Radiation Oncology/Endometrium/Staging
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Current staging
editEndometrial Carcinomas
FIGO Staging (2023)
PMID 37593813 -- "FIGO staging of endometrial cancer: 2023"
- Stage I - Confined to the uterine corpus and ovary
- IA - Disease limited to the endometrium OR non-aggressive histological type, i.e., low-grade endometroid, with invasion of less than half of myometrium with no or focal LVSI OR good prognosis disease
- IA1 : Non-aggressive histological type limited to an endometrial polyp OR confined to the endometrium
- IA2 : Non-aggressive histological types involving less than half of the myometrium with no or focal LVSI
- IA3 : Low-grade endometrioid carcinomas limited to the uterus and ovary
- IB - Non-aggressive histological types with invasion of half or more of the myometrium, and with no or focal LVSI
- IC - Aggressive histological types limited to a polyp or confined to the endometrium
- IA - Disease limited to the endometrium OR non-aggressive histological type, i.e., low-grade endometroid, with invasion of less than half of myometrium with no or focal LVSI OR good prognosis disease
- Stage II - Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological types with myometrial invasion
- IIA - Invasion of the cervical stroma of non-aggressive histological types
- IIB - Substantial LVSI of non-aggressive histological types
- IIC - Aggressive histological types with any myometrial involvement
- Stage III - Local and/or regional spread of the tumor of any histological subtype
- IIIA - Invasion of uterine serosa, adnexa, or both by direct extension or metastasis
- IIIA1 : Spread to ovary or fallopian tube (except when meeting stage IA3 criteria)
- IIIA2 : Involvement of uterine subserosa or spread through the uterine serosa
- IIIB - Metastasis or direct spread to the vagina and/or to the parametria or pelvic peritoneum
- IIIB1 : Metastasis or direct spread to the vagina and/or the parametria
- IIIB2 : Metastasis to the pelvic peritoneum
- IIIC - Metastasis to the pelvic or para-aortic lymph nodes or both
- IIIC1 : Metastasis to the pelvic lymph nodes {IIIC1i: micrometastasis; IIIC1ii: macrometastasis}
- IIIC2 : Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes {IIIC2i: micrometastasis; IIIC2ii: macrometastasis}
- IIIA - Invasion of uterine serosa, adnexa, or both by direct extension or metastasis
- Stage IV - Spread to the bladder mucosa and/or intestinal mucosa and/or distant metastasis
- IVA - Invasion of the bladder mucosa and/or the intestinal/bowel mucosa
- IVB - Abdominal peritoneal metastasis beyond the pelvis
- IVC - Distant metastasis, including metastasis to any extra-or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain, or bone
Staging footnotes:
- Disease limited to low-grade endometrioid carcinomas involving the endometrium and ovaries (Stage IA3) must be distinguished from extensive spread of the endometrial carcinoma to the ovary (Stage IIIA1), by the following criteria: 1) no more than superficial myometrial invasion is present (<50%); 2) absence of extensive/substantial LVSI; 3) absence of additional metastases; and 4) the ovarian tumor is unilateral, limited to the ovary, without capsule invasion/rupture (equivalent to pT1a).
- LVSI: LVSI as defined in WHO 2021: extensive/substantial, ≥5 vessels involved.
- Aggressive histological types:
- non-aggressive: G1-2 EEC.
- aggressive: G3 EEC, serous, clear cell, undifferentiated, mixed, mesonephric-like, gastrointestinal mucinous type carcinomas, and carcinosarcomas
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
editFIGO 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
editStaging 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
editStage | US SEER (PMID 16977653) | FIGO (PMID 17161155) |
---|---|---|
Stage I | 73% | 67% |
Stage II | 10% | 11% |
Stage III | 10% | 13% |
Stage IV | 7% | 3% |