RadOnc Resident Wiki/Endometrium/Staging

Current staging Endometrial Carcinomas AJCC 7th Edition (2009) Corresponds to updated FIGO staging (2009) FIGO 2009 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 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 Stage distribution + Stage Distribution Stage US SEER (16977653) FIGO (17161155) Stage I 73% 67% Stage II 10% 11% Stage III 10% 13% Stage IV 7% 3%