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Stage Information for Gestational Trophoblastic Tumors and Neoplasia

    Hydatidiform Mole (HM)

    HM (molar pregnancy) is disease limited to the uterine cavity.

    Invasive Mole (Chorioadenoma Destruens)

    Invasive mole (chorioadenoma destruens) is a locally invasive, rarely metastatic lesion.

    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
    IDisease confined to the uterus.
    IIGTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament).
    IIIGTN extends to the lungs, with or without known genital tract involvement.
    IVAll other metastatic sites.
    Modified WHO Prognostic Scoring System as Adapted by FIGOb
    Scores0124
    Age<40≥40
    Antecedent pregnancymoleabortionterm
    Interval months from index pregnancy<44–67–12>12
    Pretreatment serum hCG (iu/1)<103103 –104104 –105>105
    Largest tumor size (including uterus)<33–4 cm≥5 cm
    Site of metastaseslungspleen, kidneygastrointestinalliver, brain
    Number of metastases1–45–8>8
    Previous failed chemotherapysingle 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:

    1. 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.
    2. 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.

      WebMD Public Information from the National Cancer Institute

      Last Updated: February 25, 2014
      This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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