Criteria

International Federation of Gynecology and Obstetrics (FIGO) staging of uterine cancer (2009)[6]

Stage I: tumor limited to the corpus uteri

  • IA: no or <50% myometrial invasion

  • IB: ≥50% myometrial invasion.

Stage II: tumor invades cervical stroma, but does not extend beyond the uterus

  • Endocervical glandular involvement only should be considered as stage I and no longer as stage II.

Stage III: local and regional spread of the tumor

  • IIIA: tumor invades the serosa of the corpus uteri and/or adnexa; positive cytology has to be reported separately without changing the stage

  • IIIB: vaginal and/or parametrial involvement

  • IIIC: metastases to pelvic and/or para-aortic lymph nodes

  • IIIC1: positive pelvic nodes

  • IIIC2: positive para-aortic lymph nodes with or without positive pelvic lymph nodes.

Stage IV: tumor invades the bladder and/or bowel mucosa, and/or distant metastases

  • IVA: tumor invasion of the bladder and/or bowel mucosa

  • IVB: distant metastases including intra-abdominal metastases and/or inguinal lymph nodes.

Simplified FIGO staging[132]

The FIGO staging classification is sometimes simplified to:

  • Organ confined

  • Nonorgan confined.

Nonorgan confined is most commonly divided into:

  • Node-positive

  • Metastatic.

Alternatively, it may be divided into:

  • Early

  • Advanced (locally advanced, inoperable, or recurrent).

Risk stratification criteria

Following clinical evaluation, staging surgery, and histopathology assessment, women with endometrial cancer can be stratified based on risk of recurrence to help guide treatment planning.

Low risk:

  • Stage IA endometrioid carcinoma without myometrial invasion

Intermediate risk:

  • Stage IA endometrioid carcinoma with myometrial invasion

  • Stage IB or II endometrioid carcinoma

High risk:

  • Stages III to IV endometrioid carcinoma

  • Nonendometrioid (type 2) carcinomas (e.g., serous, clear-cell, undifferentiated carcinoma, carcinosarcoma)

Intermediate-risk patients can be further stratified as low- or high-intermediate risk according to age and presence of the following risk factors (based on the GOG-99 study criteria): tumor grade 2 or 3; lymphovascular space invasion; and outer third myometrial invasion:[133]

Low-intermediate risk:

  • Age <50 years and ≤2 risk factors

  • Age 50-69 years and ≤1 risk factor

  • Age ≥70 years and no risk factors

High-intermediate risk:

  • Any age and 3 risk factors

  • Age 50-69 years and ≥2 risk factors

  • Age ≥70 years and ≥1 risk factor.

Stage IB or II disease that is deeply invasive, with gross cervical involvement, and/or grade 3 is often considered high risk.

There are other risk stratification criteria for endometrial cancer, such as the PORTEC study criteria and the European Society of Medical Oncology (ESMO) risk criteria, but the GOG-99 criteria are commonly used in the US.[106][111]​​[134]​​​​​​

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