27. Anhang – Cervical Carcinoma

Version 2.2 · March 2022 · AWMF 032/033OL
Leitlinienprogramm Onkologie · Deutsche Krebsgesellschaft · Deutsche Krebshilfe · AWMF

Table 15: Übersicht der TNM-Kategorien/ FIGO-Stadien (modifiziert 2021)

N classification of regional lymph nodes (pelvic):
NX = regional lymph nodes cannot be assessed
N0 = No regional lymph node metastases
N1 = Regional lymph node metastases

M classification of distant metastases (including para-aortic lymph nodes):
cM0 = No clinical evidence of distant metastases
cM1 = Clinical evidence of distant metastases
pM1 = Histological confirmation of distant metastases
pM0 = Histologically confirmed distant metastases

Lymphatic invasion (L-status):
LX = Invasion of lymphatic vessels cannot be assessed
L0 = No lymphatic invasion
L1 = Evidence of lymphatic invasion

Vascular invasion (V status):
VX = Vascular invasion cannot be assessed
V0 = No vascular invasion
V1 = Evidence of vascular invasion

Invasion of the perineural sheaths (Pn status):
PnX = Perineural invasion cannot be assessed
Pn0 = No perineural invasion
Pn1 = Evidence of perineural invasion

Carcinoma in situ is not included in the respective FIGO classification, but is anchored in the TNM classification.
Horizontal extension is no longer relevant for staging in the 2018 FIGO classification. However, no rationale is given for this by FIGO, nor are any relevant studies cited.
In the 2018 FIGO classification, para-aortic lymph nodes are now defined as regional lymph nodes; this proposal is also followed in the revised reprint of the TNM classification [868].
It was suggested by FIGO in 2019 that adding the notation “r” (imaging) and “p” (pathology) would indicate the method by which the finding was established.

Table 16: Übersicht der UICC-Stadien (geprüft 2021)

UICC stage	Corresponding TNM categories
0	Tis	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	T1, T2, T3a	N1	M0
	T3B	Any N	M0
IVA	T4	Any N	M0
IVB	Any T	Any N	M1

References

[868] Wittekind, C, TNM Klassifikation maligner Tumoren - Korrigierter Nachdruck 2020 mit allen Ergänzungen der UICC aus den Jahren 2017 bis 2019Wiley-VCH, Weinheim, 2020.

TNM categories	FIGO- Stages (2009)	Definition	FIGO Stages (2018)	Definition
TX	-	Primary tumor cannot be assessed		-
0	-	No evidence of primary tumor		-
Tis	^{- ¹}	Carcinoma in situ (preinvasive carcinoma; adenocarcinoma in situ, stratified mucin-producing lesion; SIMLE)	- ¹	-
1	I	Tumor confined to the cervix	I	Tumor confined to the cervix
T1a	IA	Invasive carcinoma diagnosed only by microscopy. Stromal invasion with a maximum depth of 5.0 mm, with a horizontal spread of 7.0 mm or less	IA	Invasive carcinoma diagnosed only by microscopy. Stromal invasion to a maximum depth of 5.0 mm ²
T1a1	IA1	Stromal invasion of ≤ 3.0 mm in depth and ≤ 7.0 mm in horizontal spread	IA1	Stromal invasion of ≤ 3.0 mm in depth²
T1a2	IA2	Stromal invasion of > 3.0 mm and ≤ 5.0 mm with a horizontal spread of 7.0 mm or less	IA2	Stromal invasion of more than 3.0 mm but no more ≤ 5.0 mm ²
	IB	(Macroscopically) visible lesion, confined to the cervix, or microscopic lesion > T1a2 / IA2	IB	Clinically (macroscopically) visible lesion, confined to the cervix, or microscopic lesion > T1a2 / IA2
T1b1	IB1	Clinically (macroscopically) visible lesion, ≤ 4.0 cm in largest extent	IB1	Clinically (macroscopically) visible lesion, ≤ 2.0 cm in largest extent
T1b2	IB2	Clinically (macroscopically) visible lesion, > 4.0 cm in largest extent	IB2	Clinically (macroscopically) visible lesion, > 2.0 cm but ≤ 4.0cm in largest extent
Tb3	-	-	IB3	(Macroscopically) visible lesion, more than 4.0 cm in largest extent
	II	Tumor invading beyond the uterus, but not as far as the pelvic wall and not to the lower third of the vagina	II	Tumor invading beyond the uterus, but not as far as the pelvic wall and not to the lower third of the vagina
T2a	IIA	Tumor with spread into the vagina (proximal and/or middle third), but without invasion of the parametrium	IIA	Tumor with spread into the vagina (proximal and/or middle third), but without invasion of the parametrium
T2a1	IIA1	Clinically (macroscopically) visible lesion ≤ 4.0 cm at largest extent	IIA1	Clinically (macroscopically) visible lesion ≤ 4.0 cm at largest extent
T2a2	IIA2	Clinically (macroscopically) visible lesion > 4.0 cm at largest extent	IIA2	Clinically (macroscopically) visible lesion > 4.0 cm at largest extent
T2b	IIB	Tumor with invasion of the parametrium, but not as far as the pelvic wall	IIB	Tumor with invasion of the parametrium, but not as far as the pelvic wall
T3	III	Tumor extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or nonfunctional kidney	III	Tumor extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or nonfunctional kidney
T3a	IIIA	Tumor involves the lower third of the vagina, with no extension to the pelvic wall	IIIA	Tumor involves the lower third of the vagina, with no extension to the pelvic wall
T3b	IIIB	Tumor extends to the pelvic wall and/or causes hydronephrosis or nonfunctional kidney	IIIB	Tumor extends to the pelvic wall and/or causes hydronephrosis or nonfunctional kidney
pN1 or pM1	IVa	Metastases in the pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent	IIIC	Metastases in the pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent
pN1	IVa	Metastases only in pelvic lymph nodes	IIIC1	^{Metastases only in pelvic lymph nodes⁴}
pM1	IVa	Metastases in para-aortic lymph nodes (independently of whether or not pelvic lymph nodes are involved)	IIIC2	Metastases in para-aortic lymph nodes (independently of whether or not pelvic lymph nodes are involved)⁴
T4	IV	Tumor invades the mucosa of the bladder or rectum or extends beyond the boundary of the lesser pelvis	IV	Tumor invades the mucosa of the bladder or rectum or extends beyond the boundary of the lesser pelvis
T4	IVa	Tumor invades the mucosa of the bladder or rectum or extends beyond the boundary of the lesser pelvis	IVa	Spread into organs of the lesser pelvis
M1	IVb	Distant metastases, including metastases in para-aortic lymph nodes	IVb	Distant metastases