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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 January 21st, 2020.
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
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
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:
- Involvement of bladder or rectal mucosa
- Involvement of cervical stromal tissue
- Involvement of uterine serosa or adnexa
- Involvement of vagina or parametrial tissue
- Pelvic lymph node metastases
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