Table 2.
TNM (8th Edition) and FIGO (2018) Classification of cervical cancer (from refs. 26, 31)
| TNM | FIGO | Description |
|---|---|---|
| Tx | Primary tumor cannot be assessed | |
| T0 | No evidence of primary tumor | |
| Tis | Preinvasive carcinoma | |
| T1 | I | The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded) |
| T1a | IA | Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion < 5 mma |
| T1a1 | IA1 | Measured stromal invasion depth of < 3 mm |
| T1a2 | IA2 | Measured stromal invasion depth ≥ 3 mm and < 5 mm |
| T1b | IB | Invasive carcinoma with measured deepest invasion of ≥ 5 mm (greater than Stage IA), lesion limited to the cervix uterib |
| T1b1 | IB1 | Invasive carcinoma with measured deepest stromal invasion of ≥ 5 mm, and greatest dimension of < 2 cm |
| T1b2 | IB2 | Invasive carcinoma with greatest dimension of ≥ 2 cm and < 4 cm |
| - | IB3d | Invasive carcinoma with greatest dimension of > 4 cm |
| T2 | II | The carcinoma invades beyond the uterus, but has not extended into the lower third of the vagina or to the pelvic wall |
| T2a | IIA | Involvement limited to the upper two-thirds of the vagina without parametrial invasion |
| T2a1 | IIA1 | Invasive carcinoma with greatest dimension of < 4 cm |
| T2a2 | IIA2 | Invasive carcinoma with greatest dimension of ≥ 4 cm |
| T2b | IIB | With parametrial involvement but not up to the pelvic wall |
| T3 | III | The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodesc |
| T3a | IIIA | The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall |
| T3b | IIIB | Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause) |
| Nd | IIICd | Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)c |
| IIIC1d | Pelvic lymph node metastasis only | |
| IIIC2d | Para-aortic lymph nodes metastasis | |
| T4 | IV | The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum (the presence of bullous edema is not sufficient to classify a case as Stage IV) |
| IVA | Spread to adjacent pelvic organs | |
| M1 | IVB | Spread to distant organs |
When in doubt, the lower staging should be assigned
aImaging and pathology can be used, when available, to supplement clinical findings with respect to tumor size and extent in all stages
bThe involvement of vascular/lymphatic spaces does not change the staging. The lateral extent of the lesion is no longer considered
cThe notations of r (imaging) and p (pathology) are added to indicate the findings used to assign a case as Stage IIIC. For example, if imaging indicates pelvic lymph node metastasis, the stage allocation would be Stage IIIC1r, whereas if confirmed by pathologic findings, the stage would be Stage IIIC1p. The type of imaging modality or pathology technique used should always be documented
dThe revised FIGO classification was recently published (October 2018). TNM (8th Edition) does not include classification for the new FIGO groups IB3, IIIC1, and IIIC2. TNM defines only regional lymph nodes, with N0 (i+) indicating isolated tumor cells in regional lymph node(s) no greater than 0.2 mm, and N1 indicating regional lymph node metastasis