Σταδιοποίηση σε Ca Αιδίου

Ca Αιδοίου

AJCC Stages

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

IA

T1a

N0

M0

IB

T1b

N0

M0

II

T2

N0

M0

IIIA

T1, T2

N1a, N1b

M0

IIIB

T1, T2

N2a, N2b

M0

IIIC

T1, T2

N2c

M0

IVA

T1, T2

N3

M0

T3

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)

T1a

IA

Lesions ≤ 2 cm in size, confined to the vulva or perineum and with stromal invasion ≤ 1.0 mm²

T1b

IB

Lesions > 2 cm in size or any size with stromal invasion > 1.0 mm, confined to the vulva or perineum

T2³

II/III

Tumor of any size with extension to adjacent perineal structures (lower/distal 1/3 urethra, lower/distal 1/3 vagina, anal involvement)

T3⁴

IVA

Tumor of any size with extension to any of the following: Upper/proximal 2/3 of urethra, upper/proximal 2/3 vagina, 

¹FIGO no longer includes stage 0 (Tis). ²The depth of invasion is defined as the measurement of the tumor from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of invasion. ³FIGO uses the classification T2/T3. This is defined as T2 in TNM. ⁴FIGO uses the classification T4. This is defined as T3 in TNM.

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

1 or 2 regional lymph nodes with the following features

N1a

IIIA

1 or 2 lymph node metastases each < 5 mm

N1b

IIIA

1 lymph node metastasis ≥ 5 mm

N2

IIIB

Regional lymph node metastasis with the following features

N2a

IIIB

≥ 3 lymph node metastases each < 5 mm

N2b

IIIB

≥ 2 lymph node metastases ≥ 5 mm

N2c

IIIC

Lymph node metastasis with extracapsular spread

N3

IVA

Fixed or ulcerated regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

IVB

Distant metastasis (including pelvic lymph node metastasis)

Χαρακτηριστικά Επέκτασης

Contiguous spread

• Influenced by histology
  • Well differentiated: Superficial spread with minimal invasion
  • Anaplastic: More likely to be deeply invasive
• Posteriorly to anus and rectum
• Anteriorly to urethra, rarely to urinary bladder and pubic bone
• Cranially to vagina
• Usually slowly infiltrates local tissues, followed by lymph node spread

Lymphatic spread

• Typical lymphatic drainage
  • Superficial inguinal → deep femoral → external iliac lymph nodes
  • Superficial inguinal lymph nodes
    • Subcutaneous along medial inguinal ligament
    • Along saphenous vein, near saphenofemoral junction
  • Deep femoral lymph nodes
    • Along femoral artery and vein, within femoral sheath
    • Can be involved without superficial inguinal adenopathy
  • External iliac lymph nodes
    • Cloquet node: Most caudal lymph node in this chain, at entrance of femoral canal
    • Cloquet node signals likelihood of pelvic node metastases
• Drainage based on tumor location
  • Lateral lesions spread to ipsilateral lymph nodes
  • Central lesions may spread to ipsilateral, contralateral, or both lymph nodes
    • Lesions within 1 cm of vulvar midline
    • Anterior lesions (area immediately posterior to clitoris)

• Likelihood of lymphatic spread increases with each millimeter of depth of invasion
  • ≤ 1 mm → 0%
  • 1.1-2 mm → 5.4%
  • > 5 mm → 32%
• Other patterns of lymphatic spread
  • Bilateral groin metastasis
    • Drainage from midline structures: Perineum and clitoris
  • Contralateral groin metastasis
    • Bartholin cancer
  • Direct spread to pelvic nodes
    • Rarely occurs with central cancers
    • Direct drainage via internal pudendal chain to internal iliac nodes
  • Subcutaneous and dermal lymphatics
    • Obstruction of typical lymphatic drainage
    • Involves vulva, upper thighs, lower abdomen
  • Obturator or internal iliac nodes
    • Involved if invasion of vagina or bladder
• Risk factors for lymph node metastases
  • Clinical node status
  • Age
  • Degree of differentiation
  • Tumor stage
  • Tumor thickness
  • Depth of stromal invasion
  • Presence of lymphovascular invasion

Hematogenous spread

• Distant metastases are rare and usually fatal
• Occur late and rarely without nodal metastases
• 1 series showed significantly lower risk of hematogenous metastases with < 3 positive lymph nodes at time of diagnosis

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Squamous cell carcinoma
• Verrucous carcinoma
• Paget disease of vulva
• Adenocarcinoma, NOS

• Basal cell carcinoma, NOS
• Bartholin gland carcinoma

Mucosal malignant melanoma is not included in this classification and staging