RadOnc Resident Wiki/Endometrium/Staging

Current staging

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:

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.

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

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