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Endometrial Cancer Treatment (Professional) (cont.)

Cellular Classification of Endometrial Cancer

The most common endometrial cancer cell type is endometrioid adenocarcinoma, which is composed of malignant glandular epithelial elements; an admixture of squamous metaplasia is not uncommon. Adenosquamous tumors contain malignant elements of both glandular and squamous epithelium;[1] clear cell and papillary serous carcinoma of the endometrium are tumors that are histologically similar to those noted in the ovary and the fallopian tube, and the prognosis is worse for these tumors.[2] Mucinous, squamous, and undifferentiated tumors are rarely encountered. Frequency of endometrial cancer cell types is as follows:

  1. Endometrioid (75%–80%)
    1. Ciliated adenocarcinoma.
    2. Secretory adenocarcinoma.
    3. Papillary or villoglandular.
    4. Adenocarcinoma with squamous differentiation.
      1. Adenoacanthoma.
      2. Adenosquamous.
  2. Uterine papillary serous (<10%).
  3. Mucinous (1%).
  4. Clear cell (4%).
  5. Squamous cell (<1%).
  6. Mixed (10%).
  7. Undifferentiated.

References:

  1. Zaino RJ, Kurman R, Herbold D, et al.: The significance of squamous differentiation in endometrial carcinoma. Data from a Gynecologic Oncology Group study. Cancer 68 (10): 2293-302, 1991.
  2. Gusberg SB: Virulence factors in endometrial cancer. Cancer 71 (4 Suppl): 1464-6, 1993.

Stage Information for Endometrial Cancer

This Stage Information section has been updated to include information from the seventh edition (2010) of the American Joint Committee on Cancer's AJCC Cancer Staging Manual. The PDQ Adult Treatment Editorial Board, which is responsible for maintaining this summary, is currently reviewing the new staging categories to determine whether additional changes need to be made to other parts of the summary. Any necessary changes will be made as soon as possible.

Definitions of TNM and FIGO

The American Joint Committee on Cancer (AJCC) and the Féderation Internationale de Gynécologie et d'Obstétrique (FIGO) have designated staging to define endometrial cancer.[1,2] The definitions of the AJCC's T, N, and M categories correspond to the stages accepted by FIGO. Both systems are included for comparison.

Carcinosarcomas should be staged as carcinoma.[1] FIGO stages are further subdivided by histologic grade of tumor, for example, stage IC G2.

Table 1. Primary Tumor (T) (Surgical-Pathologic Findings)a

FIGO = Féderation Internationale de Gynécologie et d'Obstétrique.
a Reprinted with permission from AJCC: Corpus uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 403-18.
b FIGO no longer includes stage 0 (Tis).
c Endocervical glandular involvement only should be considered as stage I and not as stage II.
TNM CategoriesFIGO Stages
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisbCarcinoma in situ (preinvasive carcinoma).
T1ITumor confined to corpus uteri.
T1aIATumor limited to endometrium or invades less than one-half of the myometrium.
T1bIBTumor invades one-half or more of the myometrium.
T2IITumor invades stromal connective tissue of the cervix but does not extend beyond the uterus.c
T3aIIIATumor involves serosa and/or adnexa (direct extension or metastasis).
T3bIIIBVaginal involvement (direct extension or metastasis) or parametrial involvement.
T4IVATumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4).

Table 2. Regional Lymph Nodes (N)a

FIGO = Féderation Internationale de Gynécologie et d'Obstétrique.
a Reprinted with permission from AJCC: Corpus uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 403-18.
TNM CategoriesFIGO Stages
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1IIIC1Regional lymph node metastasis to pelvic lymph nodes.
N2IIIC2Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes.

Table 3. Distant Metastasis (M)a

FIGO = Féderation Internationale de Gynécologie et d'Obstétrique.
a Reprinted with permission from AJCC: Corpus uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 403-18.
TNM CategoriesFIGO Stages
M0No distant metastasis.
M1IVBDistant metastasis (includes metastasis to inguinal lymph nodes, lung, liver, or bone or intraperitoneal disease. It excludes metastasis to para-aortic lymph nodes, vagina, pelvic serosa, or adnexa).

Table 4. Anatomic Stage/Prognostic Groupsa

a Reprinted with permission from AJCC: Corpus uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 403-18.
b Carcinosarcomas should be staged as carcinoma.
c FIGO no longer includes stage 0 (Tis).
Carcinomasb
StageTNM
0cTisN0M0
IT1N0M0
IAT1aN0M0
IBT1bN0M0
IIT2N0M0
IIIT3N0M0
IIIAT3aN0M0
IIIBT3bN0M0
IIIC1T1–T3N1M0
IIIC2T1–T3N2M0
IVAT4Any NM0
IVBAny TAny NM1

Table 5. Carcinoma of the Endometriuma

a Adapted from FIGO Committee on Gynecologic Oncology.[2]
b Either G1, G2, or G3 (G = grade).
c Endocervical glandular involvement only should be considered as stage I and no longer as stage II.
d Positive cytology has to be reported separately without changing the stage.
Stage
IbTumor confined to the corpus uteri.
IAbNo or less than half myometrial invasion.
IBbInvasion equal to or more than half of the myometrium.
IIbTumor invades cervical stroma but does not extend beyond the uterus.c
IIIbLocal and/or regional spread of the tumor.
IIIAbTumor invades the serosa of the corpus uteri and/or adnexae.d
IIIBbVaginal and/or parametrial involvement.d
IIICbMetastases to pelvic and/or para-aortic lymph nodes.d
IIIC1bPositive pelvic nodes.
IIIC2bPositive para-aortic lymph nodes with or without positive pelvic lymph nodes.
IVbTumor invades bladder and/or bowel mucosa, and/or distant metastases.
IVAbTumor invasion of bladder and/or bowel mucosa.
IVBbDistant metastases, including intra-abdominal metastases and/or inguinal lymph nodes.

References:

  1. Corpus uteri. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 403-18.
  2. Pecorelli S: Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105 (2): 103-4, 2009.
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