Gestational Trophoblastic Disease Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Gestational Trophoblastic Disease
Hydatidiform Mole (HM)
HM (molar pregnancy) is disease limited to the uterine cavity.
Gestational Trophoblastic Neoplasia
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:
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.|
|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.|
|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|
|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.
- 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.