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 &ge; 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
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
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