Hysterectomy by Edward E. Wallach

Author:Edward E. Wallach
Language: eng
Format: epub, pdf
Publisher: Johns Hopkins University Press
Published: 2015-06-14T16:00:00+00:00

Grading and Staging

Uterine cancer is classified in two ways, and these classifications determine treatment possibilities and prognosis. One classification is based on grading the appearance of the cells; the other depends on the degree of extension of the tumor with respect to the uterine muscle. Once endometrial cancer is diagnosed from tissue obtained by a biopsy or D&C, the pathologist assigns a grade from 1 to 3 to the tissue that has been examined. This grade is based on degree of differentiation—the difference between the endometrial cancer cell and normal tissue, and a measure of the maturity and organization of individual cancer cells. Tissue classified as being well differentiated (grade 1) resembles normal endometrium—the closer the resemblance of the cancer cells to the normal endometrium, the better differentiated the cancer. Less differentiated tissue (grades 2 and 3) contains immature endometrial cells, which tend to be arranged in a disorganized manner. A well-differentiated cancer has an excellent prognosis for cure. The less differentiated the tumor, the greater the chance it will have invaded the uterine muscle and spread beyond the uterus itself.

The depth of invasion of the uterine muscle is another important prognostic sign. Cancers that are more superficial and confined to the endometrium have a greater chance for cure. The more deeply a cancer has entered the muscle, the greater the possibility that it has begun to spread farther into or beyond the uterus. The extent of the tumor can be determined only by microscopic examination of the whole uterus, after it has been removed. Poorly differentiated cancers have a higher chance of deep invasion and spread to lymph nodes; cancers that have deeply invaded the wall of the uterus also are more likely to have spread to lymph nodes.

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