Heintz Ap

Carcinoma of the ovary

Ovarian cancer is staged surgically. There should be histologic confirmation of the disease. Operative findings, prior to tumor debulking, determine stage, which may be modified by histopathologic as well as clinical or radiological evaluation. Laparotomy and resection of the ovarian mass, as well as hysterectomy, form the basis for staging. Biopsies of all suspicious sites, such as omentum, mesentery, liver, diaphragm, pelvic and paraaortic nodes, are required. The final histologic findings after surgery (and cytologic ones when available) are to be considered in the staging. Clinical studies include routine radiology of the chest. Imaging studies and serum tumor markers may be helpful in both initial staging and follow-up of the tumors.

Carcinoma of the corpus uteri

Notes about the staging Histopathology – degree of differentiation: Cases of carcinoma of the corpus should be grouped with regard to the degree of differentiation of the adenocarcinoma as follows: • G1: 5% of a nonsquamous or nonmorular solid growth pattern • G2: 6−50% of a nonsquamous or nonmorular solid growth pattern • G3: >50% of a nonsquamous or nonmorular solid growth pattern Notes on pathologic grading: • Notable nuclear atypia, inappropriate for the architectural grade, raises the grade of a Grade 1 or Grade 2 tumor by 1. • In serous and clear cell adenocarcinomas, nuclear grading takes precedent. • Adenocarcinomas with squamous differentiation are graded according to the nuclear grade of the glandular component. Rules related to staging: • Corpus cancer is now surgically staged, therefore procedures previously used for determination of stages are no longer applicable (e.g. the findings of fractional curettage to differentiate between Stage I and Stage II). • It is appreciated that there may be a small number of patients with corpus cancer who will be treated primarily with radiation therapy. In these cases, the clinical staging adopted by FIGO in 1971 would still apply, but designation of that staging system would be noted. • Ideally, width of the myometrium should be measured along with the depth of tumor invasion.

Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Primary site The cervix is the lower third of the uterus. It is roughly cylindrical in shape, projects through the upper, anterior vaginal wall and communicates with the vagina through an orifice called the external os. Cancer of the cervix may originate on the vaginal surface or in the canal. Nodal stations The cervix is drained by preureteral, postureteral, and uterosacral routes into the following first station nodes: parametrial, internal (obturator – hypogastric), external iliac, presacral and common iliac. Para-aortic nodes are second station and are considered metastases.

Carcinoma of the vulva. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Primary site Cases should be classified as carcinoma of the vulva when the primary site of growth is in the vulva. Tumors present in the vulva as secondary growths, from either a genital or extra-genital site, have to be excluded. Malignant melanoma should be separately reported. A carcinoma of the vulva that extends into the vagina should be considered as a carcinoma of the vulva. There must be histologic confirmation of the cancer.

Carcinoma of the vulva

Primary site Cases should be classified as carcinoma of the vulva when the primary site of growth is in the vulva. Tumors present in the vulva as secondary growths, from either a genital or extra-genital site, have to be excluded. Malignant melanoma should be separately reported. A carcinoma of the vulva that extends into the vagina should be considered as a carcinoma of the vulva. There must be histologic confirmation of the cancer.

Gestational Trophoblastic Neoplasia

The pathologic classification and histologic findings of gestational trophoblastic neoplasia are discussed.

Carcinoma of the vagina

Primary site The vagina extends from the vulva upward to the uterine cervix. Cases should be classified as carcinoma of the vagina when the primary site of the growth is in the vagina. Tumors present in the vagina as secondary growths from either genital or extra-genital sites should be excluded. A growth that has extended to the portio and reached the area of the external os should always be allotted to carcinoma of the cervix. A growth limited to the urethra should be classified as carcinoma of the urethra. Tumor involving the vulva should be classified as carcinoma of the vulva. There should be histologic verification of the disease. Nodal stations The vagina is drained by lymphatics to the pelvic nodes in its upper two-thirds and to the inguinal nodes in the lower third. Metastatic sites The most common sites of distant spread include the lungs, liver and bony skeleton. The rules for staging are similar to those for carcinoma of the cervix.

Carcinoma of the vagina. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

Primary site The vagina extends from the vulva upward to the uterine cervix. Cases should be classified as carcinoma of the vagina when the primary site of the growth is in the vagina. Tumors present in the vagina as secondary growths from either genital or extra-genital sites should be excluded. A growth that has extended to the portio and reached the area of the external os should always be allotted to carcinoma of the cervix. A growth limited to the urethra should be classified as carcinoma of the urethra. Tumor involving the vulva should be classified as carcinoma of the vulva. There should be histologic verification of the disease. Nodal stations The vagina is drained by lymphatics to the pelvic nodes in its upper two-thirds and to the inguinal nodes in the lower third. Metastatic sites The most common sites of distant spread include the lungs, liver and bony skeleton. The rules for staging are similar to those for carcinoma of the cervix.

Carcinoma of the fallopian tube

Primary site The Fallopian tube extends from the posterior superior aspect of the uterine fundus laterally and anteriorly to the ovary. Its length is approximately 10 cm. The lateral end opens to the peritoneal cavity. Metastatic sites Carcinoma of the oviduct can metastasize to the regional lymph nodes, including the para-aortic nodes. Direct extension to surrounding organs, as well as intraperitoneal seeding, occurs frequently. Peritoneal implants may occur with an intact tube.

Carcinoma of the fallopian tube. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer.

STAGING Anatomy Primary site The Fallopian tube extends from the posterior superior aspect of the uterine fundus laterally and anteriorly to the ovary. Its length is approximately 10 cm. The lateral end opens to the peritoneal cavity. Metastatic sites Carcinoma of the oviduct can metastasize to the regional lymph nodes, including the para-aortic nodes. Direct extension to surrounding organs, as well as intraperitoneal seeding, occurs frequently. Peritoneal implants may occur with an intact tube.