A 52-year-old postmenopausal woman presents with vaginal bleeding and a pelvic mass. Imaging reveals a 6 cm heterogeneous endometrial mass with invasion into the myometrium up to the inner half. Staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection is performed. Histopathology shows grade 2 endometrioid adenocarcinoma. Pelvic lymph nodes are negative, but one para-aortic node (1 of 15 sampled) shows micrometastasis. According to FIGO 2009 staging, what is the stage of this tumor?

Explanation

## FIGO 2009 Staging of Endometrial Cancer This patient has **Stage IIIC2** disease. ### Key Point: **Para-aortic lymph node involvement = Stage IIIC2** (regardless of pelvic node status) ### Staging Breakdown: | Stage | Criteria | |-------|----------| | **IA** | Tumor confined to uterus, no/less than half myometrial invasion | | **IB** | Tumor confined to uterus, invasion equal to or more than half of myometrium | | **IIA** | Cervical stromal involvement, no parametrial involvement | | **IIB** | Parametrial involvement | | **IIIA** | Tumor invades serosa and/or adnexa | | **IIIB** | Vaginal and/or parametrial involvement | | **IIIC1** | Pelvic lymph node metastasis | | **IIIC2** | Para-aortic lymph node metastasis (with or without pelvic node involvement) | ### Clinical Analysis: - **Tumor extent:** Grade 2 endometrioid adenocarcinoma with myometrial invasion to inner half → would be Stage IB if confined to uterus - **Pelvic nodes:** Negative (0/15) → does NOT upgrade to IIIC1 - **Para-aortic nodes:** 1 micrometastasis identified → **Stage IIIC2** ### High-Yield: Micrometastasis in para-aortic nodes is still counted as metastatic disease for staging purposes. Even a single positive para-aortic node upgrades the stage to IIIC2, which carries worse prognosis and typically warrants adjuvant chemotherapy ± radiation. **Mnemonic:** "Para-aortic = C2" (Stage IIIC2 is the highest regional nodal stage in endometrial cancer)