Provincial Health Services Authority (PHSA) improves the health of British Columbians by seeking province-wide solutions to specialized health care needs in collaboration with BC health authorities and other partners.
Updated June 2016
(corrected to exclude death from intercurrent disease)
Proportion of all patients
5-year overall survival
Tumour confined to corpus uteri
Tumour limited to endometrium or invades less than one half of the myometrium
Tumour invades one half or more of the myometrium
Tumour invades stromal connective tissue of the cervix but does not extend beyond uterus
Local and/or regional spread
Tumour involves serosa and/or adnexae (direct extension or metastases)
Vaginal involvement (direct extension or metastasis) or parametrial involvement
Metastases to pelvic and/or para-aortic lymph nodes
Regional lymph node metastases to pelvic lymph nodes
Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes
Tumour invades bladder mucosa and/or bowel mucosa, and/or distant metastases
Tumour invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumour as T4)
Distant metastases (includes metastases to inguinal lymph nodes, intraperitoneal disease, or lung, liver, or bone metastases)
Changes from previous staging system:
NB: Omentum or peritoneal disease = Stage IVB
It should be noted that these figures are approximations of five-year survival data collected from large numbers of patients within a given stage (FIGO data). Caution should be used in attempting to use these data to assign prognosis in an individual case as outcomes within these substages will worsen depending on grade and histotype (e.g., papillary serous and MMMT).
Updated December 2015
With respect to prevention, weight loss in obese women and improving glycemic control in diabetic women may have the most potential for reducing risk in these specific populations. The use of combination oral contraceptives has been shown to decrease risk by 50% if used for 5 or more years. The addition of a progestin to estrogen replacement therapy counteracts the adverse effects of unopposed estrogen on the endometrium. Women who are identified as having Lynch Syndrome are advised to consider risk-reducing surgery (hysterectomy and bilateral salpingo-oophorectomy) to reduce their risk of endometrial and ovarian cancers. Screening for endometrial and ovarian cancer using endometrial biopsy, transvaginal ultrasound, and CA125 has not been proven to decrease the incidence or mortality from cancer in these high-risk women.
Updated December 2015
Udpated 23 November 2012
Mixed Epithelial-Mesenchymal Tumors
Proper handling of a hysterectomy specimen by the pathologist is essential for evaluating tumour factors that may affect postoperative adjuvant treatment in patients with endometrial adenocarcinoma. If the specimen is not going to be fixed promptly (e.g., surgery on Friday afternoon, or before a holiday), the gynecologist should open the uterus at the 3 and 9 o'clock positions on the cervix, extend these incisions from the external os laterally along the sides of the uterus up to the fundus, and promptly place the specimen in formalin for overnight fixation. Lack of prompt fixation may result in severely autolyzed hysterectomy specimens that will preclude accurate histologic grading and assessment of depth of invasion, which are essential for prognosis and treatment planning.
Gross DescriptionGross description of the hysterectomy specimen should include:
Updated February 2016
Number of Risk Factors
Risk of recurrence without adjuvant therapy
Stage IA, grade 1 or 2
Stage IA, grade 3 or Stage 1B, grade 1
Stage IB, grade 3
C, P, V
O=observation V=vault brachytherapy P=pelvic radiation C=chemotherapy
Updated December 2015
In all situations outlined below, history and physical exam, including pelvirectal examination, are recommended. Patients do not need routine bloodwork, pap smear, or imaging, unless indicated by symptoms or signs on examination.
These patients are at low risk of recurrence (<5%), which is most likely to occur within the first 2 years after primary treatment. The most likely site of recurrence is the vaginal vault, therefore these patients need to be counselled about vaginal bleeding. Their follow-up care can be provided by their referring physician.
Years 1 through 5: every 6 months
Year 5+: annually
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