The 2009 FIGO staging system is as follows:
Myometrial invasion and involvement of the pelvic and para-aortic lymph nodes are the most commonly seen patterns of spread. A Stage 0 is sometimes included, in this case it is referred to as "carcinoma in situ". In 26% of presumably early-stage cancers, intraoperative staging revealed pelvic and distant metastases, making comprehensive surgical staging necessary. Management
Surgery
The initial treatment for endometrial cancer is surgery; 90% of women with endometrial cancer are treated with some form of surgery. Surgical treatment typically consists of hysterectomy including a bilateral salpingo-oophorectomy, which is the removal of the uterus, and both ovaries and Fallopian tubes. Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is performed for tumors of histologic grade II or above. Lymphadenectomy is routinely performed for all stages of endometrial cancer in the United States, but in the United Kingdom, the lymph nodes are typically only removed with disease of stage II or greater. The topic of lymphadenectomy and what survival benefit it offers in stage I disease is still being debated. In women with presumed stage I disease, a 2017 systematic review found no evidence that lymphadenectomy reduces the risk of death or relapse of cancer when compared with no lymphadenectomy. Women who undergo lymphadenectomy are more likely to experience systemic morbidity related to surgery or lymphoedema/lymphocyst formation. In stage III and IV cancers, cytoreductive surgery is the norm, and a biopsy of the omentum may also be included.
This strategy was used in Ireland, in Kenya, in Algeria and in Cyprus during their independence struggles.Stated motives for the September 11 attacks included inspiring more fighters to join the cause of repelling the United States from Muslim countries with a successful high-profile attack. The attacks prompted some criticism from domestic and international observers regarding perceived injustices in U.S. foreign policy that provoked the attacks, but the larger practical effect was that the United States government declared a War on Terror that resulted in substantial military engagements in several Muslim-majority countries. Various commentators have inferred that al-Qaeda expected a military response, and welcomed it as a provocation that would result in more Muslims fight the United States. Some commentators believe that the resulting anger and suspicion directed toward innocent Muslims living in Western countries and the indignities inflicted upon them by security forces and the general public also contributes to radicalization of new recruits. Despite criticism that the Iraqi government had no involvement with the September 11 attacks, Bush declared the 2003 invasion of Iraq to be part of the War on Terror. The resulting backlash and instability enabled the rise of Islamic State of Iraq and the Levant and the temporary creation of an Islamic caliphate holding territory in Iraq and Syria, until ISIL lost its territory through military defeats. Attacks used to draw international attention to struggles that are otherwise unreported have included the Palestinian airplane hijackings in 1970 and the 1975 Dutch train hostage crisis.