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.

Schematic illustration of Vagina. — **Fig. 414**

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)

Schematic illustration of the pelvic nodes including obdurator, internal iliac, external iliac, and pelvic nodes, NOS. — **Fig. 415**

Schematic illustration of 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

Schematic illustration of tumour confined to vagina. — **Fig. 417**

Schematic illustration of tumour invades paravaginal tissues. — **Fig. 418**

Schematic illustration of tumour extends to pelvic wall. — **Fig. 419**

Schematic illustration of tumour invades mucosa of bladder
or rectum, or extends beyond the true pelvis. — **Fig. 420**

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 )

Schematic illustration of Regional lymph node metastasis. — **Fig. 421**

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.