Work-up Staging

Question 1

Per the NCCN (2014), what is the workup for endometrial cancer?

Answer 1

1. CBC,
2. PAP smear
3. Endometrial Bx
4. CXR.

If extrauterine Dz is suspected, consider:

1. CA125
2. MRI/ CT
3. Cystoscopy
4. Sigmoidoscopy.

Question 2

What are the sensitivity and specificity of an endometrial Bx?

Answer 2

90%– 98% sensitivity and 85% specificity.

Question 3

When is D& C recommended?

Answer 3

endometrial Bx is nondiagnostic.

Question 4

What is involved in the surgical staging of pts with endometrial carcinoma?

Answer 4

Surgical staging for endometrial cancer:

1. Vertical incision/ or laparoscopy
2. Peritoneal washing/ cytology (controversial)
3. Exploration of all peritoneal surfaces with Bx of any lesions
4. Total abdominal hysterectomy (TAH)/ bilateral salpingo-oophorectomy (BSO)
5. Uterus bivalved in operating room
6. Omental Bx (omentectomy for uterine papillary serous carcinoma [UPSC]/ clear cell carcinoma [CCC])
7. Pelvic/ P-A LN sampling vs. dissection.

Question 5

During the surgical staging procedure for endometrial cancer, what features are an indication for P-A nodal sampling? Approximately what % of pts have these features?

Answer 5

P-A sampling should take place in endometrial cancer pts with the following:

1. Gross P-A Dz
2. Positive pelvic LN
3. Gross adnexal mass or peritoneal disease
4. More than one-third myometrial involvement

~ 25% of pts have these features, but they account for 98% of all positive P-A LNs.

Question 6

Cystoscopy or sigmoidoscopy indicated when?

Answer 6

Sx or Advanced lesions per NCCN

Question 7

Staging of Endometrial Cancer

Answer 7

• Stage T1a/ IA: limited to endometrium or less than one-half of myometrium
• Stage T1b/ IB: invades half or more of myometrium Note: Endocervical glandular involvement only is considered AJCC T1 and FIGO stage I.
• Stage T2/ II: invades connective tissue of cervix but does not extend beyond uterus
• Stage T3a/ IIIA: tumor involves serosa and/ or adnexa by direct extension of mets
• Stage T3b/ IIIB: vaginal involvement or parametrial involvement
• Stage T4/ IVA: tumor invades bladder mucosa (bullous edema is not sufficient) and/ or bowel mucosa
• Stage N0: no regional LN mets
• Stage N1/ IIIC1: regional LN mets to pelvic nodes
• Stage N2/ IIIC2: regional LN mets to P-A nodes
• Stage M1/ IVB: DMs Note: Per the AJCC 7th edition (2011) and FIGO (2008), positive cytology no longer alters stage.

Question 8

Stage 1A

Answer 8

<1/2 myometrium or limited to endometrium

Question 9

Stage 1B

Answer 9

1/2 or more of of myometrium involvement

Note: Endocervical glandular involvement only is considered AJCC T1 and FIGO stage I.

Question 10

Stage II

Answer 10

Invades conective tissue of cervix but does not extend beyond uterus

Question 11

Stage T3a or FIGO IIIA

Answer 11

Involves serosa or adnexa by direct extension of mets

Question 12

T3b/FIGO IIIB

Answer 12

Vaginal involvement or parametrial involvement

Question 13

IIIC1/N1

Answer 13

Pelvic LN

Question 14

IIIC2

Answer 14

PA nodes

Question 15

IVA/T4

Answer 15

Invades bladder mucosa

Question 16

IVB

Answer 16

Distant Mets

Question 18

Old Staging

Answer 18

• 1A- limited to endometrium
• 1B <1/2 endometrium
• 1C > 1/2
• Stage II Endocervical glands only
• IIB endocervical stromal invasion
• IIIA- invades serosa or adenexa or cancer cells in ascites or peritoneal washings
• IIIB vaginal involvement
• IIIIC mets to Pelvic or PA LN
• IVA bladder/bowel mucosa
• IV mets