HM (molar pregnancy) is disease limited to the uterine cavity.
Gestational Trophoblastic Neoplasia
Definitions: FIGO
The Féderation Internationale de Gynécologie et d'Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define gestational trophoblastic neoplasia; the FIGO system is most commonly used.[1,2] Some tumor registrars encourage the recording of staging in both systems.
FIGO staging system (and modified World Health Organization [WHO] prognostic scoring system)
The FIGO staging system is as follows:[1]
Table 1. Gestational Trophoblastic Neoplasia (GTN)a,b
| FIGO Anatomical Staging | ||||
|---|---|---|---|---|
| FIGO = Féderation Internationale de Gynécologie et d'Obstétrique; hCG = human chorionic gonadotropin; iu = international unit; WHO = World Health Organization. | ||||
| a Adapted from FIGO Committee on Gynecologic Oncology.[1] | ||||
| b To stage and allot a risk factor score, a patient's diagnosis is allocated to a stage as represented by a Roman numeral I, II, III, and IV. This is then separated by a colon from the sum of all the actual risk factor scores expressed in Arabic numerals, i.e., stage II:4, stage IV:9. This stage and score will be allotted for each patient. | ||||
| Stage | ||||
| I | Disease confined to the uterus. | |||
| II | GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament). | |||
| III | GTN extends to the lungs, with or without known genital tract involvement. | |||
| IV | All other metastatic sites. | |||
| Modified WHO Prognostic Scoring System as Adapted by FIGOb | ||||
| Scores | 0 | 1 | 2 | 4 |
| Age | <40 | ≥40 | - | - |
| Antecedent pregnancy | mole | abortion | term | - |
| Interval months from index pregnancy | <4 | 4-6 | 7-12 | >12 |
| Pretreatment serum hCG (iu/1) | <103 | 103 -104 | 104 -105 | >105 |
| Largest tumor size (including uterus) | <3 | 3-4 cm | ≥5 cm | - |
| Site of metastases | lung | spleen, kidney | gastrointestinal | liver, brain |
| Number of metastases | - | 1-4 | 5-8 | >8 |
| Previous failed chemotherapy | - | - | single drug | ≥2 drugs |
In addition, the FIGO staging system incorporates a modified WHO prognostic scoring system. The scores from the eight risk factors are summed and incorporated into the FIGO stage, separated by a colon (e.g., Stage II:4, Stage IV:9, etc.). Unfortunately, a variety of risk scoring systems have been published, making comparisons of results difficult.
References:
- FIGO Committee on Gynecologic Oncology.: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 105 (1): 3-4, 2009.
- Gestational trophoblastic tumors. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, p 439.