Ca endometrium stage
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"endometrial carcinoma" AND "FIGO staging"
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"endometrial cancer" AND "staging" AND "FIGO 2023"
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FIGO 2023 endometrial carcinoma staging system criteria
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https://ejgo.org/pdf/10.3802/jgo.2023.34.e85
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Here is the complete staging of carcinoma endometrium, covering both the classic FIGO 2009 system (still widely used in exams) and the updated FIGO 2023 system (which integrates histology, LVSI, and molecular markers).
Carcinoma Endometrium - FIGO Staging
FIGO 2009 Staging (Surgical)
(Berek & Novak's Gynecology; PMID: 37337978)
| Stage | Description |
|---|---|
| IA | No or < 50% myometrial invasion |
| IB | ≥ 50% myometrial invasion |
| II | Invades cervical stroma, but does not extend beyond uterus (endocervical glandular involvement alone = Stage I) |
| IIIA | Invades serosa of corpus uteri and/or adnexa |
| IIIB | Vaginal and/or parametrial involvement |
| IIIC1 | Positive pelvic lymph nodes |
| IIIC2 | Positive para-aortic lymph nodes ± pelvic nodes |
| IVA | Tumor invasion of bladder and/or bowel mucosa |
| IVB | Distant metastases, including intra-abdominal and/or inguinal lymph nodes |
Positive peritoneal cytology: reported separately, does not change the stage.
FIGO 2023 Staging (Updated - Incorporates Histology + LVSI + Molecular)
(Published: Berek et al., 2023, PMID: 37337978)
Stage I - Tumor confined to corpus uteri
| Substage | Criteria |
|---|---|
| IA1 | Non-aggressive histological type limited to an endometrial polyp OR confined to endometrium (no myometrial invasion) |
| IA2 | Non-aggressive histological type with < 50% myometrial invasion, with no or focal LVSI |
| IA3 | Low-grade endometrioid carcinoma (EEC) limited to uterus WITH simultaneous low-grade endometrioid ovarian carcinoma (criteria: < 50% MI, no/focal LVSI, no additional mets, unilateral ovarian, no capsule rupture) |
| IB | Non-aggressive histological types with ≥ 50% myometrial invasion, with no or focal LVSI |
| IC | Aggressive histological types (serous, high-grade endometrioid, clear cell, carcinosarcoma, undifferentiated, mixed) with NO myometrial invasion |
"Non-aggressive" = low-grade endometrioid. "Aggressive" = serous, clear cell, carcinosarcoma, undifferentiated, high-grade endometrioid.
Stage II - Extends beyond corpus, confined to pelvis
| Substage | Criteria |
|---|---|
| IIA | Cervical stromal invasion (confined to uterus) |
| IIB | Substantial LVSI (diffuse/extensive), regardless of depth of invasion (non-aggressive types) |
| IIC | Aggressive histological types with any myometrial invasion (but confined to uterus/cervix) |
Stage III - Local/regional spread
| Substage | Criteria |
|---|---|
| IIIA1 | Spread to ovary or fallopian tube |
| IIIA2 | Involvement of uterine subserosa or spread through uterine serosa |
| IIIB1 | Metastasis or direct spread to vagina and/or parametria |
| IIIB2 | Metastasis to pelvic peritoneum |
| IIIC1i | Pelvic lymph node micrometastasis |
| IIIC1ii | Pelvic lymph node macrometastasis |
| IIIC2i | Para-aortic lymph node micrometastasis |
| IIIC2ii | Para-aortic lymph node macrometastasis |
Stage IV - Distant spread
| Substage | Criteria |
|---|---|
| IVA | Invasion of bladder and/or bowel mucosa |
| IVB | Distant metastases (lungs, liver, bone, brain) including inguinal lymph nodes and intra-abdominal disease beyond the pelvis |
Molecular Classification (FIGO 2023 - New Addition)
The 2023 system introduces molecular subtyping (TCGA-based) recorded as a suffix "m":
| Molecular Type | Stage Implication |
|---|---|
| POLEmut (POLE mutation - best prognosis) | Downstaged: any Stage I/II with POLE mut → Stage IAmPOLEmut |
| MMRd (mismatch repair deficient) | Intermediate prognosis; recorded as suffix |
| NSMP (non-specific molecular profile) | Intermediate prognosis |
| p53abn (p53 abnormal - worst prognosis) | Upstaged: any Stage I/II with myometrial invasion + p53abn → Stage IICmp53abn |
Key Changes: 2009 vs 2023
| Feature | FIGO 2009 | FIGO 2023 |
|---|---|---|
| Histology in staging | No | Yes (aggressive vs non-aggressive) |
| LVSI | Not staged | Substantial LVSI = Stage IIB |
| Molecular markers | Not included | Integral (POLEmut, p53abn affect stage) |
| Stage IC | Didn't exist | Aggressive type, no MI |
| Ovarian involvement | Stage IIIA | Can be Stage IA3 if low-grade + criteria met |
| Pelvic peritoneum | Stage IV | Stage IIIB2 |
| Nodal substaging | IIIC1/IIIC2 only | Micro vs macro (i/ii) |
| Peritoneal cytology | Reported separately | Reported separately (unchanged) |
Risk Group Classification (ESGO/ESMO)
| Risk | Criteria (FIGO 2023) |
|---|---|
| Low | Stage IA1/IA2 MMRd/NSMP, low-grade, no LVSI |
| Intermediate | Stage IB low-grade; Stage IA high-grade, no LVSI |
| High-Intermediate | Stage I with substantial LVSI; Stage IB high-grade; Stage II |
| High | Stage III-IVA no residual disease; Stage I-IVA p53abn or non-endometrioid |
| Advanced/Metastatic | Stage III-IVA with residual disease; Stage IVB |
Note: The FIGO 2023 system represents a major shift - it is no longer purely anatomical. It integrates pathology, LVSI status, and molecular profiling into the stage assignment. In practice, full molecular subtyping is required for accurate staging. The NCCN Uterine Neoplasms Guidelines v3.2025 (PMID: 40763788) and the ESUR 2026 MRI guidelines (PMID: 40586816) have both been updated to align with FIGO 2023.
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