Uterine Sarcoma

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Early Detection, Diagnosis, and Staging TOPICS

How is uterine sarcoma staged?

Staging is the process of analyzing information about a tumor to find out how far the cancer has spread. The stage of a uterine sarcoma is an important factor in choosing treatment. Ask your health care team to explain your cancer's stage so that you can make fully informed choices about your treatment.

The 2 systems used for staging uterine sarcoma, the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM staging system, are the same. Staging is based on 3 factors: the size or extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). Uterine sarcoma is staged based on examination of tissue removed during an operation. This is known as surgical staging and means that doctors can't tell for sure what stage the cancer is in until after surgery is done (in most cases). The staging system classifies the cancer in stages I through IV, with each of these stages being further divided by letters (for example, stages IIA and IIB).

The staging system looks at how far the cancer has spread. It can spread locally to other parts of the uterus and to tissues of the pelvis, including the fallopian tubes, ovaries, and tissue near the uterus. It can also spread regionally to nearby lymph nodes (bean-sized organs that are part of the immune system) and other parts of the pelvis. 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 the para-aortic nodes. Finally, the cancer can spread (metastasize) to distant lymph nodes or organs such as the lungs, liver, bone, brain, and others.

Tumor extent (T)

T0: No signs of a tumor in the uterus can be found.

T1: The tumor is growing in the uterus, but has not started growing outside the uterus.

  • T1a: The cancer is only in the uterus and is no larger than 5 cm across (5 cm is about 2 inches).
  • T1b: The cancer is only in the uterus and is larger than 5 cm across.

T2: The tumor is growing outside the uterus but is not growing outside of the pelvis.

  • T2a: The tumor is growing into the adnexa (the ovaries and fallopian tubes).
  • T2b: The tumor is growing into tissues of the pelvis other than the adnexa.

T3: The tumor is growing into tissues of the abdomen.

  • T3a: The tumor is growing into tissues of the abdomen in one place only.
  • T3b: The tumor is growing into tissues of the abdomen in 2 or more places.

T4: The tumor is growing into the bladder or rectum.

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 nearby 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 organs (such as the lungs or liver).

Stage grouping

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 Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters.

Stage I (T1, N0, M0): The cancer is only in the uterus. It has not spread to lymph nodes or distant sites.

  • Stage IA (T1a, N0, M0): The cancer is only in the uterus and is no larger than 5 cm across. It has not spread to nearby lymph nodes or distant sites.
  • Stage IB (T1b, N0, M0): The cancer is only in the uterus and is larger than 5 cm across. It has not spread to nearby lymph nodes or distant sites.

Stage II (T2, N0, M0): The cancer is growing outside the uterus but is not growing outside of the pelvis. The cancer has not spread to nearby lymph nodes or distant sites.

  • Stage IIA (T2a, N0, M0): The cancer is growing into the adnexa (the ovaries and fallopian tubes). It has not spread to nearby lymph nodes or distant sites.
  • Stage IIB (T2b, N0, M0): The cancer is growing into tissues of the pelvis other than the adnexa. It has not spread to nearby lymph nodes or distant sites.

Stage III: Any of the following:

  • Stage IIIA (T3a, N0, M0): The cancer is growing into tissues of the abdomen in one place only. It has not spread to nearby lymph nodes or distant sites.
  • Stage IIIB (T3b, N0, M0): The cancer is growing into tissues of the abdomen in 2 or more places. It has not spread to lymph nodes or distant sites.
  • Stage IIIC (T1 to T3, N1, M0): The cancer in the uterus can be any size and may have grown into tissues in the pelvis and/or abdomen. It has not spread to the bladder or rectum. The cancer has spread to lymph nodes near the uterus (pelvic and/or para-aortic lymph nodes). It has not spread to distant sites.

Stage IV: The cancer has spread to the urinary bladder or the rectum (lower part of the large intestine), and/or to distant organs, such as the bones or lungs.

  • Stage IVA (T4, any N, M0): The cancer has spread to the rectum or urinary bladder. It may also be in the lymph nodes but has not spread to distant sites.
  • Stage IVB (any T, any N, M1): The cancer has spread to organs that are not next to the uterus (such as the bones or lungs) or it has spread to distant lymph nodes (such as those in the groin area).

Last Medical Review: 01/22/2013
Last Revised: 02/12/2014