宫颈癌FIGO分期2018

宫颈癌

FIGO2018

FIGO staging of cancer of the cervix uteri (2018).

Stage分期

Description描述

Ⅰ

The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)

肿瘤局限于宫颈（向子宫体方向的侵犯也包括在内）

ⅠA

Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion <5mm（1）

仅仅能通过显微镜诊断的微小浸润癌，最大浸润深度＜5mm（即微小浸润癌，通常体检筛查发现，肉眼和正常宫颈无区分，看不出肿瘤大小及范围）

ⅠA1

Measured stromal invasion <3mm in depth

浸润间质深度＜3mm

ⅠA2

Measured stromal invasion ≥3mm and <5mm in depth

浸润间质深度≥3mm但＜5mm

ⅠB

Invasive carcinoma with measured deepest invasion ≥5mm (greater than Stage IA), lesion limited to the cervix uteri （2）

肿瘤浸润深度≥5mm（超过ⅠA期），病变局限于子宫颈

ⅠB1

Invasive carcinoma ≥5mm depth of stromal invasion, and <2cm in greatest dimension

癌灶浸润间质深度≥5mm，但肿瘤最大径＜2cm。

ⅠB2

Invasive carcinoma ≥2cm and <4cm in greatest dimension

肿瘤最大径≥2cm，但＜4cm

ⅠB3

Invasive carcinoma ≥4cm in greatest dimension

肿瘤最大径≥4cm

Ⅱ

The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall

肿瘤侵犯超出宫颈，但未到阴道下1/3或者到达盆壁（超出宫颈会向两个方向侵犯，纵向或者横向，纵向为ⅡA，横向为ⅡB）

ⅡA

Involvement limited to the upper two-thirds of the vagina without parametrial involvement

肿瘤只向纵向发展，累及阴道，但未到达下1/3，无宫旁浸润

ⅡA1

Invasive carcinoma <4cm in greatest dimension

肿瘤最大径＜4cm

ⅡA2

Invasive carcinoma ≥4cm in greatest dimension

肿瘤最大径≥4cm

ⅡB

With parametrial involvement but not up to the pelvic wall

肿瘤往横向侵犯，有宫旁受累，但未到达盆壁（无论有无阴道受累，在妇科查体表现为宫旁增厚，活动差）

Ⅲ

The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph node （3）

肿瘤侵犯阴道下1/3，和/或者横向扩展达盆壁，和/或导致肾积水或无功能肾，和/或出现盆腔和/或腹主动脉旁淋巴转移。

ⅢA

The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall

阴道下1/3受累，宫旁浸润未达到盆壁

ⅢB

Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)

侵犯到盆壁，和/或导致肾积水或无功能肾（排除其他病因）

ⅢC

Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)（3）

盆腔和/或腹主动脉旁淋巴侵犯，无论原发肿瘤大小及侵犯范围（需以 r和p标注影像学发现还是病理发现）

ⅢC1

Pelvic lymph node metastasis only

只有盆腔淋巴结转移

ⅢC2

Para-aortic lymph node metastasis

有腹主动脉旁淋巴转移

Ⅳ

The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. (A bullous edema, as such, does not permit a case to be allotted to Stage IV)

癌已超出真骨盆，或者活检证实膀胱或直肠粘膜受累（泡状水中不归为IV期）

ⅣA

Spread to adjacent pelvic organs

肿瘤侵犯临近器官（例如如直肠、膀胱粘膜活检阳性）

ⅣB

Spread to distant organs

远处转移（例如肺转移、颈部淋巴结转移等）

When in doubt, the lower staging should beassigned.如果对分期存在争议，应当采纳相对低的分期。（例如，不太确定有无阴道受累时，按无阴道受累分期。）

（1）Imaging and pathology can be used, where available, to supplementclinical findings with respect to tumor size and extent, in all stages。对于临床判断的肿瘤大小和范围，无论任何期别均可以有影像学和病理学的结果作为补充。

（2）The involvement of vascular/lymphatic spaces does not change thestaging. The lateral extent of the lesion is no longer considered。淋巴脉管间隙浸润不影响分期。病变浸润宽度不再影响分期。

（3）Adding notation of r (imaging) and p (pathology) to indicate thefindings that are used to allocate the case to Stage IIIC. Example: If imagingindicates pelvic lymph node metastasis, the stage allocation would be StageIIIC1r, and if confirmed by pathologic findings, it would be Stage IIIC1p. Thetype of imaging modality or pathology technique used should always bedocumented.

对于ⅢC期的病例，需注明淋巴结阳性是r（影像学）和p（病理学）。例如：如果是影像学提示盆腔淋巴结转移，分期当标记为ⅢC1r，如果最后盆腔淋巴转移得到病理验证，那么分期应标注为ⅢC1p。使用的影像学手段或者病理技术类型都应该要有记录。

归纳一下，用字数最少的方法记忆

Ⅰ期，局限于宫颈，可以向宫体方向侵犯

ⅠA 镜下微小浸润癌，深度＜5mm

ⅠA1 深度＜3mm

ⅠA2 3mm≤深度＜5mm

ⅠB 肉眼可见癌

ⅠB1 最大径＜2cm

ⅠB2 2cm≤最大径＜4cm

ⅠB3 最大径≥4cm

Ⅱ 超出子宫颈，向下侵犯阴道或向两侧侵犯宫旁

ⅡA 向下侵犯阴道 只累及上2/3

ⅡA1 最大径＜4cm

ⅡA2 最大径≥4cm

ⅡB 向两侧侵犯宫旁

Ⅲ 阴道下1/3 or 达盆壁 or 肾积水、肾无功能 or 淋巴转移

ⅢA 阴道下1/3

ⅢB 达盆壁or 肾积水、肾无功能

ⅢC 淋巴转移（标注r或p）

ⅢC1 盆腔淋巴转移

ⅢC2 腹主动脉旁淋巴转移

Ⅳ 超出真骨盆，脏器转移，远处转移

ⅣA 临近脏器转移，如膀胱、直肠粘膜（水肿不算）

ⅣB 远处转移

为方便记忆和查阅整理此文

参考文献：《FIGO 2018妇癌报告》FIGO Cancer Report 2018

编辑：郭铭川

所属单位：深圳市龙岗区人民医院 妇产科