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Staging of uterine cancer

According to FIGO (The International Federation of Gynecology and Obstetrics), surgical staging should be performed. Patients not treated with primary surgery are staged according to the clinical examination limited to the following methods: inspection, colposcopy, palpation under general anesthesia, biopsies, fractionated abrasion, conization, cystoscopy, rigid sigmoidoscopy, chest X-ray, bone X-ray, and urography. 

If there is uncertainty in staging, the lowest alternative should be chosen.

Findings on MRI, CT, and ultrasound may influence the choice of therapy, but should not change the stage.

Staging according to FIGO  (revised September 2009)

The tumor should be graded histologically as G1 (highly differentiated), G2 (moderately differentiated) or G3 (low or undifferentiated).

Stage I

Stage I: Tumor is confined to the uterus.

  • Stage Ia: None or less than half myometrial infiltration.
  • Stage Ib: Infiltration in half or more than half of the myometrium.

Stage II

Stage II: Cervical stromal invasion, but not extending beyond uterus. (Endocervical glandular involvement should only be considered as stage I and not as stage II.)  

Stage III

Stage III: Local and/or regional spreading of tumor.

  • Stage IIIa: Infiltration of the serosa and/or adnexa
  • Stage IIIb: Metastasis to vagina and/or parametrial infiltration
  • Stage IIIc: Metastasis to retroperitoneal lymph nodes in the pelvis and/or paraaortally

Positive cytology should be reported separately without changing the stage.

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Stage IV

Stage IV: Tumor infiltrates the bladder and/or intestinal mucosa and/or distant metastasis 

  • Stage IVa: Infiltration of the bladder or intestinal mucosa
  • Stage IVb: Distant metastasis including intraabdominal metastases and/or inguinal node metastases.

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