Cervix Uteri Cancer Classification

One of the most frequently used classifications is the classification by the “Fédération Internationale de Gynécologie Obstétrique” (FIGO) which has allowed comparisons between hospital series for more than 40 years.

In order to obtain an accurate clinical classification, the FIGO organisation recommends a gynaecological examination under general anaesthesia.

In the past, a pelvic lymphographia was recommended to determine node metastases; it has now been replaced by abdominopelvic CT scan. This examination reveals any ureteral dilatation in relation to a compression by parametrial tumour invasion, as well as kidney malfunction.

TNM	FIGO	Description
Tx		Primary tumour cannot be assessed
T0		No evidence of primary tumour
Tis	St 0	Carcinoma in situ
T1 T1a T1a1 T1a2 T1b T1b1 T1b2	St I Ia Ia1 Ia2 Ib 1b1 1b2	Cervical carcinoma confined to cervix uteri Invasive carcinoma diagnosed only by microscopy. Measured stromal invasion 3 mm or less in depth and 7 mm or less in horizontal spread Measured stromal invasion more than 3 mm and no more than 5 mm with a horizontal spread of 7 mm or less Clinically visible lesion confined to the cervix Clinically visible lesion 4 cm or less at largest point Clinically visible lesion more than 4 cm at largest point
T2 T2a T2b	St II IIa IIb	Cervical carcinoma invading beyond cervix uteri but not to pelvic wall or to the lower third of the vagina Tumour without parametrial involvement Tumour with parametrial involvement
T3 T3a T3b	St III IIIa IIIb	Tumour extending to the pelvic wall and/or involving the lower third of the vagina, and/or causing hydronephrosis or kidney malfunction. Tumour involving lower third of the vagina, no extension to pelvic wall Tumour extending to pelvic wall and/or causing hydronephrosis or kidney malfunction.
T4	St IVa	Tumour invading mucosa of the bladder or rectum, and/or extending beyond true pelvis
M1	St IVb	Distant metastasis

N Criteria

Generally observed results

These results are issued from a recent publication by FIGO on 32,500 patients treated around the world. (Annual report on the results of treatment in gynecological cancer. Twenty-first volume. Statements of results obtained in patients treated from 1982 to 1986, inclusive 3 and 5-year survival up to 1990. Int J Gynaecol Obstet. 1991 Sep;36 Suppl:1-315)

As soon as T2, the prognosis of cervix uteri cancer is limited. Such forms would never be observed if efficient screening programs were set up.

The following table displays the extent to which node invasion is detrimental to prognosis.

For French speaking readers, the Lorraine oncology network website Oncolor is very interesting and describes classification and decision trees.

For pathology the website Webpath from Univeristy of Florida is also very useful.

N	Description
NX	Regional nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis to regional lymph nodes

% of patients	Stage	5 year survival
38%	T1	82%
32%	T2	62%
26%	T3	37%
4%	T4	12%

Stage	5 year survival
T1a	99 %
T1b, N0	90 %
T1b, N1	60 %
T2b, N0	85 %
T2b, N1	49 %

Ch 6	Example of Cancer Classification
Cancer Classification	Cervix Uteri Cancer
Cancer Classification	Cervix Uteri Cancer