Σταδιοποίηση σε Ca Τραχήλου Μήτρας

Ca Τραχήλου Μήτρας

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

IA

T1a

N0

M0

IA1

T1a1

N0

M0

IA2

T1a2

N0

M0

IB

T1b

N0

M0

IB1

T1b1

N0

M0

IB2

T1b2

N0

M0

II

T2

N0

M0

IIA

T2a

N0

M0

IIA1

T2a1

N0

M0

IIA2

T2a2

N0

M0

IIB

T2b

N0

M0

III

T3

N0

M0

IIIA

T3a

N0

M0

IIIB

T3b

Any N

M0

T1-3

N1

M0

IVA

T4

Any N

M0

IVB

Any T

Any N

M1

(T) Primary Tumor

TNM

FIGO

Definitions

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis¹

Carcinoma in situ (preinvasive carcinoma)

T1

I

Cervical carcinoma confined to uterus (extension to corpus should be disregarded)

T1a²

IA

Invasive carcinoma diagnosed only by microscopy; stromal invasion with a maximum depth of 5.0 mm measured from the base of the epithelium and a horizontal spread of ≤ 7.0 mm; vascular space involvement, venous or lymphatic, does not affect classification

T1a1

IA1

Measured stromal invasion ≤ 3.0 mm in depth and ≤ 7.0 mm in horizontal spread

T1a2

IA2

Measured stromal invasion > 3.0 mm and ≤ 5.0 mm with a horizontal spread ≤ 7.0 mm

T1b

IB

Clinically visible lesion confined to the cervix or microscopic lesions greater than T1a/IA2

T1b1

IB1

Clinically visible lesion ≤ 4.0 cm in greatest dimension

T1b2

IB2

Clinically visible lesion > 4.0 cm in greatest dimension

T2

II

Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower 1/3 of vagina

T2a

IIA

Tumor without parametrial invasion

T2a1

IIA1

Clinically visible lesion ≤ 4.0 cm in greatest dimension

T2a2

IIA2

Clinically visible lesion > 4.0 cm in greatest dimension

T2b

IIB

Tumor with parametrial invasion

T3

III

Tumor extends to pelvic wall &/or involves lower 1/3 of vagina, &/or causes hydronephrosis or nonfunctioning kidney

T3a

IIIA

Tumor involves lower 1/3 of vagina, no extension to pelvic wall

T3b

IIIB

Tumor extends to pelvic wall &/or causes hydronephrosis or nonfunctioning kidney

T4

IVA

Tumor invades mucosa of bladder or rectum, &/or extends beyond true pelvis (bullous edema is not sufficient to classify a tumor as T4)

¹FIGO no longer includes stage 0 (Tis). 
²All macroscopically visible lesions, even with superficial invasion, are T1b/IB.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

IIIB

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

IVB

Distant metastasis

Χαρακτηριστικά Επέκτασης

Contiguous spread

• Most common mode of spread
• Caudally to invade
  • Vagina
• Anteriorly to invade
  • Vesicouterine ligament
  • Urinary bladder
• Laterally to invade
  • Cardinal ligaments
  • Paracervical tissues
    • Fat, vessels, ureters, lymphatics
  • Pelvic sidewall in advanced disease
    • Iliac vessels, pelvic musculature
• Posteriorly to invade
  • Uterosacral ligaments
  • Rectum

Lymphatic spread

• Significant prognostic indicator
• ↑ incidence with advancing stage of disease
• Correlates with ↓ disease-free survival
• ↑ incidence of recurrence at each stage with lymphatic invasion
• Lymphatic drainage of cervix
  • Parametrial → obturator → internal/external iliac
• 3 pathways of lymphatic drainage of cervix
  • Lateral route
    • Parallels external iliac vessels
    • Tumor drains 1st to medial external iliac chain, then to middle and lateral chains
    • Deep inguinal lymph nodes drain via lateral route
  • Hypogastric route
    • Parallels internal iliac vessels
    • Lymph nodes along internal iliac branches drain to junctional lymph nodes
    • Junctional lymph nodes lie between internal and external iliac vessels
  • Presacral route
    • Along uterosacral ligament
    • Uterosacral ligament → lymphatic plexus anterior to sacrum

• All 3 routes of lymphatic drainage of cervix drain to common iliac chains
• Common iliac chains drain to paraaortic lymph nodes
• Depth of invasion of cervix and adjacent structures may affect nodal involvement
  • Parametrial and pelvic sidewall invasion
    • Drainage by external iliac lymph nodes
  • Invasion of lower 1/3 of vagina
    • Inguinal lymph node metastases
  • Rectal wall invasion
    • Drainage by inferior mesenteric lymph nodes

Peritoneal seeding

• Peritoneal metastasis varies from 5-27% in autopsy series
• Mesenteric or omental metastases are uncommon
• "Sister Joseph" nodule
  • Umbilical metastasis
  • Direct extension of tumor from anterior peritoneal surface

Hematogenous spread

• Liver is most common abdominal organ with metastases
• Adrenal gland is 2nd most common metastatic site in abdomen
• Pulmonary metastases are relatively common in autopsy series (33-38%)
  • May be present for significant period of time; however, may remain asymptomatic
  • 1/3 have mediastinal or hilar adenopathy
    • Lymphangitic carcinomatosis in < 5%

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Cervical intraepithelial neoplasia, grade III
• Squamous cell carcinoma in situ
• Squamous cell carcinoma
  • Invasive
  • Keratinizing
  • Nonkeratinizing
  • Verrucous
• Adenocarcinomain situ
• Invasive adenocarcinoma

• Endometrioid adenocarcinoma
• Clear cell adenocarcinoma
• Adenosquamous carcinoma
• Adenoid cystic carcinoma
• Adenoid basal cell carcinoma
• Small cell carcinoma
• Neuroendocrine
• Undifferentiated carcinoma