TNM 7 Classification





TNM 6 Classification



1. Rules for Classification


The classification applies to malignant surface epithelial-stromal
tumours including those of borderline malignancy or of low
malignant potential (WHO histological classification, 2nd edition,
Scully 1999) corresponding to "common epithelial tumours" of the
earlier terminology. Non-epithelial ovarian cancers may also be
classified using this scheme. There should be histological
confirmation of the disease and division of cases by histological
type.


The following are the procedures for assessing T, N, and M categories:



T categories. Physical examination, imaging, laparoscopy, and/or
surgical exploration

N categories. Physical examination, imaging,
laparoscopy, and/or surgical exploration

M categories. Physical
examination, imaging, laparoscopy, and/or surgical exploration The
FIGO stages are based on surgical staging. (TNM stages are based
on clinical and/or pathological classification.)



The definitions of the T, N, and M categories correspond to the FIGO stages.
Both systems are included for comparison.

2. Regional Lymph Nodes


The regional lymph nodes are the hypogastric (obturator), common iliac, external iliac, lateral sacral, para-aortic, and inguinal nodes.



3. TNM Clinical Classification


3.1. T - Primary Tumour


























































































TNM Categories
 FIGO Stages
TX
Primary tumour cannot be assessed
T0
No evidence of primary tumour
T1
 I
 Tumour limited to the ovaries
T1a
 IA
 Tumour limited to one ovary; capsule intact, no tumour on ovarian surface; no malignant cells in ascites or perito-neal washings
T1b
 IB
 Tumour limited to both ovaries; capsule intact, no tumour on ovarian surface; no malignant cells in ascites or perito-neal
washings
T1c
 IC
 Tumour limited to one or both ovaries with any of the following: capsule ruptured, tumour on ovarian surface, malignant cells
in ascites or peritoneal washings
T2
 II
 Tumour involves one or both ovaries with pelvic extension
T2a
 IIA
 Extension and/or implants on uterus and/or tube(s); no malignant cells in ascites or peritoneal washings
T2b
 IIB
 Extension to other pelvic tissues; no malignant cells in ascites or peritoneal washings
T2c
 IIC
 Pelvic extension (2a or 2b) with malignant cells in ascites or peritoneal washings
T3 and/or N1
 III
 Tumour involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional
lymph node metastasis
T3a
 IIIA
 Microscopic peritoneal metastasis beyond pelvis
T3b
 IIIB
 Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension
T3 and/or N1
 IIIC
 Peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension and/or regional lymph node metastasis
M1
 IV
 Distant metastasis (excludes peritoneal metastasis)




Note: Liver capsule metastasis is T3/stage III, liver parenchymal metastasis M1/stage IV. Pleural effusion must have positive cytology for M1/stage IV.


3.2. N - Regional Lymph Nodes



NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Regional lymph node metastasis



3.3. M - Distant Metastasis



MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis



4. pTNM Pathological Classification


The pT, pN, and pM categories correspond to the T, N, and M categories.



pN0. Histological examination of a pelvic lymphadenectomy specimen will
ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but
the number ordinarily examined is not met, classify as pN0.



5. G Histopathological Grading


See definitions on .


6. Stage Grouping












































































Stage IA
 T1a
 N0
 M0
Stage IB
 T1b
 N0
 M0
Stage IC
 T1c
 N0
 M0
Stage IIA
 T2a
 N0
 M0
Stage IIB
 T2b
 N0
 M0
Stage IIC
 T2c
 N0
 M0
Stage IIIA
 T3a
 N0
 M0
Stage IIIB
 T3b
 N0
 M0
Stage IIIC
 T3c
 N0
 M0
Any T
 N1
 M0
Stage IV
 Any T
 Any N
 M1







7. Summary















































































TNM
 Ovary
 FIGO
T1
 Limited to the ovaries
 I
T1a
 One ovary, capsule intact
 IA
T1b
 Both ovaries, capsule intact
 IB
T1c
 Capsule ruptured, tumour on surface, malignant cells in ascites or peritoneal washings
 IC
T2
 Pelvic extension
 II
T2a
 Uterus, tube(s)
 IIA
T2b
 Other pelvic tissues
 IIB
T2c
 Malignant cells in ascites or peritoneal washings
 IIC
T3 and/or N1
 Peritoneal metastasis beyond pelvis and/or regional lymph node metastasis
 III
T3a
 Microscopic peritoneal metastasis
 IIIA
T3b
 Macroscopic peritoneal metastasis ≤2 cm
 IIIB
T3 and/or N1
 Peritoneal metastasis >2 cm and/or regional lymph node metastasis
 IIIC
M1
 Distant metastasis (excludes peritoneal metastasis)
 IV