The Stages of Uterine Cancer

Uterine cancer is cancer that begins in the uterus, one of the organs in the female reproductive system, which also includes the ovaries, fallopian tubes, cervix, and vagina. It is a hollow, pear-shaped organ in a woman’s pelvis (between your hip bones). The uterus, or womb, is where a baby develops and grows.

The most common type of uterine cancer is also called endometrial cancer because it forms in the lining of your uterus, called the endometrium.

Anybody who has a uterus is at risk of developing uterine cancer. However, the risk of developing uterine cancer increases with age. People who are entering menopause or in menopause (the time when you stop having periods) is when most uterine cancers are found.

Unfortunately, there are no screening tests that can be performed for uterine cancer before there are any signs and symptoms. If you are at high risk for uterine cancer, you should speak with your doctor about early warning signs and symptoms and whether you would be a good candidate for taking any diagnostic tests to check for uterine cancer.

Diagnostic tests that can detect or rule out uterine cancer include endometrial biopsy (removing a small piece of tissue for examining under a microscope) or transvaginal ultrasound (a type of ultrasound that uses a wand inserted into the vagina to visualize the pelvic area).

Determining the Stage

Once a doctor confirms a diagnosis of uterine cancer, staging is the next step. Staging refers to how much the cancer has grown and whether it has spread beyond where it started. To stage the cancer, a physical exam, biopsy, or imaging tests may be used. Understanding which stage your cancer is in can help determine the best treatment plan.

TNM Staging System

The TNM system, developed and maintained by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), is used to stage uterine cancer. The system uses a letter or number to describe the tumor (T), node (N), and metastasis (M) categories.

Tumor (T): What is the size and extent of the tumor? How far has it grown in the uterus? Has it reached any other surrounding organs?

Lymph nodes (N): Has the cancer spread to nearby lymph nodes? The nearest lymph nodes are in the pelvis and the aorta, the main artery that runs from the heart down to the abdomen and pelvis.

Metastasis (M): Has the cancer spread to other parts of the body? This includes distant lymph nodes and organs.

Stage 1

In stage 1, the cancer is growing inside the uterus and may be growing into the glands of the cervix, but not the connective tissues of the cervix. There is no sign of the cancer in the nearby lymph nodes. Additional letters provide more information about the extent of the growth, including:

• Stage 1A: The cancer is growing in the endometrium (inner lining of the uterus) and may have grown less than halfway through the underlying muscle layer of the uterus.
• Stage 1B: The cancer has grown from the inner lining of the uterus into the muscle layer of the uterus. It has grown more than halfway through the muscle layer but has not spread beyond the organ.
  

Symptoms

Some of the early signs of uterine cancer include vaginal discharge and bleeding that is abnormal. This can include very heavy bleeding that is not typical for you or bleeding after you've begun menopause (when your periods stop).

Treatments

Options to treat stage 1 uterine cancer include surgery, radiation therapy, or clinical trials.

Surgery options include:

• Total hysterectomy and bilateral salpingo-oophorectomy: Removal of the uterus and cervix, fallopian tubes, and ovaries
• Radical hysterectomy with bilateral salpingo-oophorectomy: Removal of the uterus and cervix, and part of the vagina, fallopian tubes, and ovaries. Nearby tissues and lymph nodes may also be removed.

Surgery may be followed by chemotherapy and radiation therapy for high-risk endometrial cancers, or types of uterine cancers that tend to spread quickly and have poorer prognoses.

In some cases, pelvic washing may also be used. Pelvic washing is a procedure used during surgery in which a saline solution is pumped into different areas of the abdominal cavity and pelvis and then collected. The cells collected from the pelvic and abdominal region can be sent to a lab to be further analyzed for cancerous cells.

Stage 2

Stage 2 indicates that the cancer has spread from the uterus and is growing into the connective tissue of the cervix. However, it has not spread outside the uterus. There is no cancer in nearby lymph nodes or distant sites.

Symptoms

Symptoms of stage 2 are similar to stage 1. You may experience unusual bleeding, spotting, or vaginal discharge that is not normal for you.

Treatments

Treatment for stage 2 include all the options for treating stage 1 uterine cancer.

Stage 3

Stage 3 indicates that the cancer has spread outside the uterus but has not spread to the rectum or bladder. There is no spread to lymph nodes or distant sites. Additional letters or numbers can tell you more about where the cancer has spread and the extent, including:

• Stage 3A: The cancer has spread to the outer surface of the uterus and/or to the nearby fallopian tubes or ovaries.
• Stage 3B: The cancer has spread to the vagina or tissues around the uterus.
• Stage 3CC1: The cancer is growing in the body of the uterus but not inside the bladder or rectum. It has spread to the lymph nodes in the pelvis.
• Stage 3C2: The cancer is growing in the body of the uterus but not inside the bladder or rectum. It has spread to lymph nodes around the aorta.

Symptoms

Along with the symptoms experienced in stages 1 and 2 you may also experience some pain or pressure in the pelvis. Other symptoms may include your belly bloating, discomfort during sex, feeling full very quickly when eating, or changes in bowel and bladder habits. You may undergo weight loss or feel a mass or lump in the abdomen.

Treatments

Treatment of stage 3 cancer includes all the treatment options for stages 1 and 2 uterine cancer, and additional treatments, such as:

• Surgery: In addition to radical hysterectomy and bilateral salpingo-oophorectomy, surgery may be used to remove lymph nodes that may be affected, such as those in the pelvis. Surgery may be followed by chemotherapy or radiation therapy.
• Chemotherapy or internal and external radiation therapy: These therapies use drugs or radiation to treat or kill cancer cells. Internal radiation therapy seals radioactive material directly in or near the cancer whereas external therapy uses high-energy rays aimed at the cancer from outside the body.
• Hormone therapy: Hormone therapy adds, blocks, or removes hormones. It may be used for patients who are unable to have chemo or radiation therapy.
• Targeted therapy: Uses substances that aim to slow or stop cancer growth through different mechanisms. For example, a substance may be used to block proteins necessary for cancer cells to grow and new blood vessels to form (cancer cells need new blood vessels to grow) or bind to cancer cells so that drugs, toxins, or radioactive substances can find and act on the cancer cells.
• Select clinical trials: Speak with your doctor about clinical trials that may be available to you through clinical trials that are testing new treatments that may include a novel combination of different therapies.
  

Stage 4

Stage 4 indicates that cancer has spread to the inner lining of the rectum or bladder. Additional letters provide more information about the extent of the spread, including:

• Stage 4A: The cancer has spread to the inner lining of the rectum and/or bladder.
• Stage 4B: The cancer has spread beyond the pelvic area to the lymph nodes in the groin, upper abdomen, or other organs farther from the uterus, such as the lungs, liver, or bones.
  

Symptoms

You'll experience the same symptoms as stage 3, with additional symptoms near where the cancer may have spread. If it has spread to your bones, you may feel bone aches and pains. If it has spread to your lungs, you may have shortness of breath.

Treatment

Stage 4 treatment includes all the treatment options for stage 3 uterine cancer. For very aggressive forms of stage 4 uterine cancer, there is no standard of treatment. You should speak with your doctor about the best treatment plan or options for clinical trials for you.

A Word From Verywell

Receiving a uterine cancer diagnosis is a scary and overwhelming experience, but it is important to know that there are treatment options at all stages. The five-year survival rate for this type of cancer is promising. Work with your doctor to determine the best course of treatment for you. Your medical team may also be able to provide some assistance with improving or maintaining a good quality of life during treatment.