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)

Schematic illustration of Endocervix and Exocervix. — **Fig. 424**

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).

Note
In 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
	T1a^3,4	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 more than than 5.0 mm with a horizontal spread of 7.0 mm or less (Fig. 428)

Note
¹FIGO 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)

Note
¹ 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.

Schematic illustration of paracervical, parametrial, hypogastric, common and external iliac, presacral, lateral sacral nodes and para-aortic nodes. — **Fig. 425**

Schematic illustration of Invasive carcinoma diagnosed only by microscopy. — **Fig. 426**

Schematic illustration of 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 less. — **Fig. 427**

Schematic illustration of Measured stromal invasion more than 3.0 mm and not more than than 5.0 mm with a horizontal spread of 7.0 mm or less. — **Fig. 428**

Schematic illustration of Clinically visible lesion confined to the cervix. — **Fig. 429**

Schematic illustration of Clinically visible lesion 4.0 cm or less in greatest dimension. — **Fig. 430**

Schematic illustration of tumour invades beyond uterus but not to pelvic wall or to lower
third of vagina. — **Fig. 432**

Schematic illustration of tumour with parametrial invasion. — **Fig. 433**

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

Notes
¹Bullous oedema is not sufficient to classify a tumour as T4.

Schematic illustration of tumour extends to pelvic wall, involves lower third of vagina, causes
hydronephrosis or non-functioning kidney. — **Fig. 434**

Schematic illustration of tumour invades mucosa of the bladder or rectum, or extends beyond
true pelvis. — **Fig. 435**

Schematic illustration of Regional lymph node metastasis. — **Fig. 436**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis* (Fig. 436)

Note
FIGO 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

Note
pM0 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.