Corpus Uteri

TNM 7 Classification

TNM 6 Classification

1. Rules for Classification

The definitions of the T, N, and M categories correspond to the FIGO stages.
Both systems are included for comparison.


The classification applies to carcinomas and malignant mixed mesodermal tumours.
There should be histological verification with subdivision by histological type
and grading of the carcinomas. The diagnosis should be based on examination
of specimens taken by endometrial biopsy.


The following are the procedures for assessing T, N, and M categories:


T categories. Physical examination and imaging including urography and cystoscopy

N categories. Physical examination and imaging including urography

M categories. Physical examination and imaging.



The FIGO stages are based on surgical staging. (TNM stages are based on clinical
and/or pathological classification.)

2. Anatomical Subsites

1. Isthmus uteri (C54.0)

2. Fundus uteri (C54.3)

3. Regional Lymph Nodes

The regional lymph nodes are the pelvic (hypogastric [obturator, internal iliac],
common and external iliac, parametrial, and sacral) and the para-aortic nodes.

4. TNM Clinical Classification

4.1. T - Primary Tumour

TNM Categories FIGO Stages TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis 0 Carcinoma in situ (preinvasive carcinoma) T1 I Tumour confined to corpus uteri T1a IA Tumour limited to endometrium T1b IB Tumour invades less than one half of myometrium T1c IC Tumour invades one half or more of myometrium T2 II Tumour invades cervix but does not extend beyond uterus T2a IIA Endocervical glandular involvement only T2b IIB Cervical stromal invasion T3 and/or N1 III Local and/or regional spread as specified in T3a, b, N1, and FIGO IIIA, B, C below T3a IIIA Tumour involves serosa and/or adnexa (direct extension or metastasis) and/or cancer cells in ascites or peritoneal washings T3b IIIB Vaginal involvement (direct extension or metastasis) N1 IIIC Metastasis to pelvic and/or para-aortic lymph nodes T4 IVA Tumour invades bladder mucosa and/or bowel mucosa Note: The presence of bullous edema is not sufficient evidence to classify a tumour as T4. The lesion should be confirmed by biopsy. M1 IVB Distant metastasis (excluding metastasis to vagina, pelvic serosa, or adnexa) Note: FIGO (2001) recommends that Stage I patients given primary radiation therapy can be clinically classified as follows: Stage I: Tumour confined to corpus uteri Stage IA: Length of uterine cavity 8 cm or less Stage IB: Length of uterine cavity more than 8 cm

4.2. N - Regional Lymph Nodes



NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Regional lymph node metastasis



4.3. M - Distant Metastasis



MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M
categories.

pN0. Histological examination of a pelvic lymphadenectomy specimen
will ordinarily include 10 or more lymph nodes. If the lymph nodes
are negative, but the number ordinarily examined is not met,
classify as pN0.

6. G Histopathological Grading

For histopathological grading see: Creasman WT, Odicino F,
Maisoneuve P, Beller U, Benedet JL, Heintz APM, Ngan HYS, Sideri
M, Pecorelli S. FIGO Annual Report on the results of treatment in
gynaecological cancer. Vol. 24. Carcinoma of the corpus uteri. J
Epidemiol Biostat 2001;6:45-86.

7. Stage Grouping

Stage 0 Tis N0 M0 Stage IA T1a N0 M0 Stage IB T1b N0 M0 Stage IC T1c N0 M0 Stage IIA T2a N0 M0 Stage IIB T2b N0 M0 Stage IIIA T3a N0 M0 Stage IIIB T3b N0 M0 Stage IIIC T1, T2, T3 N1 M0 Stage IVA T4 Any N M0 Stage IVB Any T Any N M1

8. Summary

TNM Corpus Uteri FIGO Tis In situ 0 T1 Confined to corpus I T1a Tumour limited to endometrium IA T1b Less than half of myometrium IB T1c One half or more of myometrium IC T2 Invades cervix II T2a Endocervical glandular only IIA T2b Cervical stroma IIB T3 and/or N1 Local or regional as specified below III T3a Serosa/adnexa/positive peritoneal cytology IIIA T3b Vaginal involvement IIIB N1 Regional lymph node metastasis IIIC T4 Mucosa of bladder/bowel IVA M1 Distant metastasis IVB