VAGINA (ICD‐O‐3 C52) (Fig. 414)
The definitions of the T and M categories correspond to the FIGO stages. Both systems are included for comparison.
Rules for Classification
The classification applies to primary carcinomas only. Tumours present in the vagina as secondary growths from either genital or extragenital sites are excluded. A tumour that has extended to the portio and reached the external os (orifice of uterus) is classified as carcinoma of the cervix. A vaginal carcinoma occurring 5 years after successful treatment (complete response) of a carcinoma of the cervix uteri is considered a primary vaginal carcinoma. A tumour involving the vulva is classified as carcinoma of the vulva. There should be histological confirmation of the disease.
The FIGO stages are based on surgical staging. TNM stages are based on clinical and/or pathological classification.
Regional Lymph Nodes
Upper two‐thirds of vagina:
The pelvic nodes including obdurator, internal iliac (hypogastric), external iliac, and pelvic nodes, NOS. (Fig. 415)
Lower third of vagina:
The inguinal and femoral nodes. (Fig. 416)
TNM Clinical Classification
T – Primary Tumour
TNM Categories | FIGO Stages | Definition |
TX | Primary tumour cannot be assessed | |
T0 | No evidence of primary tumour | |
Tis | * | Carcinoma in situ (preinvasive carcinoma) |
T1 | I | Tumour confined to vagina (Fig. 417) |
T2 | II | Tumour invades paravaginal tissues (paracolpium) (Fig. 418) |
T3 | III | Tumour extends to pelvic wall (Fig. 419) |
T4 | IVA | Tumour invades mucosa of bladder or rectum, or extends beyond the true pelvis** (Fig. 420) |
Note | ||
*FIGO no longer includes Stage 0 (Tis). | ||
**The presence of bullous oedema is not sufficient evidence to classify a tumour as T4. | ||
M1 | IVB | Distant metastasis |
N – Regional Lymph Nodes
NX | Regional lymph nodes cannot be assessed |
N0 | No regional lymph node metastasis |
N1 | Regional lymph node metastasis (Figs. 421, 422, 423 ) |
M – Distant Metastasis
M0 | No distant metastasis |
M1 | Distant metastasis |
TNM Pathological Classification
The pT and pN categories correspond to the T and N categories.
pM1 | Distant metastasis microscopically confirmed |
Note pM0 and pMX are not valid categories.
pN0 | Histological examination of an inguinal lymphadenectomy specimen will ordinarily include 6 or more lymph nodes; 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. |