Vulva, vagina & female urethra
General
Staging-vagina carcinoma


Topic Completed: 31 January 2020

Minor changes: 11 September 2020

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PubMed Search: Staging vaginal carcinoma [title]

Carlos Parra-Herran, M.D.
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Cite this page: Parra-Herran C. Staging-vagina carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vaginastaging.html. Accessed October 20th, 2020.

Pathologic TNM staging of carcinoma of the vagina, AJCC 8th edition and FIGO 2018 update
Definition / general
  • Based on the American Joint Committee on Cancer (AJCC) Staging Manual (8th edition) and the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO) 2018 update
  • Includes tumors with primary site of growth in vagina only; tumors with secondary spread to the vagina from other genital (vulva, cervix, endometrium) or extragenital sites should not be included
  • Staging is mostly clinical; however, information available from pathologic evaluation of resection specimens needs to be used
Essential features
Primary tumor [pT] and FIGO () stage
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor
  • pT1 (I): tumor confined to the vagina
    • pT1a (I): tumor confined to the vagina, measuring ≤ 2 cm
    • pT1b (I): tumor confined to the vagina, measuring > 2 cm
  • pT2 (II): tumor invades paravaginal tissues but not to pelvic wall
    • pT2a (II): tumor invading paravaginal tissues but not to pelvic side wall, measuring ≤ 2 cm
    • pT2b (II): tumor invading paravaginal tissues but not to pelvic side wall, measuring > 2 cm
  • pT3 (III): tumor extends to pelvic wall (muscle, fascia, neurovascular structures or skeletal portions of bony pelvis; on rectal examination, there is no cancer free space between the tumor and pelvic wall) or causing hydronephrosis or nonfunctioning kidney
  • pT4 (IVA): tumor invades mucosa of bladder or rectum or extends beyond the true pelvis (bullous edema is not sufficient evidence to classify a tumor as pT4)
Regional lymph nodes [pN] and FIGO () stage
  • pNX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
    • pN0(i+): isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
  • pN1 (III): pelvic or inguinal lymph node metastasis
Distant metastasis [pM] and FIGO () stage
  • pM0: no distant metastasis
  • pM1 (IVB): distant metastasis
Stage grouping and FIGO stage
Stage 0: Tis N0 M0
Stage I: T1 N0 M0
Stage II: T2 N0 M0
Stage III: T1 - 3 N1 M0
T3 N0 M0
Stage IVA: T4 any N M0
Stage IVB: any T any N M1
Board review style question #1
The most important tumor related feature for staging early vaginal carcinoma (confined to the vagina) is:

  1. Depth of invasion
  2. Involvement of paravaginal adipose tissue
  3. Lymphovascular space invasion
  4. Multifocality
  5. Tumor size
Board review answer #1
E. Tumor size. Staging of vaginal cancer is mostly clinical (with aid from pathology or radiology data, if available). Tumor size divides early stage tumors in 1a (≤ 2 cm) and 1b (> 2 cm in size). Unlike vulva and cervix, depth of invasion is not required for staging purposes. Lymphovascular invasion and multifocality are prognostic factors but do not influence staging. Involvement of paravaginal adipose tissue is, by definition, extension outside the vagina and qualifies as stage II.

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