About GYN Cancer


Staging


Cancer staging, or determining the extent of cancer, is a key factor in creating the best treatment plan. Gynecologic cancers are staged as I, II, II, and IV, with subgroups of A, B and sometimes C, as well as further possible subgroups 1, 2, etc. A general explanation of staging, by type of gynecologic cancer follows:

 

Cervical Cancer

Stage I: Lesions confined to the cervix.

Stage II: The carcinoma extends beyond the cervix, but has not extended to the pelvic sidewall or the lower 1/3 of the vagina.

Stage III: The carcinoma has extended to the pelvic wall with no cancer free space between the tumor and the pelvic wall. The tumor involves the lower 1/3 of the vagina. All cases of hydronephrosis or non-functioning kidney unless secondary to unrelated cause.

Stage IV: The carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum.

 

Ovarian Cancer

Stage I: Growth limited to the ovaries.

Stage II: Growth involving one or both ovaries with pelvic extension.

Stage III: Tumor involving one or both ovaries with peritoneal implants outside the pelvis and/or positive retroperitoneal or inguinal nodes. Superficial liver metastases equals stage III. Tumor is limited to the true pelvis but with histologically proven malignant extension to small bowel or omentum.

Stage IV: Growth involving one or both ovaries with distant metastases. If pleural effusion (a buildup of fluid between the layers of tissue that line the lungs and chest cavity) is present, there must be positive cytology to allot a case to stage IV. Parenchymal liver metastases equals stage IV.

 

Uterine Cancer

Stage I: Tumor confined to the uterus

Stage II: Cervical stromal invasion, but not beyond the uterus

Stage III: Tumor invades uterine serosa or adnexae, there is vaginal and/or parametrial involvement, there is pelvic node involvement or there is periaortic node involvement.

Stage IV: There is tumor invasion of bladder and/or bowel mucosa, or there are distant metastases including abdominal metastases and/or inguinal node involvement

*Grade: Uterine cancers are also graded, which designates the appearance and growth pattern of the cancer cells.

G1 = 5% or less of a non-squamous or non-morular solid growth pattern.

G2 = 6-50% of a non-squamous or non-morular solid growth pattern.

G3 = More than 50% of a non-squamous or non-morular solid growth pattern.

 

Vaginal Cancer

Stage 0: Carcinoma in situ, intraepithelial carcinoma

Stage I: Carcinoma limited to the vaginal wall.

Stage II: The carcinoma has involved the subvaginal tissue but has not extended to the pelvic wall.

Stage III: The carcinoma has extended to the pelvic wall.

Stage IV: The carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum. This stage includes spread of growth to adjacent and distant organs.

Vulvar Cancer

Since 1988 Vulvar cancer has been staged using a surgical system which utilizes the TNM classification with modifications added in 1995. “T” stands for tumor size, “N” stands for lymph nodes and “M” is for metastasis. Tumor size is determined when the tumor is removed and sent to the pathologist. Lymph nodes are checked for evidence of tumor spread with CT scans, PET scans, lymph node biopsy or at the time of surgery, in a procedure called a lymph node dissection. Metastasis, or spread to other organs, is assessed with bone scans, x-rays and CT scans.

Stage I: T1N0M0 (tumor confined to the vulva and/or perineum 2cm or less in diameter with stromal invasion no greater than 1.0 mm, nodes negative) or T1N0M0 (tumor confined to the vulva and/or perineum 2cm or less in diameter with stromal invasion greater than 1.0 mm, nodes negative).

Stage II: T2N0M0 (tumor confined to the vulva and/or perineum >2cm in diameter, nodes negative).

Stage III: T3N0M0 (tumor of any size with adjacent spread to the lower urethra or the anus) T1N1M0 2 (unilateral regional lymph node metastases), T2N1M0 or T3N1M0

Stage IV: (tumor invades any of the following: upper urethra, bladder mucosa, rectal mucosa, pelvic bone; or when there is bilateral regional node metastasis), T1N2M0, T2N2M0, T3N2M0, T4 any N M0, and any distant metastasis, including pelvic nodes; Any T, any N, M.

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