Endometrial (Uterine) Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How is endometrial cancer staged?

Staging is the process of looking at all of the information the doctors have learned about your tumor to tell how much the cancer may have spread. The stage of an endometrial cancer is the most important factor in choosing a treatment plan. Ask your doctor to explain the stage of your cancer so that you can make fully informed choices about your treatment.

Doctors use a staging system to describe how far a patient's cancer has spread. The 2 systems used for staging endometrial cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM staging system are basically the same. They both classify this cancer on the basis of 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). The system described below is the most recent AJCC system, which went into effect January 2010. The difference between the AJCC system and the FIGO system is that the FIGO system doesn’t include stage 0.

Endometrial cancer is staged based on examination of tissue removed during an operation. This is known as surgical staging, and means that doctors often can't tell for sure what stage the cancer is in until after surgery is done.

A doctor may order tests before surgery, such as ultrasound, MRI, or CT scan, to look for signs that a cancer has spread. Although it is not as good as the surgical stage, this information can be helpful in planning surgery and other treatments. If these tests show that the cancer may have spread outside the uterus, you may be referred to a gynecologic oncologist (if you are not already seeing one).

The staging system looks at how far the cancer has spread:

  • It can spread locally to the cervix and other parts of the uterus.
  • It can also spread regionally to nearby lymph nodes (bean-sized organs that are part of the immune system). The regional lymph nodes are found in the pelvis and farther away along the aorta (the main artery that runs from the heart down along the back of the abdomen and pelvis). The lymph nodes along the aorta are called para-aortic nodes.
  • Finally, the cancer can spread (metastasize) to distant lymph nodes, the upper abdomen, the omentum (a large fatty sheet of tissue in the abdomen that drapes like an apron over the stomach, intestines, and other organs), or other organs such as lung, liver, bone, and brain.

Tumor extent (T)

T0: No signs of a tumor in the uterus

Tis: Pre-invasive cancer (also called carcinoma in-situ). Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below.

T1: The cancer is only growing in the body of the uterus. It may also be growing into the glands of the cervix, but is not growing into the supporting connective tissue of the cervix.

  • T1a: The cancer is in the endometrium (inner lining of the uterus) and may have grown from the endometrium less than halfway through the underlying muscle layer of the uterus (the myometrium).
  • T1b: The cancer has grown from the endometrium into the myometrium, growing more than halfway through the myometrium. The cancer has not spread beyond the body of the uterus.

T2: The cancer has spread from the body of the uterus and is growing into the supporting connective tissue of the cervix (called the cervical stroma). The cancer has not spread outside of the uterus.

T3: The cancer has spread outside of the uterus, but has not spread to the inner lining of the rectum or urinary bladder.

  • T3a: The cancer has spread to the outer surface of the uterus (called the serosa) and/or to the fallopian tubes or ovaries (the adnexa)
  • T3b: The cancer has spread to the vagina or to the tissues around the uterus (the parametrium).

T4: The cancer has spread to the inner lining of the rectum or urinary bladder (called the mucosa)

Lymph node spread (N)

NX: spread to nearby lymph nodes cannot be assessed

N0: no spread to nearby lymph nodes

N1: cancer has spread to lymph nodes in the pelvis

N2: cancer has spread to lymph nodes along the aorta (peri-aortic lymph nodes)

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or other organs (such as the lungs or liver)

AJCC stage grouping and FIGO stages

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers.

Stage 0

Tis, N0, M0: This stage is also known as carcinoma in-situ. Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below. The cancer has not spread to nearby lymph nodes or distant sites. This is a pre-cancerous lesion. This stage is not included in the FIGO staging system.

Stage I

T1, N0, M0: The cancer is only growing in the body of the uterus. It may also be growing into the glands of the cervix, but is not growing into the supporting connective tissue of the cervix. The cancer has not spread to lymph nodes or distant sites.

  • Stage IA (T1a, N0, M0): In this earliest form of stage I, the cancer is in the endometrium (inner lining of the uterus) and may have grown from the endometrium less than halfway through the underlying muscle layer of the uterus (the myometrium). It has not spread to lymph nodes or distant sites.
  • Stage IB (T1b, N0, M0): The cancer has grown from the endometrium into the myometrium, growing more than halfway through the myometrium. The cancer has not spread beyond the body of the uterus.

Stage II

T2, N0, M0: The cancer has spread from the body of the uterus and is growing into the supporting connective tissue of the cervix (called the cervical stroma). The cancer has not spread outside of the uterus. The cancer has not spread to lymph nodes or distant sites.

Stage III

T3, N0, M0: Either the cancer has spread outside of the uterus or into nearby tissues in the pelvic area.

  • Stage IIIA (T3a, N0, M0): The cancer has spread to the outer surface of the uterus (called the serosa) and/or to the fallopian tubes or ovaries (the adnexa). The cancer has not spread to lymph nodes or distant sites.
  • Stage IIIB (T3b, N0, M0): The cancer has spread to the vagina or to the tissues around the uterus (the parametrium). The cancer has not spread to lymph nodes or distant sites.
  • Stage IIIC1 (T1 to T3, N1, M0): The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to pelvic lymph nodes but not to lymph nodes around the aorta or distant sites.
  • Stage IIIC2 (T1 to T3, N2, M0): The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to lymph nodes around the aorta (peri-aortic lymph nodes) but not to distant sites.

Stage IV

The cancer has spread to the inner surface of the urinary bladder or the rectum (lower part of the large intestine), to lymph nodes in the groin, and/or to distant organs, such as the bones, omentum or lungs.

  • Stage IVA (T4, any N, M0): The cancer has spread to the inner lining of the rectum or urinary bladder (called the mucosa). It may or may not have spread to nearby lymph nodes but has not spread to distant sites.
  • Stage IVB (any T, any N, M1): The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or to organs away from the uterus, such as the bones, omentum, or lungs. The cancer can be any size and it may or may not have spread to lymph nodes.

Last Medical Review: 11/04/2013
Last Revised: 02/03/2014