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Staging
is the process of finding out how far a cancer has spread. This
information helps doctors choose the type of treatment that offers the
best possible results.
Molar pregnancies (complete and partial moles) are usually
completely removed during a D&C (or, rarely, a hysterectomy),
so they don't need to be surgically "staged". Staging is more useful
for persistent GTDs, including invasive moles and choriocarcinomas.
Gestational trophoblastic disease (GTD)
classification
The stage of most cancers depends on how large they are and
whether they have spread to lymph nodes or distant sites. This is part
of staging for GTD as well (and is described below). But because
treatment is usually effective regardless of the extent of the disease,
other factors such as a woman's age, length of time from the pregnancy,
and HCG level are more useful in predicting a woman's outlook
(prognosis). These factors are taken into account in a scoring system.
Prognostic scoring system
In the United States, most cancer centers use a system that
describes women with persistent GTDs according to their prognosis,
based on several factors.
| Age |
Score |
| Younger than 40 |
0 |
| 40 or older |
1 |
|
|
| Preceding
pregnancy |
Score |
| Molar pregnancy |
0 |
| Abortion (includes
miscarriage) |
1 |
| Birth (term pregnancy) |
2 |
|
|
| Time
since pregnancy |
Score |
| Less than 4 months |
0 |
| More than 4 months but
less than 7 months |
1 |
| 7 - 13 months |
2 |
| More than 13 months |
4 |
|
|
| Blood
HCG level (IU/L) before treatment |
Score |
| Less than 1,000 |
0 |
| 1,000 - 9,999 |
1 |
| 10,000 - 99,999 |
2 |
| 100,000 or more |
4 |
|
|
| Largest
tumor size,including the original one in the uterus |
Score |
| Less than 3 cm (1.2
inches) across |
0 |
| Between 3 cm and 5 cm |
1 |
| 5 cm (2 inches) or more |
2 |
|
|
| Site of
metastases (if any) |
Score |
| Lung |
0 |
| Spleen, kidney |
1 |
| Gastrointestinal tract |
2 |
| Brain, liver |
4 |
|
|
| Number
of metastases found |
Score |
| 0 |
0 |
| 1 – 4 |
1 |
| 5 – 8 |
2 |
| More than 8 |
4 |
|
|
| Prior
failed chemotherapy? |
Score |
| None |
0 |
| Single drug |
2 |
| 2 or more drugs |
4 |
The numbers are then added up, and the overall score
determines a woman's risk level.
- Women with a score of 7 or less are at low risk and tend to
have a good outlook regardless of how far the cancer has spread. The
tumor(s) will usually respond well to chemotherapy.
- Women with a score of 8 or more are at high risk, and their
tumors tend to respond less well to chemotherapy, even if they haven't
spread much. They may require more intensive chemotherapy.
FIGO anatomic staging
The International Federation of Gynecology and Obstetrics
(FIGO) has developed a staging system based on the extent of the GTD as
follows:
Stage I: The
tumor is still within the uterus.
Stage II:
The tumor has grown outside of the uterus to involve other genital
structures (like the vagina or ovaries). It has not spread outside the
pelvis.
Stage III:
The tumor has spread to the lungs; it may or may not also involve
genital structures such as the vagina or vulva.
Stage IV:
The tumor has spread to distant organs such as the brain, liver,
kidneys, and/or gastrointestinal tract.
Stage grouping
Stage grouping
is a process that some doctor use that combines the prognostic score
and the anatomic stage. This is listed as the anatomic stage, followed
by the letter A if the prognostic score was low risk or B if the
prognostic score resulted in high risk.
Stage IA:
The tumor has not spread outside the uterus, and the prognostic score
puts you at low risk.
Stage IB:
The tumor has not spread outside the uterus, and the prognostic score
puts you at high risk.
Stage IIA: The
tumor has grown outside of the uterus but not beyond the vagina or
pelvis, and the prognostic score puts you at low risk.
Stage IIB:
The tumor has grown outside of the uterus but not beyond the vagina or
pelvis, and the prognostic score puts you at high risk.
Stage IIIA:
The tumor has spread to the lungs, and may or may not also involve
genital structures such as the vagina or vulva. The prognostic score
puts you at low risk.
Stage IIIB:
The tumor has spread to the lungs, and may or may not also involve
genital structures such as the vagina or vulva. The prognostic score
puts you at high risk.
Stage IVA:
The cancer has spread to distant organs such as the brain, liver,
kidneys, and/or gastrointestinal tract. The prognostic score puts you
at low risk.
Stage IVB:
The cancer has spread to distant organs such as the brain, liver,
kidneys, and/or gastrointestinal tract. The prognostic score puts you
at high risk.
Last Medical Review: 10/13/2009
Last Revised: 10/13/2009
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