Reading your staging report

Staging Systems — Other Than TNM

If your report shows a FIGO stage or an Ann Arbor stage instead of a TNM code, it is using a system built for a specific cancer type. Both still tell your team how far the cancer has spread — the format is just different from what most people expect.

Medically reviewed by Dr. Mohammed Imaduddin, Surgical Oncologist, MBBS · MS (General Surgery) · M.Ch (Surgical Oncology) · Last reviewed September 2026

FIGO for gynaecological cancers — Cervix, uterus, ovary, vulva and vagina are staged using FIGO, not TNM.
Ann Arbor for lymphomas — Hodgkin lymphoma and most non-Hodgkin lymphomas use Ann Arbor or its updated form, Lugano.
Same I–IV scale, different criteria — Both systems run from Stage I to Stage IV, but what qualifies as each stage differs by cancer type.
Biopsy stage is provisional — The stage on a pathology report is confirmed by your treating team after imaging and all results are reviewed together.

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FIGO staging is used for gynaecological cancers — cervix, uterus, ovary, vulva and vagina. Ann Arbor staging is used for lymphomas. Both use stages I to IV, but the criteria differ from TNM. Your final stage is confirmed by your treating team after combining biopsy and imaging results.

What do the terms in your staging report mean?

FIGO: The staging system for gynaecological cancers. FIGO stands for Fédération Internationale de Gynécologie et d'Obstétrique — the international body that sets the staging rules. Your report will show a Roman numeral from I to IV.
Ann Arbor / Lugano: The staging system for lymphomas. Ann Arbor gives a stage from I to IV based on how many lymph node regions are involved and whether organs outside the nodes are affected. The Lugano classification is its updated form, now used by most centres, which incorporates PET-CT scan findings into the staging decision.
FIGO Stage I to IV: The number describes how far the cancer has spread within and beyond the gynaecological organs. Stage I means limited to the organ where the cancer started. Stage IV means it has reached distant sites such as the bladder, rectum or organs well beyond the pelvis.
A and B suffix (lymphoma): Letters added after the Ann Arbor stage number. A means none of the constitutional symptoms — fever, drenching night sweats or significant unintentional weight loss — have been present. B means at least one has. B symptoms are taken into account in treatment planning.
E suffix (lymphoma): E stands for extranodal — the lymphoma has involved an organ or tissue outside the lymph nodes, such as bone, liver, skin or lung. It is recorded alongside the stage number to help your team plan treatment.

Which cancers use FIGO, and which use Ann Arbor?

FIGO staging is used for cancers of the cervix, uterus, ovary, fallopian tube, vagina and vulva, as well as gestational trophoblastic disease.

Ann Arbor — or Lugano — is used for Hodgkin lymphoma and most non-Hodgkin lymphomas, including diffuse large B-cell lymphoma and follicular lymphoma.

Other cancers have their own systems. Multiple myeloma uses the International Staging System. Chronic leukaemias use Rai or Binet staging. If your report shows an unfamiliar staging system, ask your oncologist to name it and explain what your result means for you.

Why does the staging system used matter?

Each system was designed around how a specific cancer spreads. Lymphomas move through the lymphatic system in a pattern that TNM was not built to capture. Gynaecological cancers are often staged using both clinical examination and surgical findings, which is why they have their own criteria.

The stage on your pathology report reflects what the biopsy or surgery showed at that point. It is provisional. Your oncologist sets the confirmed stage after combining that result with your imaging — CT, MRI or PET-CT — and any other findings.

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What should you check before your next appointment?

Identify the staging system named on your report — FIGO, Ann Arbor, Lugano or another — before reading anything about your stage online.
Note whether the stage is described as clinical (from examination and imaging) or pathological (from tissue removed during surgery).
If an A or B appears after a lymphoma stage number, ask your team which symptoms led to that assignment.
Confirm with your oncologist whether imaging results have been reviewed alongside the pathology — your stage may still change.
Do not compare a FIGO or Ann Arbor stage against a TNM chart. The number looks similar but the criteria are not the same.

Did you know?

The FIGO staging system for cervical cancer was revised in 2018 to allow imaging and pathology findings — not just clinical examination — to be used when assigning the stage.

A stage assigned before 2018 and one assigned today may reflect different information, even if the Roman numeral is the same.

Source: FIGO Committee on Gynecologic Oncology, 2018 revised staging

Questions families ask about these staging systems

Does Stage IV in FIGO mean the same as Stage IV in TNM?

No. The Roman numerals look identical but what qualifies as Stage IV differs between systems and between cancer types. In FIGO staging for cervical cancer, Stage IV means the cancer has reached the bladder, rectum or sites beyond the pelvis. In TNM, Stage IV primarily describes distant metastasis as defined for that specific cancer. Do not compare your FIGO or Ann Arbor stage against a TNM reference — ask your oncologist to explain what your specific result means for your cancer.

My lymphoma report says B — does that mean it is more advanced?

B symptoms indicate that the lymphoma is producing constitutional effects — fever, night sweats or significant unintentional weight loss — and your team factors this into treatment planning. They do not automatically mean the cancer has spread further than one without B symptoms. A lower-stage lymphoma with B symptoms and a higher-stage one without them are different situations, and treatment is tailored to the full picture. Your oncologist will explain what the B suffix means for your specific case.

My ovarian cancer report shows FIGO Stage III — why is there no TNM code?

Ovarian cancer is staged using FIGO, not TNM, because international gynaecological oncology guidelines specify that system and its criteria were designed for how ovarian cancer spreads within the abdomen and pelvis. Some laboratories include both FIGO and a TNM cross-reference in the same report; others use FIGO alone. Both describe the same cancer from the same evidence — they are not contradictory. If you would like to understand the full picture, ask your oncologist at your next appointment.

Can my FIGO or Ann Arbor stage change after more tests?

Yes. The stage on a biopsy or pathology report is based on the tissue findings at that point, and it is considered provisional. Once imaging — PET-CT, CT or MRI — is reviewed alongside the pathology, the stage may be confirmed, refined or revised. This is a normal part of the staging process and does not mean an error was made on the first report. Your treating oncologist assigns the final working stage after all results have been reviewed together.

Are there other staging systems I might see on a report?

Yes. Multiple myeloma is staged using the Revised International Staging System, which uses Roman numerals I, II and III rather than I to IV. Chronic lymphocytic leukaemia uses Rai staging in some centres and Binet staging in others — both may appear in Indian reports. Neuroblastoma in children uses the International Neuroblastoma Risk Group staging system. If your report shows a stage that uses unfamiliar letters or does not follow the I–IV format, ask your oncologist to name the system and explain what your specific result means for treatment planning.

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Common questions

Frequently asked questions

What is FIGO staging?

FIGO staging is the system used for gynaecological cancers — cervix, uterus, ovary, fallopian tube, vagina and vulva. It assigns a stage from I to IV based on how far the cancer has spread within and beyond the reproductive organs. The criteria differ from TNM because gynaecological cancers spread in ways that TNM was not designed to capture, and because staging combines clinical examination, imaging and — where applicable — surgical findings.

What is Ann Arbor staging?

Ann Arbor staging is the system for lymphomas. It gives a stage from I to IV based on how many lymph node regions are involved and whether organs outside the lymph nodes are affected. A letter — A or B — records whether constitutional symptoms such as fever, night sweats or significant weight loss have been present. Most centres now use the Lugano classification, which updated Ann Arbor to incorporate PET-CT findings into the staging decision.

Why do lymphomas not use TNM staging?

Lymphomas start in the lymphatic system and spread through lymph node regions rather than by invading adjacent tissue the way solid tumours do. TNM measures tumour size, local node involvement and distant spread — criteria that map poorly onto how lymphoma behaves. Ann Arbor was designed specifically for lymphoma's pattern of spread, which is why it, and not TNM, remains the standard for these cancers.

Does a higher FIGO stage mean treatment is not possible?

No. A higher FIGO stage describes where and how far the cancer has spread — it is a description of extent, not a determination of whether treatment is available. Treatment options for gynaecological cancers at all stages are discussed by your treating team based on the type of cancer, its biology, your general health and your imaging findings. Your oncologist is the right person to explain what is possible for your specific situation.

Can I look up what my FIGO or Ann Arbor stage means online?

You can, and it may help you ask better questions at your appointment. Be cautious about survival statistics attached to stage numbers — these come from population-level datasets that do not describe your individual situation and vary by data source and year. Use what you read online to frame specific questions for your oncologist rather than to draw conclusions about your own case.

Does CION use these staging systems?

Yes. Staging for gynaecological cancers and lymphomas at CION follows FIGO and Ann Arbor or Lugano respectively, in line with NCCN and ESMO guidelines. Pathology findings are reviewed alongside imaging — including PET-CT coordinated with partner imaging centres — and your oncologist confirms the working stage before the treatment plan is finalised. If you have received a biopsy report and have not yet had staging confirmed, ask your team when that appointment will take place.

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