722721_print

www.medscape.com

TheNewFIGOStagingforCarcinomaoftheVulva,
Cervix,Endometrium,andSarcomas
JasmineJ.Han,EliseC.Kohn
AccessMedicinefromMcGrawHill
TheInternationalFederationofGynecologyandObstetrics(FIGO)stagingsystemsforvulva,cervix,endometrium,and
sarcomashavebeenrevisedforthefirsttimeinoveradecade.Thepurposeofthestagingsystemistoprovideuniform
terminologyforbettercommunicationamonghealthprofessionalsandtoprovideappropriateprognosistothepatients
whichresultsintreatmentimprovement.Thisisaconstantlyevolvingprocessasnewtherapeuticmodalitiesare
developed,newimagingandsurgicalapproachesareapplied,andmoreprognosticinformationbecomesavailable.The
previoussystemdidnotreflecttheprognosisinsomepatientsubsetswheremedicalresearchandpracticehaveshown
explosivegrowthofnewknowledgeinrecentyears.

The41stAnnualMeetingoftheSocietyofGynecologicOncologistswasheldinMarch2010.Severalabstractsreported
retrospectivestudiesthatevaluatedtheprognosticsignificanceofnew2009FIGOstagingguidelinescomparedtotheold
1988FIGOsystem.Inendometrialcancer,thereductioninthesubstageswithinstageI,andtheseparationofpelvicand
paraaorticnodalinvolvementfurtherclarifiedimportantprognosticfactorsthatyieldedcleardelineationofsurvival.[1]The
new2009FIGOvulvarcancerstagingsystemwasvalidatedbyclearlydemonstratingdistinctgroupswithdiffering
survivals.[2]

Thefollowingrevisionsoncarcinomaofvulva,cervix,andendometriumstaging[3,4]willreplacepriortables416,418,
and419,respectively.

CarcinomaoftheVulva

IATumorconfinedtothevulvaorperineum,2cminsizewithstromalinvasion1mm,negativenodes

IBTumorconfinedtothevulvaorperineum,>2cminsizeorwithstromalinvasion>1mm,negativenodes

IITumorofanysizewithadjacentspread(1/3lowerurethra,1/3lowervagina,anus),negativenodes

IIIATumorofanysizewithpositiveinguinofemorallymphnodes

(i)1lymphnodemetastasisgreaterthanorequalto5mm

(ii)12lymphnodemetastasis(es)oflessthan5mm

IIIB(i)2ormorelymphnodesmetastasesgreaterthanorequalto5mm

(ii)3ormorelymphnodesmetastaseslessthan5mm

IIICPositivenode(s)withextracapsularspread

IVA(i)Tumorinvadesotherregionalstructures(2/3upperurethra,2/3uppervagina),bladdermucosa,rectalmucosa,
orfixedtopelvicbone

(ii)Fixedorulceratedinguinofemorallymphnodes

IVBAnydistantmetastasisincludingpelviclymphnodes

CarcinomaoftheCervix

IA1Confinedtothecervix,diagnosedonlybymicroscopywithinvasionof<3mmindepthandlateralspread<7mm

IA2Confinedtothecervix,diagnosedwithmicroscopywithinvasionof>3mmand<5mmwithlateralspread<7mm

IB1ClinicallyvisiblelesionorgreaterthanA2,<4cmingreatestdimension

IB2Clinicallyvisiblelesion,>4cmingreatestdimension

http://www.medscape.com/viewarticle/722721_print 1/3
4/4/2017 www.medscape.com/viewarticle/722721_print
IIA1Involvementoftheuppertwothirdsofthevagina,withoutparametrialinvasion,<4cmingreatestdimension

IIA2>4cmingreatestdimension

IIBWithparametrialinvolvement

IIIA/BUnchanged

IVA/BUnchanged

CarcinomaoftheEndometrium

IATumorconfinedtotheuterus,noor<myometrialinvasion

IBTumorconfinedtotheuterus,>myometrialinvasion

IICervicalstromalinvasion,butnotbeyonduterus

IIIATumorinvadesserosaoradnexa

IIIBVaginaland/orparametrialinvolvement

IIIC1Pelvicnodeinvolvement

IIIC2Paraaorticinvolvement

IVATumorinvasionbladderand/orbowelmucosa

IVBDistantmetastasesincludingabdominalmetastasesand/oringuinallymphnodes

Uterinesarcomaswerestagedpreviouslyasendometrialcancers,whichdidnotreflectclinicalbehavior.Therefore,anew
corpussarcomastagingsystemwasdevelopedbasedonthecriteriausedinothersofttissuesarcomas.[2]Thisis
describedasabestguessstagingsystem,sodatawillneedtobecollectedandevaluatedforfurtherrevision.

UterineSarcomas(Leiomyosarcoma,EndometrialStromalSarcoma,andAdenosarcoma)

IATumorlimitedtouterus<5cm

IBTumorlimitedtouterus>5cm

IIATumorextendstothepelvis,adnexalinvolvement

IIBTumorextendstoextrauterinepelvictissue

IIIATumorinvadesabdominaltissues,onesite

IIIBMorethanonesite

IIICMetastasistopelvicand/orparaaorticlymphnodes

IVATumorinvadesbladderand/orrectum

IVBDistantmetastasis

AdenosarcomaStageIDiffersfromOtherUterineSarcomas

IATumorlimitedtoendometrium/endocervix

IBInvasionto<myometrium

IBInvasionto>myometrium

References

http://www.medscape.com/viewarticle/722721_print 2/3
4/4/2017 www.medscape.com/viewarticle/722721_print
1.LewinS,HerzogT,BarrenaMedelN,etal:ComparativeperformanceofthenewversusoldFIGOstagingsystem
forendometrialcancer.GynecolOncol116:S67,2010.

2.TanJ,ChettyN,KondalsamyChennakesavanSetal:ApplyingtheFIGO2009stagingsystemforcarcinomaofthe
vulvatopatientspreviouslystagedwiththeFIGO1988stagingsystem.GynecolOncol116:S212,2010.

3.PecorelliS:RevisedFIGOstagingforcarcinomaofthevulva,cervix,andendometrium.IntJGynaecolObstet
105(2):1034,2009.[PMID:19367689]

4.MutchDG:TheNewFIGOstagingsystemforcancersofthevulva,cervix,endometrium,andsarcomas.Gynecol
Oncol115:325328,2009.

AccessMedicinefromMcGrawHill2010TheMcGrawHillCompanies

ThiswebsiteusescookiestodeliveritsservicesasdescribedinourCookiePolicy.Byusingthiswebsite,youagreetothe
useofcookies.
close

http://www.medscape.com/viewarticle/722721_print 3/3