Endometrial carcinoma (staging)

Endometrial carcinoma staging allows appropriate treatment options to be considered and enables greater prognostic accuracy for endometrial carcinoma. 

Staging

Staging can be based on the TNM or FIGO system. 

MR imaging is the modality of choice for staging with CT having relatively low specificity (especially for myometrial invasion ⁵).

FIGO system

An updated FIGO system was introduced in 2023¹⁰. The new system includes non-anatomical parameters such as tumour hystological type, grade, lymphovascular invasion (LVSI) and molecular subtype.

Revised 2023 FIGO staging for carcinoma of the endometrium ¹⁰:

• stage I: limited to the uterine corpus and ovary

  • Ia: limited to the endometrium or non-aggressive histological type with no or less than half (≤ 50%) myometrial invasion, no or focal LVSI

  • Ib: non-aggressive histological type with invasion equal to or more than half (≥ 50%) of the myometrium, no or focal LVSI

  • Ic: aggressive histological type confined to the endometrium or to a polyp

• stage II: cervical stromal involvement without extrauterine spread or with extensive LVSI or aggressive histological type with myometrial invasion

  • IIa: cervical stromal involvement and non-aggressive histological type

  • IIb: extensive LVSI and non-aggressive histological type

  • IIc: aggressive histological type with myometrial invasion of any depth

• stage III: local or regional spread of the tumour

  • IIIa: tumour invades the serosa of the body of the uterus and/or adnexa

  • IIIb: vaginal or parametrial involvement

  • IIIc:  pelvic or para-aortic lymphadenopathy

• stage IV: involvement of intestinal/bowel and/or bladder mucosa and/or distant metastasis

  • IVa: bladder or intestinal/bowel mucosal involvement

  • IVb: extrapelvic peritoneal involvement

  • IVc: distant metastases

  The histological type and grade, LVSI must be included in all cases. Molecular subtype of tumour (POLEmut, MMRd, NSMP, p53abn) is encouraged in all patients if available. The molecular subtype modifies the I and II stages. POLEmut endometrial carcinoma, limited to the corpus of uteri or with cervical involvement regardless of the degree of LVSI is now classified as Stage IAm_POLEmut, whereas a p53abn endometrial carcinoma limited to the corpus of uteri with or without cervical involvement regardless of the degree of myometrial invasion and LVSI is classified as Stage IICm_p53abn. Findings of MMRd or NSMP subtypes do not modify FIGO 2023 system stage.

See also

• cervical cancer staging

• tubal carcinoma staging

• choriocarcinoma staging

• ovarian cancer staging

• vaginal cancer staging

• vulval cancer staging

• FIGO staging system