Endometrial Cancer Staging and Management

Initial Diagnostic Workup

The National Comprehensive Cancer Network recommends office endometrial biopsy as the initial diagnostic step, which is diagnostic in 90% of cases, though it has a 10% false-negative rate requiring fractional dilation and curettage if symptoms persist 2, 3
Complete blood count, liver and renal function tests are essential components of the preoperative evaluation 4, 5
Chest X-ray is recommended as part of the initial diagnostic workup 4, 1
Contrast-enhanced dynamic MRI is the best imaging tool for assessing cervical invasion if suspected 4, 5, 1
Serum CA-125 may help monitor clinical response in patients with extrauterine disease, though it has limitations 2, 3

The American College of Obstetricians and Gynecologists and the National Comprehensive Cancer Network support the use of the FIGO 2009 staging system, which emphasizes complete surgicopathologic assessment including depth of myometrial invasion, cervical stromal involvement, and lymph node status 1, 2, 3
The FIGO 2009 staging system defines Stage IA as no myometrial invasion or invasion to less than half of the myometrium 1
The FIGO 2009 staging system defines Stage IB as invasion equal to or more than half of the myometrium 1
The FIGO 2009 staging system defines Stage II as tumor invasion of cervical stroma but does not extend beyond the uterus 1

The Society of Gynecologic Oncology recommends complete surgical staging, including total hysterectomy with bilateral salpingo-oophorectomy, assessment of depth of myometrial invasion, evaluation of cervical stromal or glandular involvement, and systematic pelvic and para-aortic lymphadenectomy 1, 2, 4
The National Comprehensive Cancer Network suggests that sentinel lymph node mapping is an acceptable alternative to systematic lymphadenectomy, with 97.2% sensitivity and 99.6% negative predictive value when using indocyanine green 1

The College of American Pathologists recommends that the pathology review document the ratio of depth of myometrial/stromal invasion to myometrial thickness, cervical stromal or glandular involvement, tumor size, tumor location, histologic subtype with grade, lymphovascular space invasion, and level of nodal involvement 2, 3

Approximately 75% of patients present with Stage I disease, resulting in a 5-year survival rate of 90% for Stage I patients, according to the American Cancer Society 4, 5, 6

The National Comprehensive Cancer Network advises against relying on a negative office endometrial biopsy in a symptomatic patient, due to the 10% false-negative rate 2, 3
The Society of Gynecologic Oncology states that clinical staging alone is inadequate, as it understages disease in 15-20% of patients 2, 3
The American College of Surgeons recommends against performing routine systematic lymphadenectomy in all Stage I patients, as randomized trials showed no improvement in disease-free or overall survival 1