According to the FIGO 2009 staging system for endometrial carcinoma, which finding defines Stage II disease?

Explanation

## FIGO 2009 Staging System for Endometrial Carcinoma **Key Point:** FIGO 2009 staging is based on surgical findings and histopathological examination. Stage II is defined by **cervical stromal invasion without extension beyond the uterus**. ### FIGO 2009 Staging Criteria | Stage | Definition | 5-Year Survival | | --- | --- | --- | | **Stage I** | Tumor confined to corpus uteri | ~85–90% | | **IA** | No or <50% myometrial invasion | ~90% | | **IB** | ≥50% myometrial invasion | ~80% | | **Stage II** | Cervical stromal invasion; no extension beyond uterus | ~75% | | **Stage III** | Local and/or regional spread | ~45–60% | | **IIIA** | Tumor invasion of serosa and/or adnexa | ~50% | | **IIIB** | Vaginal and/or parametrial involvement | ~40% | | **IIIC1** | Pelvic lymph node metastases | ~40% | | **IIIC2** | Para-aortic lymph node metastases ± pelvic nodes | ~25% | | **Stage IV** | Tumor invasion of bladder/bowel mucosa; distant metastases | <10% | | **IVA** | Bladder and/or bowel mucosa invasion | ~5% | | **IVB** | Distant metastases (lung, liver, peritoneum) | <5% | **High-Yield:** The **critical distinction** between Stage I and Stage II is **cervical involvement**: - **Stage I:** Confined to corpus (body) of uterus; may have myometrial invasion - **Stage II:** Cervical stromal invasion (endocervical glands do NOT count as Stage II) **Warning:** Endocervical glandular involvement (without stromal invasion) is **NOT** Stage II—it remains Stage I. Only **cervical stromal invasion** elevates to Stage II. **Clinical Pearl:** Depth of myometrial invasion is the most important prognostic factor within Stage I (IA vs. IB). Cervical involvement (Stage II) worsens prognosis compared to Stage IB. **Mnemonic:** **"CERVIX"** for Stage II: - **C**ervical - **E**xploration (stromal invasion) - **R**emains - **V**ital (confined to uterus) - **I**nvasion - **X** (no eXtension beyond)