Historical aspects of endometrial cancer staging: the transition to molecular classification (a literature review)

Abstract

Determining the stage of a tumour is a crucial step in the management of patients with malignant diseases; it is directly linked to prognosis and the choice of specialised treatment, whilst facilitating the exchange of information between healthcare professionals. A staging system must possess three key characteristics: it must be effective, reliable and practical. The current staging (classification) system for endometrial cancer, developed in 2009, is highly reproducible and does not require excessive diagnostic investigations. However, the classification contains numerous ‘grey areas’ that hinder the evidence-based selection of appropriate treatment for patients falling within them. The most striking example is the need for lymph node dissection in clinical stage I endometrial cancer, where, in cases of intermediate risk, the decision to proceed is left to the discretion of the treating physician. To address this issue, and in an effort to individualise treatment and stratify the risk of recurrence, molecular classification has become widely adopted in recent years. Furthermore, in 2023, the International Federation of Gynaecologists proposed a new staging system for endometrial cancer. This review focuses on the historical aspects of the evolution of the concept of systematic assessment of endometrial cancer and provides a better understanding of recent advances in the biology of endometrial tumours.