Staging of endometrial cancer

Endometrium carcinoma is generally staged according to the International Federation of Gynecology and Obstetrics (FIGO)

Revised (2009) FIGO staging of endometrial cancer:

• stage I -confined to the corpus uteri
  • I A - no myometrial invasion or less than half
  • I B - invasion equal to or more than half the myometrium
• stage II - tumour invades cervical stroma but does not extend beyond uterus
• stage III - local and/or regional spread of the tumour
  • III A - tumour invades serosa of corpus uteri and/or adnexae
  • III B - vaginal and/or parametrial involvement
  • III C - metastases to pelvic and/or para-aortic lymph nodes
  • III C1 - positive pelvic nodes
  • III C2 - positive para-aortic lymph nodes with or without positive pelvic
• stage IV – tumour invades bladder and/or bowel mucosa and/or distant metastases
  • IVA - tumour invasion of bladder and/or bowel mucosa
  • IV B - distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes

Furthermore cases of carcinoma of the corpus should be grouped with regard to the degree of differentiation of the adenocarcinoma as follows:

• G1: <5% of a nonsquamous or nonmorular solid growth pattern
• G2: 6%–50% of a nonsquamous or nonmorular solid growth pattern
• G3: >50% of a nonsquamous or nonmorular solid growth pattern (2)

Note:

• notable nuclear atypia (pleomorphism and prominent nucleoli), inappropriate for the architectural grade, raises the grade of a Grade 1 or Grade 2 tumor by 1
• in serous and clear cell adenocarcinomas, nuclear grading takes precedent. Most authors consider serous and clear cell carcinomas high grade by definition

Reference:

• (1) Saso S et al. Endometrial cancer. BMJ. 2011;343:d3954
• (2) Amant F, Mirza MR, Creutzberg CL.Cancer of the corpus uteri. Int J Gynaecol Obstet. 2012;119 Suppl 2:S110-7.