Uterus - Staging - uterine carcinoma

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Uterus

Miscellaneous tumors

Staging - uterine carcinoma

Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 5 September 2011, last major update September 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Use clinical staging only if the surgeon feels systemic regional lymph node sampling is not indicated or if the patient was treated with primary radiation therapy (record as cT, cN, cM)
● Otherwise use surgical / pathologic staging, assigned at the time of definitive surgical treatment or prior to radiation therapy or chemotherapy
● 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

Uterine carcinoma TNM staging
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● Based on AJCC Cancer Staging Manual (7th ed)

Primary tumor (T) and FIGO stage:
● TX: primary tumor cannot be assessed
● T0: no evidence of primary tumor
● Tis: carcinoma in situ (preinvasive carcinoma)
● T1 (I): tumor confined to corpus uteri
● T1a (IA): tumor limited to endometrium or invades less than 1/2 of the myometrium
● T1b (IB): tumor invades 1/2 or more of the myometrium
● T2 (II): tumor invades stromal connnective tissue of the cervix but does not extend beyond uterus
● T3a (IIIA): tumor involves serosa or adnexa (direct extension or metastasis)
● T3b (IIIB): vaginal involvement (direct extension or metastasis) or parametrial involvement
● T4 (IVA): tumor invades bladder mucosa or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)

Notes:
● Endocervical glandular involvement only should be considered as Stage I and not Stage II
● FIGO no longer includes Tis

Regional lymph nodes (N) and FIGO stage:
● NX: regional lymph nodes cannot be assessed
● N0: no regional lymph node metastasis
● N1 (IIIC1): regional lymph node metastasis to pelvic lymph nodes
● N2 (IIIC2): regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes

Distant Metastasis (M) and FIGO stage:
● M0: no distant metastasis
● M1 (IVB): distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease or lung, liver or bone; it excludes metastasis to para-aortic lymph nodes, vagina, pelvic serosa or adnexa)

Stage grouping and FIGO stage:
● Stage 0: T1s 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

Notes:
● FIGO no longer includes Stage 0 (Tis)

Histopathology - Degree of differentiation:
● G1: 5% or less of a nonsquamous or nonmorular solid growth pattern
● G2: 6%-50% of a nonsquamous or nonmorular solid growth pattern
● G3: more than 50% of a nonsquamous or nonmorular solid growth pattern

Notes on pathologic grading:
1. Notable nuclear atypia, inappropriate for the architectural grade, raises the grade to 3
2. Serous, clear cell and mixed mesodermal tumors are high risk and considered grade 3
3. Adenocarcinomas with benign squamous elements (squamous metaplasia) are graded according to the nuclear grade of the glandular component

Uterine Leiomyosarcoma and Endometrial Stromal Sarcoma
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Primary tumor (T) and FIGO stage:
● TX: primary tumor cannot be assessed
● T0: no evidence of primary tumor
● T1 (I): tumor confined to the uterus
● T1a (IA): tumor 5 cm or less in greatest dimension
● T1b (IB): tumor more than 5 cm
● T2 (II): tumor extends beyond the uterus, within the pelvis
● T2a (IIA): tumor involves adnexa
● T2b (IIB): tumor involves other pelvic tissues
● T3 (III): tumor infiltrates abdominal tissues (lesions must not just protrude into abdominal cavity)
● T3a (IIIA): tumor infiltrates abdominal tissues - one site
● T3b (IIIB): tumor infiltrates abdominal tissues - more than one site
● T4 (IVA): tumor invades bladder or rectum

Notes:
● Simultaneous tumors of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent primary tumors

Regional lymph nodes (N) and FIGO stage:
● NX: regional lymph nodes cannot be assessed
● N0: no regional lymph node metastasis
● N1 (IIIC): regional lymph node metastasis

Distant Metastasis (M) and FIGO stage:
● M0: no distant metastasis
● M1 (IVB): distant metastasis (excludes adnexa, pelvic and abdominal tissues)

Stage grouping and FIGO stage:
● Stage I: T1 N0 M0
● Stage IA: T1a N0 M0
● Stage IB: T1b N0 M0
● Stage II: T2 N0 M0
● Stage IIIA: T3a N0 M0
● Stage IIIB: T3b N0 M0
● Stage IIIC: T1-3 N1 M0
● Stage IVA: T4 any N M0
● Stage IVB: any T any N M1

Uterine Adenosarcoma
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Primary tumor (T) and FIGO stage:
● TX: primary tumor cannot be assessed
● T0: no evidence of primary tumor
● T1 (I): tumor limited to the uterus
● T1a (IA): tumor limited to the endometrium / endocervix
● T1b (IB): tumor invades to less than 1/2 of the myometrium
● T1c (IC): tumor invades more than 1/2 of the myometrium
● T2 (II): tumor extends beyond the uterus, within the pelvis
● T2a (IIA): tumor involves adnexa
● T2b (IIB): tumor involves other pelvic tissues
● T3 (III): tumor infiltrates abdominal tissues (lesions must not just protrude into abdominal cavity)
● T3a (IIIA): tumor infiltrates abdominal tissues - one site
● T3b (IIIB): tumor infiltrates abdominal tissues - more than one site
● T4 (IVA): tumor invades bladder or rectum

Notes:
● Simultaneous tumors of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent primary tumors

Regional lymph nodes (N) and FIGO stage:
● NX: regional lymph nodes cannot be assessed
● N0: no regional lymph node metastasis
● N1 (IIIC): regional lymph node metastasis

Distant Metastasis (M) and FIGO stage:
● M0: no distant metastasis
● M1 (IVB): distant metastasis (excludes adnexa, pelvic and abdominal tissues)

Stage grouping and FIGO stage:
● Stage I: T1 N0 M0
● Stage IA: T1a N0 M0
● Stage IB: T1b N0 M0
● Stage IC: T1c N0 M0
● Stage II: T2 N0 M0
● Stage IIIA: T3a N0 M0
● Stage IIIB: T3b N0 M0
● Stage IIIC: T1-3 N1 M0
● Stage IVA: T4 any N M0
● Stage IVB: any T any N M1

Staging diagrams
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Endometrial carcinoma


FIGO-2009


FIGO-1988

FIGO-1971

Additional references
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● Best Pract Res Clin Obstet Gynaecol 2011 Jul 12 [Epub ahead of print], Obstet Gynecol 2010;116:1141, National Cancer Institute

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