CERVIX UTERI (ICD‐O‐3 C53)
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 only to carcinomas. There should be histological confirmation of the disease.
FIGO staging of cervical carcinoma was updated in 2018 (ref: DOI: 10.1002/ijgo.12611) and has significant differences to TNM. Please note a new version of TNM staging for cervix is proposed which aligns with the new version of FIGO (see https://www.uicc.org/resources/tnm/publications‐resources for details)
Anatomical Subsites (Fig. 424)
- Endocervix (C53.0)
- Exocervix (C53.1)
Regional Lymph Nodes (Fig. 425)
The regional lymph nodes are the paracervical (1), parametrial (2), hypogastric (internal iliac, obturator) (3), common (5) and external iliac (4), presacral (6), lateral sacral nodes (7) and para‐aortic nodes (8).
NoteIn the 7th edition the para‐aortic nodes were considered to be distant metastatic, but to be consistent with advice from FIGO the para‐aortic nodes are now classified as regional.
TNM Clinical Classification
T – Primary Tumour
TNM Categories | Definition | ||
TX | Primary tumour cannot be assessed | ||
T0 | No evidence of primary tumour | ||
Tis1 | Carcinoma in situ (preinvasive carcinoma) | ||
T1 | Tumour confined to the cervix (extension to corpus should be disregarded)2 | ||
T1a3,4 | Invasive carcinoma diagnosed only by microscopy (Fig. 426). Stromal invasion with a maximal depth of 5.0 mm measured from the base of the epithelium and a horizontal spread of 7.0 mm or less2 (Fig. 427) | ||
T1a1 | Measured stromal invasion 3.0 mm or less in depth and 7.0 mm or less in horizontal spread | ||
T1a2 | Measured stromal invasion more than 3.0 mm and not morethan than 5.0 mm with a horizontal spread of 7.0 mm or less (Fig. 428) |
Note1FIGO no longer include Stage 0 (Tis)
2The depth of invasion should be 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 papillae to the deepest point of invasion.
3Vascular space involvement, venous or lymphatic, does not affect classification.
4FIGO does not consider horizontal extent in definition of IA1 or IA2.
T1b | Clinically visible lesion confined to the cervix (Figs. 429, 431 ) or microscopic lesion greater than T1a/IA2 (Fig. 430) |
T1b1 | Clinically visible lesion 4.0 cm or less in greatest dimension1 (Fig. 429) |
T1b2 | Clinically visible lesion more than 4.0 cm in greatest dimension2 (Fig. 431) |
Note1 FIGO defines IB1 as Invasive carcinoma ≥ 5.0 mm depth of invasion and < 2.0 cm in greatest dimension.
2 FIGO defines IB2 as Invasive carcinoma ≥ 2.0 cm and > 4.0 cm in greatest dimension. FIGO has an additional category of IB3: Invasive carcinoma ≥ 4.0 cm in greatest dimension.
T2 | Tumour invades beyond uterus but not to pelvic wall or to lower third of vagina (Fig. 432) |
T2a | Tumour without parametrial invasion |
T2a1 | Clinically visible lesion 4.0 cm or less in greatest dimension |
T2a2 | Clinically visible lesion more than 4.0 cm in greatest dimension |
T2b | Tumour with parametrial invasion (Fig. 433) |
T3 | Tumour extends to pelvic wall, involves lower third of vagina, causes hydronephrosis or non‐functioning kidney (Fig. 434) |
T3a | Tumour involves lower third of vagina |
T3b | Tumour extends to pelvic wall, causes hydronephrosis or nonfunctioning kidney |
T4 | Tumour invades mucosa of the bladder or rectum, or extends beyond true pelvis1 (Fig. 435) |
M1 | Distant metastasis |
Notes1Bullous oedema is not sufficient to classify a tumour as T4.
N – Regional Lymph Nodes
NX | Regional lymph nodes cannot be assessed |
N0 | No regional lymph node metastasis |
N1 | Regional lymph node metastasis* (Fig. 436) |
NoteFIGO now includes regional lymph nodes in staging of cervical carcinoma. IIIC1 pelvic lymph node metastasis only. IIIC2 para‐aortic lymph node metastasis.
M – Distant Metastasis
M0 | No distant metastasis |
M1 | Distant metastasis (includes inguinal lymph nodes and intraperitoneal disease). It excludes metastasis to para‐aortic lymph nodes, vagina, pelvic serosa, and adnexa |
pTNM Pathological Classification
The pT and pN categories correspond to the T and N categories.
pM1 | Distant metastasis microscopically confirmed |
NotepM0 and pMX are not valid 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. |