Radiation Oncology/Endometrium/Staging

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Current staging[edit | edit source]

Endometrial Carcinomas

AJCC 7th Edition (2009)

Corresponds to updated FIGO staging (2009)
FIGO 2009 PMID 19345353 -- "Revised FIGO staging for carcinoma of the endometrium."
This staging now applies only to endometrial carcinomas and there is now a separate staging for uterine sarcomas.
Carcinosarcomas (MMMT) should be staged as high grade carcinoma.

Primary Tumor: (FIGO Stage in parentheses)

Note: FIGO uses pathologic staging
  • Tis - in situ
    Note: FIGO no longer includes Stage 0
  • T1 (I) - confined to corpus
    • T1a (IA) - limited to endometrium or invades less than 1/2 of myometrium
    • T1b (IB) - invades ≥ 1/2 of myometrium
  • T2 (II) - invades stromal tissue of the cervix but does not extend beyond uterus
    Note: endocervical glandular involvement only should be considered as Stage I not Stage II
  • T3
    • T3a (IIIA) - involves serosa and/or adnexa (direct extension or metastasis)
    • T3b (IIIB) - vaginal involvement (direct extension or metastasis) or parametrial involvement
  • T4 (IVA) - invades bladder mucosa and/or bowel mucosa

Regional Lymph Nodes:

  • N0 - none
  • N1 (IIIC1) - metastasis to pelvic lymph nodes
  • N2 (IIIC2) - metastasis to para-aortic lymph nodes
    Note: Regional nodes include obturator, internal iliac, external iliac, common iliac, para-aortic, presacral, and parametrial
    Note: For pathologic staging, FIGO classifies cases with <6 resected LNs as pNX

Distant Metastases:

  • M0 - none
  • M1 (IVB) - distant metastasis - includes inguinal LN, intraperitoneal disease (including omentum), lung, liver, or bone.

Stage Grouping:

  • Corresponds to FIGO stage given above (in parentheses)

Changes from 6th Edition:

  • No longer includes uterine sarcoma (now staged with a new staging system)
  • Positive peritoneal cytology is no longer considered (previously was T3a/IIIA)
  • Involvement of the endocervical glands is no longer considered (previously was Stage IIA)
  • Stages IA+IB combined (now: IA). IC moved to IB.
  • Stage IIIC subdivided into IIIC1 and IIIC2.

Older staging systems[edit | edit source]

FIGO moved to surgical staging in 1988 (AJCC 6th edition same). There is also a clinical staging system developed by FIGO in 1971.

Note: until the update of the FIGO / AJCC in 2009, uterine sarcomas and carcinomas were staged using the same system

AJCC 6th Edition (2002)

  • IA - Limited to endometrium
  • IB - < 1/2 of myometrium
  • IC - 1/2 or more of myometrium
  • II - invades cervix
    • IIA - glandular epithelium of endocervix
    • IIB - stroma of cervix
  • III - extra-uterine
    • IIIA - involves serosa and/or adnexa (direct extension or mets) and/or ascites or positive peritoneal washings
    • IIIB - vaginal involvement (direct extension or mets)
    • IIIC - LN+ (pelvic and/or paraaortic)
  • IV - other organs
    • IVA - bladder or bowel
    • IVB - distant mets

Clinical staging[edit | edit source]

Staging is now surgical (see above), but clinical staging may be utilized for non-operative pts.

FIGO 1971

  • I - Confined to corpus
    • IA - Length of uterine cavity 8 cm or less
    • IB - Length of uterine cavity > 8 cm
  • II - Involves corpus and cervix, but no extension beyond the uterus
  • III - Extends outside uterus but not outside true pelvis
  • IV - Outside the true pelvis or involves bladder or rectum
    • IVA - Involves bladder, rectum, sigmoid, or small bowel
    • IVB - Distant mets

Stage distribution[edit | edit source]

Stage Distribution
Stage US SEER (PMID 16977653) FIGO (PMID 17161155)
Stage I 73% 67%
Stage II 10% 11%
Stage III 10% 13%
Stage IV 7% 3%