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Gestational Trophoblastic Disease Treatment (PDQ®)

  • Last Modified: 04/12/2013

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Stage Information for Gestational Trophoblastic Disease

Hydatidiform Mole (HM)
Gestational Trophoblastic Neoplasia
        Definitions: FIGO



Hydatidiform Mole (HM)

HM (molar pregnancy) is disease limited to the uterine cavity.

Gestational Trophoblastic Neoplasia

Definitions: FIGO

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:[1]

Table 1. Gestational Trophoblastic Neoplasia (GTN)a,b
FIGO Anatomical Staging 
Stage
IDisease confined to the uterus.
IIGTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament).
IIIGTN extends to the lungs, with or without known genital tract involvement.
IVAll other metastatic sites.
Modified WHO Prognostic Scoring System as Adapted by FIGOb
Scores 0124
Age<40≥40
Antecedent pregnancymoleabortionterm
Interval months from index pregnancy<44–67–12>12
Pretreatment serum hCG (iu/1)<103103–104104–105>105
Largest tumor size (including uterus)<33–4 cm≥5 cm
Site of metastaseslungspleen, kidneygastrointestinalliver, brain
Number of metastases1–45–8>8
Previous failed chemotherapysingle drug≥2 drugs

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique; hCG = human chorionic gonadotropin; iu = international unit; WHO = World Health Organization.
aAdapted from FIGO Committee on Gynecologic Oncology.[1]
bTo 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.

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.

References
  1. 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.  [PUBMED Abstract]

  2. 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.