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Histopathology of the uterine cervix - digital atlas

Classification TNM/FIGO

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T — Primary tumour 1,2
Categories Stages
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
Tis 0 Carcinoma in-situ (preinvasive carcinoma)
T1 I Cervical carcinoma confined to uterus (extension to corpus should be disregarded)
T1a IA Invasive carcinoma diagnosed only by microscopy. All macroscopically visible lesions — even with superficial invasion — are T1b/Stage IB
T1a1 IA1 Stromal invasion no greater than 3.0 mm in depth and 7.0 mm or less in horizontal spread
T1a2 IA2 Stromal invasion more than 3.0 mm and not more than 5.0 mm with a horizontal spread 7.0 mm or less

Note: The depth of invasion should not be more than 5 mm taken from the base of the epithelium, either surface or glandular, from which it originates. The depth of invasion is defined as the measurement of the tumour from the epithelial-stromal junction of the adjacent most superficial epithelial papilla to the deepest point of invasion. Vascular space involvement, venous or lymphatic, does not affect classification.

T1b IB Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a2/IA2
T1b1 IB1 Clinically visible lesion 4.0 cm or less in greatest dimension
T1b2 IB2 Clinically visible lesion more than 4 cm in greatest dimension
T2 II Tumour invades beyond uterus but not to pelvic wall or to lower third of the vagina
T2a IIA Without parametrial invasion
T2b IIB With parametrial invasion
T3 III Tumour extends to pelvic wall, involves lower third of vagina, or causes hydronephrosis or non-functioning kidney
T3a IIIA Tumour involves lower third of vagina, no extension to pelvic wall
T3b IIIB Tumour extends to pelvic wall or causes hydronephrosis or non-functioning kidney
T4 IVA Tumour invades mucosa of bladder or rectum or extends beyond true pelvis

Note: The presence of bullous oedema is not sufficient to classify a tumour as T4.

M1 IVB Distant metastasis

N - Regional Lymph Nodes3
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1   Regional lymph node metastasis

M - Distant Metastasis
MX   Distant metastasis cannot be assessed
M0   No distant metastasis
M1   Distant metastasis

Stage grouping
Stage 0 Tis N0 M0
Stage IA T1a N0 M0
Stage IA1 T1a1 N0 M0
Stage IA2 T1a2 N0 M0
Stage IB T1b N0 M0
Stage IB1 T1b1 N0 M0
Stage IB2 T1b2 N0 M0
Stage IIA T2a N0 M0
Stage IIB T2b N0 M0
Stage IIIA T3a N0 M0
Stage IIIB T1, T2, T3a N1 M0
T3b Any N M0
Stage IVA T4 Any N M0
Stage IVB Any T Any N M1

1 AJCC (2002). AJCC Cancer Staging Manual. Sixth ed. Springer Verlag: New York.
UICC (2002). TNM classification of malignant tumors. Sixth ed. John Wiley & Sons: New York.

2 A help desk for specific questions about the TNM classification is available at https://www.uicc.org.

3 The regional lymph nodes are the paracervical, parametrial, hypogastric (internal ilial, obturator), common and external iliac, presacral, and lateral sacral nodes.
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