Latest TNM staging of endometrium
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I now have comprehensive staging data from two authoritative sources. Let me compile the complete answer.
TNM / FIGO Staging of Endometrial Carcinoma (2009 Revision)
The FIGO (2009) surgical-pathological staging system is the standard for endometrial carcinoma. TNM categories run in parallel. Staging is based on operative and pathological findings.
FIGO / TNM Staging Table
| FIGO Stage | TNM | Description |
|---|---|---|
| Stage I | T1 | Tumour confined to the corpus uteri |
| IA | T1a | No or < 50% myometrial invasion |
| IB | T1b | Invasion ≥ 50% of the myometrium |
| Stage II | T2 | Tumour invades cervical stroma, but does not extend beyond the uterus |
| Stage III | T3 | Local and/or regional spread |
| IIIA | T3a | Tumour invades serosa of the corpus uteri and/or adnexa |
| IIIB | T3b | Vaginal and/or parametrial involvement |
| IIIC | N1 | Metastases to pelvic and/or para-aortic lymph nodes |
| IIIC1 | N1a | Positive pelvic nodes |
| IIIC2 | N1b | Positive para-aortic lymph nodes ± positive pelvic lymph nodes |
| Stage IV | T4 / M1 | Tumour invades bladder/bowel mucosa or distant metastases |
| IVA | T4 | Tumour invades bladder and/or bowel mucosa (biopsy-proven; bullous oedema alone does not qualify) |
| IVB | M1 | Distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes |
Note on cytology: Positive peritoneal washings (malignant cells) are reported separately but do not change the stage in the 2009 revision.
Key Points
Staging procedure requires:
- Total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO)
- Peritoneal washings
- Retroperitoneal lymph node assessment (pelvic ± para-aortic)
Myometrial invasion is the pivotal Stage I determinant — the 50% threshold separates IA from IB.
Cervical involvement (Stage II) = stromal invasion only. A widened internal os with tumour protruding into the endocervical canal does not constitute Stage II.
Lymph node sub-staging (IIIC1 vs IIIC2) was a major change in 2009, recognising that para-aortic nodal spread (IIIC2) carries a worse prognosis than pelvic-only nodal disease (IIIC1).
High-risk features warranting full surgical staging: grade 3 histology, deep myometrial invasion (IB), lymphovascular space invasion.
MRI Correlates (Grainger & Allison)
| Stage | MRI Findings |
|---|---|
| IA | Abnormal signal extends into < 50% of myometrium |
| IB | Abnormal signal extends into ≥ 50% of myometrium |
| II | Disruption of low-signal cervical stroma by tumour |
| IIIA | Disruption of outer myometrial continuity; irregular uterine contour |
| IIIB | Segmental loss of hypointense vaginal wall |
| IIIC | Regional/para-aortic nodes > 1 cm short-axis; irregular contour, necrosis, or abnormal signal |
| IVA | Abnormal signal disrupting bladder/rectal mucosa |
| IVB | Tumour in distant organs |
Sources: Berek & Novak's Gynecology (Table 37-6); Grainger & Allison's Diagnostic Radiology (Table 34.2) — both citing Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet 2009;105:103–104.
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