Definition of cervical carcinoma nomenclature.
| Name | Synonyms | English | TNM | FIGO | UICC |
| Preinvasive lesions | |||||
| CIN 1 | LSIL | CIN 1/LSIL | – | – | – |
| CIN 2 | HSIL | CIN 2/HSIL | – | – | – |
| CIN 3 | HSIL | CIN 3/HSIL | Tis | FIGO has no stage 0 | 0 |
| CIS | HSIL | CIS/HSIL | Tis | FIGO has no stage 0 | 0 |
| Invasive carcinomas | |||||
| Microinvasive carcinoma | Early invasive carcinoma, early stromal invasion, microcarcinoma. | Microinvasive disease Early (minimal) stromal invasion, – early stage disease. | T1a (T1a1 and T1a2) | IA (IA1 and IA2) | IA (IA1 and IA2) |
| Macroinvasive carcinoma | Macroinvasive disease | ≥ Ib | ≥ IB | ≥ IB | |
| Early cervical carcinoma | Localized cervical carcinoma | Early cervical cancer | 1A, 1b1, IIa1 | IA, IB1, selected IIA1 | IA, IB1, selected IIA1 |
| Advanced cervical carcinoma | Advanced (stage) disease | ≥ 2b and/or pN1 and/or pM1 | ≥ IIB (to IVB) Or also additionally IB2 and IIA2 with multiple histologic risk factors or pN1 | ≥ IIB (up to IVB) Or also additionally IB2 and IIA2 with multiple histologic risk factors or pN1 | |
| Locally advanced cervical carcinoma | Locally advanced disease | 2b to 4 and/or pN1 pM0 | IIB to IVA Or also additionally IB2 and IIA2 with multiple histologic risk factors or pN1 and c/pM0 | IIB to IVA Or also additionally IB2 and IIA2 with multiple histologic risk factors or pN1 and c/pM0 | |
| Locally advanced cervical carcinoma. | Disease limited to the pelvis, more advanced disease | 3 to 4 and/or pN1 pM0 | IIIA to IVA or pN1 and c/pM0 | IIIA to IVA or pN1 and c/pM0 | |
| Incidental cervical carcinoma | Accidental cervical carcinoma | Incidental cervical cancer | – | – | – |
| Recurrence | Recurrent disease, Relapse | – | – | – | |
| Early Recurrence | – | – | – | ||
| Late relapse | |||||
| Local recurrence | Locoregional recurrence Central recurrence, pelvic recurrence, vaginal recurrence, isolated pelvic recurrence | Local recurrence, localized recurrence, locoregional recurrence, central pelvic recurrence, – isolated central pelvic relapse | Any T, Any N, | – | – |
| Persistent primary disease | Tumor persistence | Persistent disease | – | – | – |
| Metastatic disease | Metastatic Disease | Any T, Any N, M1 | IVB | IVB | |
| Regional metastases | Locoregional metastases | Regional lymph node metastasis | Any T, N1, M0 | IIIB, IVa | IIIB, IVA |
| Distant metastases | Distant metastasis | Any T, Any N, M1 | IVB | IVB | |
| Isolated distant metastases | Isolated distant metastases | Any T, Any N, M1 | IVB | IVB | |
| Disseminated distant metastases | Disseminated metastases, Oligometastatic disease, | Any T, Any N, M1 | IVB | IVB | |
Legend
- TNM= general tumor classification of the WHO (World Health Association).
- FIGO = International Federation of Gynecology and Obstetrics.
- UICC = Union internationale contre le cancer
- CIN = cervical intraepithelial neoplasia
- CIS = carcinoma in situ
- LSIL = low grade squamous intraepithelial lesion
- HSIL = high grade squamous intraepithelial lesion
TNM classification of cervical carcinoma.
| T | Infiltration depth of the tumor |
| Tis | Carcinoma in situ |
| T1a | Tumor visible only microscopically; stromal invasion max. 5 mm, surface extension max. 7 mm |
| T1a1 | Stroma invasion max. 3 mm, surface expansion max. 7mm. |
| T1a2 | Stroma invasion max. 5 mm; surface expansion max. 7 mm. |
| T1b | Tumor visible macroscopically, confined to cervix uteri |
| T1b1 | Tumor extension max. 4 cm |
| T1b2 | Tumor extension > 4 cm |
| T2a | Tumor infiltration beyond uterus (womb), vagina (vagina; upper 2/3); without infiltration of parametria |
| T2b | Tumor infiltration beyond uterus, vagina (upper 2/3), parametria |
| T3a | Tumor infiltration into lower third of vagina |
| T3b | Tumor spread to pelvic wall or causes hydronephrosis/stumpy kidney |
| T4 | Tumor infiltration of bladder or rectum and/or crossing the borders of the lesser pelvis |
| N | Lymph node involvement |
| N0 | No lymph node metastases |
| N1 | Lymph node metastases in pelvic and/or para-aortic lymph nodes |
| M | Distant metastases |
| M0 | No distant metastases |
| M1 | Distant metastases |
The following histologic distinction can be made:
- Adenocarcinoma (approximately 20%).
- Adenosquamous carcinoma
- Endometrioid carcinoma
- Clear cell carcinoma
- Minimally deviant adenocarcinoma
- Mucinous adenocarcinoma
- Squamous cell carcinoma (about 80%)
FIGO classification of cervical carcinoma 2019 and its possible equivalent in the TNM.
| TNM stage | Definition | FIGO |
| Carcinoma in situ | ||
| Tis a | Carcinoma in situ | 0 |
| Invasive cervical carcinoma | ||
| T1 | Carcinoma confined to cervix uteri (infiltration of corpus uteri not staging relevant) | I |
| Microinvasive cervical carcinoma | ||
| T1a | Invasive carcinoma that can only be diagnosed microscopically, with an inversion depth ≤ 5.0 mm,Horizontal (planar) extent is irrelevant | IA |
| T1a1 | Cervical stromal invasion ≤ 3.0 mm | IA1 |
| T1a2 | Cervical stromal invasion ≥ 3.0 mm and ≤ 5.0 mm | IA2 |
| Macroinvasive cervical carcinoma | ||
| T1b | Invasive carcinoma with inversion deep > 5 mm, confined to the cervix uteri | IB |
| T1b1 | Cervical stromal inversion greater than 5.0 mm and ≤ 2 cm maximum tumor size | IB1 |
| T1b2 | Tumor size > 2 cm and ≤ 4 cm in maximal extension. | IB2 |
| T1b3 | Tumor size > 4 cm in maximal extension. | IB3 |
| T2 | Infiltration of cervical carcinoma outside the uterus, but no infiltration to the pelvic wall and not to the distal (lower) third of the vagina | II |
| T2a | Infiltration of upper 2 thirds of vagina, no parameters parametranous infiltration | IIA |
| T2a1 | Tumor size ≤ 4 cm at maximum extension. | IIA2 |
| T2a2 | Tumor size > 4 cm in maximal extension | IIA2 |
| T2b | Cervical carcinoma with parametranous infiltration, with/without concomitant detectable infiltration of the upper two-thirds of the vagina | IIB |
| Cervical carcinoma with extrauterine spread | ||
| T3 | Tumor spreads to pelvic wall and/or infiltrates distal third of vagina and/or causes hydronephrosis or nonfunctioning kidney | III |
| T3a | Tumor spreads to the lower third of the vagina without involvement of the pelvic wall | IIIA |
| T3b | Spread to pelvic wall and/or hydronephrosis or tumor-related nonfunctioning kidney b | IIIB |
| N1 | Metastases to pelvic and/or para-aortic lymph nodes regardless of tumor size and spread b | IIIC |
| N1a | Metastases only in pelvic lymph nodes b | IIIC1 |
| N1b | Metastases to para-aortic lymph nodes (whether or not pelvic lymph nodes are involved) | IIIC2 |
| T4 | The carcinoma crosses the borders of the lesser pelvis or infiltrates the mucosa of the urinary bladder or rectum (confirmed by biopsy; cystoscopic evidence of bullous edema is not sufficient to classify the case as FIGO IV/T4) | IV |
| T4 | Spread to organs of the small pelvis | IVA |
| M1 | Distant metastases | IVB |
Legend
- A Carcinoma in situ has not been listed by FIGO since 2009, nor has it been reincluded in the 2014 FIGO classification
- B By FIGO 2019, it was proposed to indicate the method by which the finding was made by adding the notation “r” (imaging) and “p” (pathology). Either turned on.
Other notes
- If there is any doubt in the stage grouping, the lower stage should always be assumed.
- The final stage grouping should not be made until all examination results are available.