Workup/Staging

Question 1

Per the NCCN (2018), what is the workup for endometrial cancer?

Answer 1

NCCN endometrial cancer workup: H&P, CBC, PAP smear, endometrial Bx, and CXR. If extrauterine Dz is suspected, consider CA125, MRI/CT/PET, cystoscopy, and sigmoidoscopy.

Question 2

What are the sensitivity and specificity of an endometrial Bx?

Answer 2

Endometrial Bx has 90%–98% sensitivity and 85% specificity.

Question 3

When is D&C recommended?

Answer 3

D&C is recommended if 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:

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

Question 5

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

Answer 5

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

Gross P-A Dz
Positive Pelvic
Gross adnexal mass or peritoneal Dz
More than 1/3 myometrial invasion
High-grade histology
∼25% of pts have these features, but they account for 98% of all positive P-A LNs.

Question 6

What is the AJCC 8th edition (2017)/FIGO (2009) pathologic staging for endometrial cancer?

Answer 6

Stage T1a/IA: limited to endometrium or less than one-half of myometrium including endocervical glandular involvement.

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 8th edition (2017) and FIGO (2009), positive cytology no longer alters stage. Endometrial intraepithelial carcinoma is considered T1. LN micro mets >0.2 mm and <2 mm are considered N1mi and N2mi respectively.