Hi Vlad,

According to a well recognized study of Shimada et al (Gynecol Oncol 101:234-7, 2006), the incidence of ovarian metastasis in patients with cervical cancer was 0.22% for stage Ib, 0.75% for stage IIa, and 2.17% for stage IIb with squamous cell carcinoma, and 3.72%, 5.26%, and 9.85%, respectively, in adenocarcinoma. 

So, you can semi-quantitatively speculate about pTNM value presented in your question.

Best regards,

Ilya

any cervical cancer has invasion beyond uterus is stage T2

but you should see if their is parametrial invasion or not,  to do proper staging

if the patient had complete uterine invasion reaching ovary , not parametrium, you should confirm that its cervical origin, or uterine cancer by IHC

TNM and FIGO Classifications for Cervical Cancer

The American Joint Committee on Cancer (AJCC) TNM classification and the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer are provided below.[1, 2, 3]

Table. TNM and FIGO Classifications for Cervical Cancer (Open Table in a new window)

Primary tumor (T)

TNM

FIGO

Surgical-Pathologic Findings

Categories

Stages

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ (preinvasive carcinoma)

T1

I

Cervical carcinoma confined to the cervix (disregard extension to the corpus)

T1a

IA

Invasive carcinoma diagnosed only by microscopy; stromal invasion with a maximum depth of 5.0 mm measured from the base of the epithelium and a horizontal spread of 7.0 mm or less; vascular space involvement, venous or lymphatic, does not affect classification

T1a1

IA1

Measured stromal invasion ≤ 3.0 mm in depth and ≤ 7.0 mm in horizontal spread

T1a2

IA2

Measured stromal invasion > 3.0 mm and ≤ 5.0 mm with a horizontal spread ≤ 7.0 mm

T1b

IB

Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a/IA2

T1b1

IB1

Clinically visible lesion ≤ 4.0 cm in greatest dimension

T1b2

IB2

Clinically visible lesion > 4.0 cm in greatest dimension

T2

II

Cervical carcinoma invades beyond uterus but not to pelvic wall or to lower third of vagina

T2a

IIA

Tumor without parametrial invasion

T2a1

IIA1

Clinically visible lesion ≤ 4.0 cm in greatest dimension

T2a2

IIA2

Clinically visible lesion > 4.0 cm in greatest dimension

T2b

IIB

Tumor with parametrial invasion

T3

III

Tumor extends to pelvic wall and/or involves lower third of vagina and/or causes hydronephrosis or nonfunctional kidney

T3a

IIIA

Tumor involves lower third of vagina, no extension to pelvic wall

T3b

IIIB

Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctional kidney

T4

IV

Tumor invades mucosa of bladder or rectum and/or extends beyond true pelvis (bullous edema is not sufficient to classify a tumor as T4)

T4a

IVA

Tumor invades mucosa of bladder or rectum (bullous edema is not sufficient to classify a tumor as T4)

T4b

IVB

Tumor extends beyond true pelvis

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis (including peritoneal spread; involvement of supraclavicular, mediastinal, or

http://emedicine.medscape.com/article/2006486-overview

First it needs to determine whether it refers to endometrial or cervical cancer. If any of the cervix, although it spread by local parametral infiltration - FIGO classification is pT2b. This means that changes in the ovary were not hematogenous.

In this situation there is no direct spread. There is separate metastatic small squamous carcinoma nodule in the ovary. Parametrial tissue without direct invasion.

 Ilya, I've saw that article. But it is still unclear how we should stage it. 

Rasha, but there is no direct invasion into ovary. Is it still pT2?

Ulduz, I know it ;). But there is no clarification about ovarian metastasis.

Lena, primary tumor is in the exocervix. And there is no direct ovary invasion. Only separate nodule.

in T4 classification: tumor invading beyond =,  true pelvis or invading rectum or bladder

in my opinion I will consider ovarian metastases is T4.

but in case of small cell carcinoma is the highly aggressive type of cervix cancer.

but if you mean small nodule of squamous cell carcinoma in the ovary, spreading through blood or lymphatic from cervix to ovary, then I will consider it T4 and treat according. 

Rasha, thank you for your opinion. 

Agree with Rasha, Beyond true pelvis-T4.Thank You.

This finding is casuistry. I think that is not important how to staging, perhaps M1. You should post this event. You can view article - Naoyuki Toki, Naoki Tsukamoto, Tsunehisa Kaku et al. Microscopic ovarian metastasis of the uterine cervical cancer. Gynecologic Oncology 1991; Vol 41; Issue 1, Pages 46-51.

I've asked this question on TNM help desk.

And yesterday I recieved and answer.

Here it is.

------

Dear Dr. Kropelnytskyi,

Thank you very much for your question and your interest in TNM.

In the TNM classification, 7th edition, on page 209 it is stated:

M1 Distant metastasis. ... It excludes metastasis to vagina,

Pelvic serosa, and adnexa

If the adnexa is outside the true pelvis the case should be classified as pT4.

Lymph node metastasis, I assume, is in regional lymph nodes.

The summary classification should be pT4pN1M0, Stage IVA

Sincerely,

Christian Wittekind

Professor and Chair

Institute of Pathology

University Hospital Leipzig

Member of the UICC TNM Prognostic Factors Core Group

--------

Will treat it as distant mets either thru hematogenous route or thru lymphatics and treat her Stage IV A

According to my experience with similar cases, this is a distant metastasis, and she needs radiotherapy to pelvis and para-aortic area.

Additionally, the 10 lymph nodes dissected are few. At least 20 lymph nodes are required  for a radical pelvic lymphadenectomy. This circumstance reinforces the need for radiotherapy.

This case requires periodic CT scan evaluations, in particular, in para-aortic lymph nodes where tumor progression is possible due to lymphatic ovary drainage.

I agree with all of those who thought about M1. Because medical papers say that ovarian metastasis is a predictor of poor outcome.

But official position is T4

Any staging system not useful for patients or physician must change.

These rare cases of cervical cancer with ovarian metastases should be staged like M1. However, due to its rarity, only case reports exist. This is a great opportunity for a multi-institutional, even multinational, research to obtain many cases to evaluate evolution and surviving. With this information, TNM system must change.

If we use FIGO staging, it clearly states that any distant metastasis means stage IVB. SO, ovarian metastasis is IVB. 

If we use TNM, then of course M1

What is the importance of classification of very rare cases?

To justify six weeks of Radiation?

How could this be classified as pT4 if there was no direct extension of cervical tumor to left adnexa? This is to be considered as haema- or lymhp-born Mts.

Oophorectomy is not a part of Radical hysterectomy. In other words ovaries can be preserved if needed and are not part of radical loco-regional extirpative procedure for ca cervix.

This is an indirect evidence that ovarian metastasis is distant metastasis for ca cervix and should be considered as IVB...