Cervical Cancer: Classification

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.