Vagina 27 27

American Joint Committee on Cancer • 2006 243 Vagina 27

27

SUMMARY OF CHANGES

• The definitions of TNM and the Stage Grouping for this chapter have not changed from the Fifth Edition.

C52.9 Vagina, NOS

ANATOMY

Primary Site. The vagina extends from the vulva upward to the uterine cervix.

It is lined by squamous epithelium with only rare glandular structures. The vagina (Figure 27.1) is drained by lymphatics toward the pelvic nodes (Figure 27.2) in its upper two-thirds and toward the inguinal nodes (Figure 27.3) in its lower third.

Regional Lymph Nodes. The upper two-thirds of the vagina is drained by lymphatics to the pelvic nodes, including:

Obturator

Internal iliac (hypogastric) External iliac

Pelvic, NOS

The lower third of the vagina is drained to the groin nodes, including:

Inguinal Femoral

Metastatic Sites. The most common sites of distant spread include the aortic lymph nodes, lungs, and skeleton.

DEFINITIONS

The definitions of the T categories correspond to the stages accepted by the Fed- eration Internationale de Gynecologie et d’Obstetrique (FIGO). Both systems are included for comparison.

Primary Tumor (T) TNM FIGO Definitions Categories Stages

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis 0 Carcinoma in situ

T1 I Tumor confined to vagina (Figure 27.4)

T2 II Tumor invades paravaginal tissues but not to pelvic wall

(Figure 27.5)

C53.0

C52.9

Lower third Upper two-thirds

C51

FIGURE 27.1. Anatomical sites and subsites of the vagina.

C77.5

FIGURE 27.2. Regional pelvic lymph nodes draining the upper two-thirds of the vagina.

C77.4

FIGURE 27.3. Regional lymph nodes in the groin draining the lower third of the

vagina.

American Joint Committee on Cancer • 2006 245

27

T1 TNM:

FIGO: I

T1 TNM:

FIGO: I

T1 TNM:

FIGO: I

FIGURE 27.4. Three views of T1, each showing tumor confined to the vagina.

TNM: T2 FIGO: II

FIGURE 27.5. T2 tumor invading paravaginal tissues but not to pelvic wall.

T3 III Tumor extends to pelvic wall

(Figure 27.6)

T4 IVA Tumor invades mucosa of the bladder or rectum and/or extends beyond the true pelvis (bullous edema is not suffi- cient evidence to classify a tumor as T4) (Figure 27.7) Regional Lymph Nodes (N)

NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis

N1 Pelvic or inguinal lymph node metastasis (Figures 27.8A–C)

246 American Joint Committee on Cancer • 2006

TNM: T3 FIGO: III

FIGURE 27.6. T3 tumor extending to pelvic wall.

TNM: T4 FIGO: IVA

TNM: T4 FIGO: IVA

FIGURE 27.7. Two views of T4 showing tumor invading rectum (left side of dotted line) or extending beyond true pelvis or invading bladder (right side of dotted line).

FIGURE 27.8. A–C. N1: pelvic (27.8A) or unilateral inguinal (27.8B) or bilateral inguinal (27.8C) lymph node metastasis.

䉴

27

N1 FIGO: IVB

A

N1 FIGO: IVB

B

N1 FIGO: IVB

C

Distant Metastasis (M)

MX Distant metastasis cannot be assessed M0 No distant metastasis

M1 IVB Distant metastasis

STAGE GROUPING (AJCC/UICC/FIGO)

0 Tis N0 M0

I T1 N0 M0

II T2 N0 M0

III T1–T3 N1 M0

T3 N0 M0

IVA T4 Any N M0

IVB Any T Any N M1

NOTE

1. Pelvic wall is defined as the muscle, fascia, associated neurovascular structures, or skeletal portions of the bony pelvis.

248 American Joint Committee on Cancer • 2006