Uterus
Miscellaneous
Staging - corpus uteri - carcinoma and carcinosarcoma


Topic Completed: 31 January 2019

Revised: 25 November 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed search: Staging[TIAB] corpus uteri (carcinoma OR carcinosarcoma)

Carlos Parra-Herran, M.D.
Page views in 2018: 7,511
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Cite this page: Parra-Herran C. Staging - corpus uteri - carcinoma and carcinosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusstaging.html. Accessed December 11th, 2019.

Pathologic TNM staging of carcinoma and carcinosarcoma of the corpus uteri, AJCC 8th edition and FIGO 2018 update
Definition / general
  • International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO) recommends surgical / pathologic staging of uterine carcinoma (which now includes carcinosarcoma)
  • Clinical staging is assigned only if primary radiation or chemotherapy is indicated over primary surgery (record as cT, cN, cM)
  • Clinical and pathologic staging is used if the surgeon feels systemic regional lymph node sampling is not indicated
  • Otherwise, surgical / pathologic staging is indicated, assigned at the time of definitive surgical management
  • Initial stage should not be changed due to disease progression or recurrence or based on response to initial radiation therapy or chemotherapy that precedes primary tumor resection
  • American Joint Committee on Cancer (AJCC) / TNM system now includes staging categories for lymph node metastases according to metastatic tumor size: isolated tumor cells (ITCs), micrometastases and macrometastases
Essential features
Primary tumor [pT] and FIGO () stage
  • pTX: primary tumor cannot be assessed
  • pT0: no evidence of primary tumor
  • pT1 (I): tumor confined to corpus uteri
    • pT1a (IA): tumor limited to endometrium or invades < 50% of the myometrium
    • pT1b (IB): tumor invades ≥ 50% of the myometrium
  • pT2 (II): tumor invades stromal connective tissue of the cervix but does not extend beyond uterus
  • pT3 (III): tumor involving serosa, adnexa, vagina or parametrium
    • pT3a (IIIA): tumor involves serosa or adnexa (direct extension or metastasis)
    • pT3b (IIIB): vaginal involvement (direct extension or metastasis) or parametrial involvement
  • pT4 (IVA): tumor invades bladder mucosa or bowel mucosa (bullous edema is not sufficient to classify a tumor as pT4)


Notes:
  • Endocervical glandular involvement only should be considered as stage I and not stage II
  • pTis is no longer a staging category
Regional lymph nodes [pN] and FIGO () stage
  • pNX: regional lymph nodes cannot be assessed
  • pN0: no regional lymph node metastasis
    • pN0(i+): isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
  • pN1 (IIIC1): regional lymph node metastasis to pelvic lymph nodes
    • pN1mi: regional lymph node metastasis (> 0.2 mm but ≤ 2 mm in diameter) to pelvic lymph nodes
    • pN1a: regional lymph node metastasis (> 2 mm in diameter) to pelvic lymph nodes
  • pN2 (IIIC2): regional lymph node metastasis to paraaortic lymph nodes, with or without positive pelvic lymph nodes
    • pN2mi: regional lymph node metastasis (> 0.2 mm but ≤ 2 mm in diameter) to pelvic lymph nodes
    • pN2a: regional lymph node metastasis (> 2 mm in diameter) to pelvic lymph nodes
Distant metastasis [pM] and FIGO () stage
  • pM0: no distant metastasis
  • pM1 (IVB): distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease or lung, liver or bone; it excludes metastasis to paraaortic lymph nodes, vagina, pelvic serosa or adnexa)
Stage grouping and FIGO stage
Stage 0: Tis N0 M0
Stage I: T1 N0 M0
Stage IA: T1a N0 M0
Stage IB: T1b N0 M0
Stage II: T2 N0 M0
Stage III: T3 N0 M0
Stage IIIA: T3a N0 M0
Stage IIIB: T3b N0 M0
Stage IIIC1: T1 - 3 N1 M0
Stage IIIC2: T1 - 3 N2 M0
Stage IVA: T4 any N M0
Stage IVB: any T any N M1
Histopathology - degree of differentiation
  • 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

Notes on pathologic grading:
  • Notable nuclear atypia, inappropriate for the architectural grade, raises the grade by 1 (1 to 2 and 2 to 3); although it has been suggested that tumors with significant nuclear atypia are classified as grade 3 regardless of the architecture
  • Serous, clear cell and carcinosarcoma are high risk and considered grade 3
  • Adenocarcinomas with benign squamous elements (squamous metaplasia) are graded according to the glandular component
Diagrams / tables

Images hosted on other servers:

Endometrial carcinoma

Board review question #1
The defining feature of stage T3a / IIIA carcinoma of the uterine corpus is:

  1. Involvement of bladder or rectal mucosa
  2. Involvement of cervical stromal tissue
  3. Involvement of uterine serosa or adnexa
  4. Involvement of vagina or parametrial tissue
  5. Pelvic lymph node metastases
Board review answer #1
C. Involvement of uterine serosa or adnexa

Reference: Uterus - Staging - corpus uteri - carcinoma and carcinosarcoma

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