Endometrial Cancer Staging
- Endometrial cancer staging is a way to describe the extent of cancer in the body, if or where it has spread, and whether it is affecting other parts of the body.
- Endometrial cancer is assigned a stage between I and IV, where a lower number means it is less advanced and has not spread very far.
- Your doctor may not know the stage of your cancer until after your have had surgery to remove your cancer and it can be sent for testing.
- Earlier stage endometrial cancer is usually treated with surgery followed by radiation, chemotherapy and/or hormone therapy. For later stages, your doctor may recommend a targeted therapy that is personalized for your specific case.
- While earlier stages of endometrial cancer have the best chances of living a longer, healthier life, treatment options are often available even in later stages.
A key step in this process is determining the stage of your endometrial cancer. Staging is a way to describe the extent of cancer in the body, if or where it has spread, and whether it is affecting other parts of the body.
Read MoreHow Do Doctors Test for Endometrial Cancer?
Physicians use diagnostic tests to discover the cancer’s stage. This may require taking samples of the tumor during surgery and sending them to a lab for analysis, a process known as a biopsy.“The staging surgery typically includes the removal of the uterus, cervix, tubes, ovaries, and an assessment of lymph nodes through a procedure known as sentinel lymph node evaluation,” Dr. Mueller explains. “This involves injecting a bright green dye into the cervix at the time of surgery to trace lymphatic channels to the first lymph node(s) draining the uterus, known as the sentinel node(s). These nodes are then removed and examined by a pathologist to determine if they contain tumor cells, which is crucial for staging.”
Because of this, your doctor may not know the stage of your cancer until after your have had surgery to remove your cancer and all of your tests are in.
Once your cancer stage is determined, this will help guide further treatment decisions and predict which therapies are likely to work best for you.
“So you’ve had your surgery and the biggest question people have truly from the minute they’re diagnosed with endometrial cancer is am I going to be okay? Can you get the cancer out and then do I need any additional treatment?” Dr. Mueller points out. “This is a time after surgery where when we get a report back, the pathology, we can talk about what stage cancer you have. We can talk about if you need treatment at all after surgery.”
The most widely used classification for determining the extent of endometrial cancer is known as the International Federation of Gynecology and Obstetrics staging system, or FIGO for short.
How is Endometrial Cancer Staged?
The initial FIGO Staging System for Endometrial Cancer was published in 2009 and, since then, a wealth of information has emerged about how to classify the disease. The update helped explain the diverse biological nature of endometrial cancers and the expected treatment outcomes.
“The changes incorporated in the 2023 staging system should provide an evidence-based context for treatment recommendations and a more refined future collection of outcomes and survival data,” says Professor Jonathan Berek, the chair of the FIGO Committee on Women’s Cancer.
The system classifies endometrial cancers into various stages and substages, reflecting how aggressive the disease is and how far it has spread.
- Stage I: These are endometrial cancers where the cancer is only found in the uterus and ovaries. Subtypes include 1A1, with cancer in less than half the endometrium, and 1A2, with cancer in more than half but not the full thickness. Prognosis is usually good, especially for 1A1 tumors, which often have high survival rates.
- Stage II: The endometrial cancer extends beyond the uterus to involve the cervix but remains within the pelvis. Subtypes include 2A, where cancer involves the cervix but not the tissues next to the uterus, and 2B, where it spreads to nearby tissues. Prognosis depends on factors like tumor size, spread, and lymph node involvement.
- Stage III: In this stage, the cancer has spread beyond the pelvis to nearby organs like the ovaries or lymph nodes. There are different subtypes: 3A involves the outer layer of the uterus or nearby tissues, while 3B spreads to the vagina or tissues around the uterus. Prognosis depends on factors like tumor size, how far it has spread, and how well it responds to treatment.
- Stage IV: The disease has spread to distant organs beyond the pelvis, such as the lungs or liver. Prognosis is generally poorer than earlier stages due to the advanced spread of the disease. Treatment focuses on managing symptoms and may include surgery, radiation, chemotherapy, or targeted therapy.
Once your doctor has tested your cancer to determine its stage and other factors, Dr. BJ Rimel, a gynecologic oncologist at Cedar-Sinai Medical Center in Los Angeles, California, says they will have a discussion with you about where you are and what treatment options you have.
“So a patient that’s coming into my office with a new diagnosis of endometrial cancer is going to have a consultation with me regarding what’s on their pathology report,” Dr. Rimel explains. “Then we’re going to talk about what that pathology shows and what the next steps in treatment would be. If the diagnosis has been made after a hysterectomy, then we’re going to talk a little bit about what that diagnosis shows and what the stage, grade or extent of disease might be and how we proceed for treatment from there.”
Rimel adds that there are treatment options for every stage of the disease with new options approved all the time.
Related: Next-Generation Sequencing Helps Understand Genetic Mutations in Endometrial Cancer
How Does Molecular Information Change My Diagnosis?
Several factors go into deciding on what kind of treatment is best, depending on the type and stage of endometrial cancer, your age and whether or not you have plans to get pregnant.
One significant update in the 2023 FIGO Staging System is the inclusion of molecular data, which enhances the personalization of treatment plans. Molecular data in cancer staging refers to information about the genetic and molecular characteristics of the tumor.
By adding in information about the molecular subcategories into endometrial cancer staging, doctors can factor in different genetic or molecular features of the tumor, such as mutations in specific genes like PTEN or TP53, or variations in hormone receptor expression like estrogen or progesterone receptors.
The molecular subcategories provide additional information about the genetic and molecular characteristics of the tumor within each stage of endometrial cancer. This helps doctors better understand the behavior of the cancer and tailor treatments based on the specific molecular profile of the tumor for a more personalized approach.
For instance, previously, a patient with stage I endometrial cancer might only undergo surgery. However, under the new system, if molecular analysis reveals high-risk factors such as a p53 mutation, the same patient might also receive chemotherapy.
“If you do have a defect in one of those genes, you could have Lynch syndrome, which is a common cause hereditarily for endometrial cancer,” explains Dr. Michael Toboni, an assistant professor of gynologic oncology at University of Alabama Medicine. “MMR proficient is when you do not have a defect in one of those genes, which is the majority of endometrial cancers, approximately 70%.”
Related: Immunotherapy For Advanced Endometrial Cancer Has Fewer Side Effects Than Other Treatments
Questions to Ask Your Doctor
- What is the stage of my endometrial cancer, and what does that mean for my prognosis?
- What are the recommended treatment options for my specific cancer stage?
- How often will I need follow-up appointments and tests to monitor my condition after treatment?
- Can you explain the potential side effects of the recommended treatments, and how can they be managed?
- Are there any clinical trials or newer treatment approaches that I should consider?
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