What are the limitations of the endometrial staging?

While the endometrial staging is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the endometrial staging to ensure safe bedside use and optimal diagnostic accuracy.

How does the endometrial staging compare to other Obstetrics scores?

The endometrial staging is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the endometrial staging free to use?

Yes. OpiCalc provides the endometrial staging completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

Endometrial Staging

Endometrial Staging (2023)

Molecular & Pathology Integrated

Confined to Corpus

IA (≤50% Myometrium) | IB (>50% Myometrium) | IC (Integrated Molecular Stage)

Cervical Stroma Involved

Does NOT extend beyond uterus

III

Local / Regional Spread

IIIA (Serosa/Adnexa) | IIIB (Vagina/Parametrium) | IIIC (Lymph Nodes)

Bladder / Rectum / Distant

IVA (Bowel/Bladder Mucosa) | IVB (Distant Metastasis)

Molecular update: Stage I includes POLE mutations (favorable) and p53 mutations (unfavorable).

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Primary Clinical Uses

Surgical and pathological staging of endometrial carcinoma and carcinosarcoma
Directing postoperative adjuvant treatment (radiation vs chemotherapy)

The 2023 Molecular Revolution

The 2023 update was the most radical change in history. It officially incorporated molecular classification (POLEmut, MMRd, NSMP, p53abn) into the staging system. A p53-abnormal tumor is now heavily upstaged regardless of myometrial invasion, whereas a POLE-mutated tumor may be downstaged due to exceptional prognosis.

CLINICAL INSIGHT

How it Works

Stage I — Confined to Uterus (Ovary involvement nuanced)

IA1

IA2

IA3

Stage II — Cervical Stroma or Extrauterine extensions

IIA

IIB

IIC

Stage III — Local/Regional Spread

IIIA

IIIB

IIIC1

IIIC2

Stage IV — Distant Spread

IVA

IVB

CLINICAL INSIGHT

Practical Pearls

Molecular Modifiers (The "m" suffix)

Prognosis classification: POLEmut (favorable), MMRd (intermediate), p53abn (poor).
If molecular profiling is done, append "m" to the stage (e.g., IAm).
Any p53abn tumor with any myometrial invasion is automatically staged as IICm (high risk), overriding its anatomical Stage I boundaries.
A stage II (cervical stroma) tumor with POLE mutation is distinctly down-staged biologically due to nearly zero recurrence risk.

CLINICAL INSIGHT

Next Steps

Clinical Action

Determine initial anatomical stage from TAH-BSO pathology.
Perform IHC testing for MMR proteins and p53, plus POLE sequencing if available.
Apply upstaging/downstaging rules based on 2023 FIGO molecular integration.
Route patient into PORTEC-guided therapeutic pathways (e.g., observation vs vaginal brachytherapy vs pelvic EBRT vs systemic chemo).

CLINICAL INSIGHT

Evidence Base

2023 Landmark Release

FIGO staging of endometrial cancer: 2023.

Berek JS, Matias-Guiu X, Creutzberg C, et al.Int J Gynaecol Obstet.2023

CLINICAL INSIGHT

Background

TCGA Influence

The 2023 system was heavily catalyzed by The Cancer Genome Atlas (TCGA) Research Network, which in 2013 entirely redefined endometrial cancer biology by proving that distinct molecular subgroups exist and wildly outpredict traditional anatomical grade and stage.

Endometrial Staging

Endometrial Staging (2023)

Molecular & Pathology Integrated

Confined to Corpus

IA (≤50% Myometrium) | IB (>50% Myometrium) | IC (Integrated Molecular Stage)

Cervical Stroma Involved

Does NOT extend beyond uterus

III

Local / Regional Spread

IIIA (Serosa/Adnexa) | IIIB (Vagina/Parametrium) | IIIC (Lymph Nodes)

Bladder / Rectum / Distant

IVA (Bowel/Bladder Mucosa) | IVB (Distant Metastasis)

Molecular update: Stage I includes POLE mutations (favorable) and p53 mutations (unfavorable).

EVIDENCE SYNTHESIS

Clinical Reference Hub

Curated insights • How it Works • Practical Pearls • Evidence Base

CLINICAL INSIGHT

When to Use

Primary Clinical Uses

Surgical and pathological staging of endometrial carcinoma and carcinosarcoma
Directing postoperative adjuvant treatment (radiation vs chemotherapy)

The 2023 Molecular Revolution

CLINICAL INSIGHT

How it Works

Stage I — Confined to Uterus (Ovary involvement nuanced)

IA1

IA2

IA3

Stage II — Cervical Stroma or Extrauterine extensions

IIA

IIB

IIC

Stage III — Local/Regional Spread

IIIA

IIIB

IIIC1

IIIC2

Stage IV — Distant Spread

IVA

IVB

CLINICAL INSIGHT

Practical Pearls

Molecular Modifiers (The "m" suffix)

Prognosis classification: POLEmut (favorable), MMRd (intermediate), p53abn (poor).
If molecular profiling is done, append "m" to the stage (e.g., IAm).
Any p53abn tumor with any myometrial invasion is automatically staged as IICm (high risk), overriding its anatomical Stage I boundaries.
A stage II (cervical stroma) tumor with POLE mutation is distinctly down-staged biologically due to nearly zero recurrence risk.

CLINICAL INSIGHT

Next Steps

Clinical Action

Determine initial anatomical stage from TAH-BSO pathology.
Perform IHC testing for MMR proteins and p53, plus POLE sequencing if available.
Apply upstaging/downstaging rules based on 2023 FIGO molecular integration.
Route patient into PORTEC-guided therapeutic pathways (e.g., observation vs vaginal brachytherapy vs pelvic EBRT vs systemic chemo).

CLINICAL INSIGHT

Evidence Base

2023 Landmark Release

FIGO staging of endometrial cancer: 2023.

Berek JS, Matias-Guiu X, Creutzberg C, et al.Int J Gynaecol Obstet.2023

CLINICAL INSIGHT