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Uterine cancer

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Staging uterine cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes the size of the tumour and where the cancer is in the body. Your healthcare team uses the stage to plan treatment and estimate your prognosis.

The most common staging system for uterine cancer is the International Federation of Gynecology and Obstetrics (FIGO) staging system. It is based on the TNM staging system. Each stage is given a number from 1 to 4. Stages 1 to 4 are usually given as the Roman numerals I, II, III and IV. Generally, the higher the number, the more the cancer has spread.

When describing the stage, doctors may use the terms local, regional or distant. Local means that the cancer is only in the uterus and has not spread to other parts of the body. Regional means close to or around the uterus. Distant means in a part of the body farther from the uterus.

FIGO staging system

Doctors use the FIGO staging system for both endometrial carcinoma and uterine sarcoma. Uterine carcinosarcoma is staged as an endometrial carcinoma.

FIGO stages are based on surgical staging. TNM stages are based on clinical classification, pathological classification or both. Clinical classification is determined by physical exam and imaging tests. Pathological classification is determined by examining the tumour and the lymph nodes under a microscope.

Surgical staging

To begin, the doctor will do a pelvic exam while you are under general anesthetic. The doctor will also do surgery to explore the abdomen, including:

  • looking at all of the surfaces in the pelvis and abdomen
  • taking biopsy samples from the peritoneumperitoneumThe membrane that lines the walls of the abdomen and pelvis (parietal peritoneum), and covers and supports most of the abdominal organs (visceral peritoneum). and any areas that look like cancer
  • removing lymph nodes in the pelvis and from around the aorta
  • doing a total hysterectomy and bilateral salpingo-oophorectomy
  • removing the omentumomentumA fold in the peritoneum (the membrane that lines the walls of the abdomen and pelvis) that covers and supports organs and blood vessels in the abdomen.
  • removing any tumours in the peritoneum

Tissues removed during surgery are sent to the lab to be examined under a microscope. The cancer is given a stage based on the TNM descriptions.

TNM descriptions

T describes the size of the primary tumour. It also describes if the tumour has grown into other parts of the uterus or tissues around the uterus. T is usually given as a number from 1 to 4. A higher number means that the tumour is larger or has grown deeper into nearby tissues or both.

N describes whether or not cancer has spread to lymph nodes around the uterus. N0 means the cancer hasn’t spread to any nearby lymph nodes. N1 means the cancer has spread to the pelvic lymph nodes. N2 means the cancer has spread to para-aortic lymph nodes (lymph nodes around the aorta). It may or may not have spread to the pelvic lymph nodes.

 

M describes whether or not the cancer has spread, or metastasized, to other parts of the body. M0 means that cancer has not spread to other parts of the body. M1 means that it has spread to other parts of the body, including lymph nodes in the abdomen or groin.

Endometrial carcinoma and uterine carcinosarcoma

Doctors use the following FIGO stage and TNM descriptions for endometrial carcinoma and uterine carcinosarcoma. Stage 0 describes a carcinoma in situcarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues. in the TNM staging system only. The FIGO system does not include stage 0.

Stage I
StageTNMDescription

IA

T1a

N0

M0

The tumour is only in the lining of the uterus (called the endometrium) or it has grown less than halfway through the muscle layer of the uterus wall (called the myometrium).

IB

T1b

N0

M0

The tumour has grown halfway or more than halfway through the myometrium.

Stage II
StageTNMDescription

II

T2

N0

M0

The tumour has grown into the cervix but not beyond the uterus.

Stage III
StageTNMDescription

IIIA

T3a

N0

M0

The tumour has grown into the serous covering of the uterus (called the perimetrium), nearby structures (including the fallopian tubes, ligaments and ovaries) or both.

IIIB

T3b

N0

M0

The tumour has grown into the vagina, connective tissue around the uterus or both.

IIIC

T1, T2 or T3

N1

M0

The tumour is only in the endometrium or it has grown less than halfway or more than halfway through the myometrium. It may have grown into the cervix, the perimetrium, nearby structures (including the fallopian tubes, ligaments and ovaries) or into the vagina and connective tissue around the uterus.

The cancer has spread to the lymph nodes in the pelvis or around the aorta (called para-aortic lymph nodes).

Stage IV
StageTNMDescription

IVA

T4

any N

M0

The tumour has grown into the inner lining (called the mucosa) of the intestine, bladder or both.

The cancer may or may not have spread to lymph nodes in the pelvis or around the aorta.

IVB

any T

any N

M1

The tumour can be any size and may or may not have grown into any surrounding tissues.

The cancer may or may not have spread to lymph nodes in the pelvis or around the aorta.

The cancer has spread to other parts of the body, such as the lungs, liver, bone or lymph nodes in the abdomen or groin (called distant metastasis).

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Uterine sarcoma

Doctors use the following FIGO stage and TNM descriptions for uterine leiomyosarcoma and endometrial stromal sarcoma.

Stage I
StageTNMDescription

IA

T1a

N0

M0

The tumour is only in the uterus. It is 5 cm or less at its widest point.

IB

T1b

N0

M0

The tumour is only in the uterus. It is more than 5 cm at its widest point.

Stage II
StageTNMDescription

IIA

T2a

N0

M0

The tumour has grown beyond the uterus, but it is only in the pelvis. The tumour has grown into nearby structures, including the fallopian tubes, ligaments or ovaries.

IIB

T2b

N0

M0

The tumour has grown beyond the uterus, but it is only in the pelvis. The tumour has grown into other tissues in the pelvis.

Stage III
StageTNMDescription

IIIA

T3a

N0

M0

The tumour has grown into only one place in the abdomen.

IIIB

T3b

N0

M0

The tumour has grown into 2 or more places in the abdomen.

IIIC

T1, T2 or T3

N1

M0

The tumour is any size and may have grown into tissues in the pelvis, abdomen or both. The cancer has spread to lymph nodes in the pelvis.

Stage IV
StageTNMDescription

IVA

T4

any N

M0

The tumour has grown into the inner lining (called the mucosa) of the intestine, bladder or both.

The cancer may or may not have spread to lymph nodes in the pelvis or around the aorta.

IVB

any T

any N

M1

The tumour can be any size and may or may not have grown into any surrounding tissues.

The cancer may or may not have spread to lymph nodes in the pelvis or around the aorta.

The cancer has spread to other parts of the body, such as the lungs, liver, bone or lymph nodes in the abdomen or groin (called distant metastasis).

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Recurrent uterine cancer

Recurrent uterine cancer means that the cancer has come back after it has been treated. If it comes back in the same place where the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called distant metastasis, or distant recurrence.

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