FIGO Staging of Uterine Corpus Carcinoma and Carcinosarcoma
Stage* | Definition |
|---|---|
I† | Confined to the uterine corpus and ovaryǂ |
| Disease limited to the endometrium OR non-aggressive histologic type#, with invasion of less than half of myometrium with no or focal lymphovascular space involvement (LVSI)§ OR good prognosis disease |
| Non-aggressive histologic type limited to an endometrial polyp OR confined to the endometrium |
| Non-aggressive histologic type involving less than half of the myometrium with no or focal LVSI |
| Low-grade endometrioid endometrial carcinomas (EECs) limited to the uterus and ovaryǂ |
| Non-aggressive histologic types# with invasion of half or more of the myometrium, and with no or focal LVSI§ |
| Aggressive histologic types# limited to a polyp or confined to the endometrium |
II† | Invasion of the cervical stroma without extension outside the uterus OR with substantial LVSI OR aggressive histologic types with myometrial invasion |
IIA | Invasion of the cervical stroma of non-aggressive histologic types |
IIB | Substantial LVSI§ of non-aggressive histologic types |
IIC | Aggressive histologic types with any myometrial involvement |
III | Local and/or regional spread of the tumor of any histologic subtype |
| Invasion of uterine serosa, adnexa, or both (direct extension or metastasis) |
| Spread to ovary or fallopian tube (except when meeting stage IA3 criteria)ǂ |
| Involvement of uterine subserosa or spread through the uterine serosa |
| Metastasis or direct spread to the vagina and/or spread to the parametria or pelvic peritoneum |
| Metastasis or direct spread to the vagina and/or the parametria |
| Metastasis to the pelvic peritoneum |
| Metastases to pelvic or para-aortic lymph nodes or to both¶ |
| Metastases to pelvic lymph nodes |
| Micrometastasis |
| Macrometastasis |
| Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes |
| Micrometastasis |
| Macrometastasis |
IV | Spread to the bladder and/or intestinal mucosa and/or distant metastasis |
| Invasion of the bladder, intestinal mucosa, or both |
| Abdominal peritoneal metastasis beyond the pelvis |
| Distant metastasis, including metastasis to any extra- or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain, or bone |
Endometrial cancer stage with molecular classification (examples) | |
| Molecular findings in patients with early endometrial cancer (Stages I and II after surgical staging) |
| POLEmut endometrial carcinoma, confined to the uterine corpus or with cervical extension, regardless of the degree of LVSI or histological type |
| p53abn endometrial carcinoma confined to the uterine corpus with any myometrial invasion, with or without cervical invasion, and regardless of the degree of LVSI or histological type |
* In all stages, the grade of the lesion, the histologic type, and LVSI must be recorded. | |
† If available and feasible, molecular classification testing (POLEmut, MMRd, NSMP, p53abn) is encouraged in all patients with endometrial cancer for prognostic risk-group stratification and as factors that might influence adjuvant and systemic treatment decisions. | |
‡ Low-grade endometrioid endometrial carcinomas (EECs) involving both the endometrium and the ovary are considered to have a good prognosis, and no adjuvant treatment is recommended, only if all criteria are met to distinguish disease limited to low-grade endometrioid carcinomas involving the endometrium and ovaries (Stage IA3) from extensive spread of the endometrial carcinoma to the ovary (Stage IIIA1). These criteria are: (1) no more than superficial myometrial invasion is present (< 50%); (2) absence of extensive/substantial LVSI; (3) absence of additional metastases; and (4) the ovarian tumor is unilateral, limited to the ovary, without capsule invasion/rupture. | |
# Non-aggressive histologic types are composed of low-grade (grade 1 and 2) EECs. Aggressive histologic types are composed of high-grade EECs (grade 3), serous, clear cell, undifferentiated, mixed, mesonephric-like, gastrointestinal mucinous type carcinomas, and carcinosarcomas. | |
§ LVSI as defined as extensive/substantial, ≥ 5 vessels involved. | |
¶ Micrometastases are considered to be metastatic involvement (pN1 (mi)). The prognostic significance of isolated tumor cells (ITCs) is unclear. The presence of ITCs should be documented and is regarded as pN0(i+). According to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th ed, macrometastases are > 2 mm in size, micrometastases are 0.2–2 mm and/or > 200 cells, and isolated tumor cells are ≥ 0.2 mm and ≤ 200 cells. | |
Berek JS, Matias-Guiu X, Creutzberg C, et al: FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet 2023;162(2):383-394. doi:10.1002/ijgo.14923 | |