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Health & Pregnancy

Pregnancy Essentials

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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 of TNM and FIGO

The American Joint Committee on Cancer (AJCC) and the F�deration Internationale de Gyn�cologie et d'Obst�trique (FIGO) have designated staging to define gestational trophoblastic neoplasia.[1,2] The definitions of the AJCC's T, N, and M categories correspond to the stages accepted by FIGO. The FIGO staging and classification system is in more common use, but both systems are included for comparison. Some tumor registrars encourage the recording of staging in both systems.

AJCC TNM staging system

The AJCC has designated staging by TNM classification to define gestational trophoblastic tumors.[1] Given the high cure rates even in the setting of metastatic disease, the traditional TNM system is of limited prognostic value. In fact, regional nodal designation is not part of the routine staging system. However, in the rare circumstance of nodal involvement, prognosis is poor.

Within the AJCC anatomic groups (I-IV), there is prognostic subclassification into low-risk (A) and high-risk (B) based upon the prognostic scoring index derived from the FIGO/WHO scoring system in Table 4 below.

Table 1. Primary Tumor (T)a

^a Reprinted with permission from AJCC: Gestational trophoblastic tumors. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 437-44.
TNM Categories	FIGO Stages	�
TX	�	Primary tumor cannot be assessed.
T0	No evidence of primary tumor.
T1	I	Tumor confined to uterus.
T2	II	Tumor extends to other genital structures (ovary, tube, vagina, broad ligaments) by metastasis or direct extension.

Table 2. Distant Metastasis (M)a

^a Reprinted with permission from AJCC: Gestational trophoblastic tumors. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 437-44.
TNM Categories	FIGO Stages	�
M0	�	No distant metastasis.
M1	Distant metastasis.
M1a	III	Lung metastasis.
M1b	IV	All other distant metastases.

Table 3. Anatomic Stage/Prognostic Groupsa

^a Reprinted with permission from AJCC: Gestational trophoblastic tumors. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 437-44.
Group (by Stage)	T	M	Risk Factors
I	T1	M0	Unknown
IA	T1	M0	Low risk
IB	T1	M0	High risk
II	T2	M0	Unknown
IIA	T2	M0	Low risk
IIB	T2	M0	High risk
III	Any T	M1a	Unknown
IIIA	Any T	M1a	Low risk
IIIB	Any T	M1a	High risk
IV	Any T	M1b	Unknown
IVA	Any T	M1b	Low risk
IVB	Any T	M1b	High risk

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WebMD Public Information from the National Cancer Institute

Last Updated: May 16, 2012

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.