4 Stages of Uterine Cancer

How staging helps doctors determine your course of treatment.

Uterine-Cancer-Stages-GettyImages-1088373654
Photo: Getty Images / Design by Jo Imperio

Like many cancers, uterine cancer is a nuanced disease. There are different stages of uterine cancer, and knowing which stage of cancer you have can help your doctor determine the best form of treatment for you.

What are uterine cancer stages, exactly? Put simply, these categories describe how large the cancer is and how far it has spread in a person's body.

How is uterine cancer staged?

Doctors commonly use a method developed by the International Federation of Obstetrics and Gynecology (FIGO) to stage uterine cancer, Alison Schram, MD, attending physician in the early drug development and gynecologic medical oncology services at Memorial Sloan Kettering Cancer Center, tells Health.

You may also hear about the TNM method, developed and maintained by the American Joint Committee on Cancer and the Union for International Cancer Control. TNM is used to describe not just uterine cancer but most types of cancer, per the National Cancer Institute (NCI).

The TNM method and the FIGO method are analogous, Ursula Matulonis, MD, chief of the division of gynecologic oncology at Dana-Farber Cancer Institute, tells Heath.

As the American Cancer Society (ACS) points out, each method describes:

  • the tumor's size and location
  • its spread to lymph nodes in the region
  • its spread to other areas of the body, a process known as metastasis

Staging for uterine cancer is usually determined through surgery, notes ACS. "Essentially, you have to have surgery to know exactly where the cancer is to assign an accurate stage," Pamela Soliman, MD, professor and deputy chair of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center, tells Health.

During surgery, doctors typically try to remove as much of the cancer as they can from your body as a way to treat the disease. (More on that in a minute.)

FYI, cancer is always referred to by the stage it was given at diagnosis, even if it gets worse or spreads, per the NCI.

What are the stages of uterine cancer?

In the FIGO method, uterine cancer is classified into four main stages (plus a few substages), says the American Society of Clinical Oncology (ASCO).

Stage 1

What it means: The cancer cells are in the body of the uterus and nowhere else, per Dr. Soliman.

Symptoms: Irregular vaginal bleeding is the most common symptom of early stage uterine cancer, says Dr. Soliman. For premenopausal women, this irregular bleeding can look like spotting in between periods, explains Dr. Matulonis. Or it can be changes in the frequency or duration of your period, according to Dr Schram. For postmenopausal women, it can be any type of vaginal bleeding or spotting.

Patients may also experience pain during sex or have no symptoms at all. The majority of women who have a common type of uterine cancer—like endometrioid adenocarcinoma (which accounts for up to 75% of all uterine cancers, per MSKCC)—are diagnosed at stage 1, says Dr. Soliman.

Treatment options: Standard treatment for stage 1 is surgery to remove the cancer, and then sometimes radiation to prevent the cancer from coming back, explains Dr. Schram. The surgery typically involves removing the uterus and ovaries. The surgeon may also remove the lymph nodes that drain the tumor, known as a sentinel lymph node biopsy. In more rare, aggressive types of uterine cancer, doctors may also use chemotherapy, says Dr. Schram.

For some uterine cancer patients, surgery isn't the best option. This includes patients who are diagnosed with low-risk uterine cancer at a young age and still want the option to have children, as well as those who are at high-risk of complications from surgery, Dr. Soliman explains. In such cases, hormonal therapy is typically considered instead.

Stage 2

What it means: The cancer has spread to the cervix, according to the ACS. The cervix sits at the lower, narrow end of the uterus, per the NCI.

Symptoms: Same as stage 1: irregular vaginal bleeding, pain during sex, or no symptoms at all, explains Dr. Schram.

Treatment options: Typically, surgery and radiation. Sometimes, patients will get chemotherapy as well, says Dr. Schram.

Stage 3

What it means: The cancer has spread to other local structures, says the ACS. That may include organs such as the ovaries, fallopian tubes, vagina, and lymph nodes in the abdomen or pelvis, per Dr. Schram.

Symptoms: Same symptoms as stage 1 and 2, plus pain in the pelvic area, bloating, increased abdominal girth, stomach pains, and getting full fast, says Dr. Schram.

Treatment options: Treatment options in this stage tend to be more nuanced than stages 1 and 2. Typically, patients will have surgery followed by a combination of chemotherapy and radiation, according to Dr. Schram. This combination can be a chemotherapy drug given at the same time as radiation. Or, it can be a set of two chemotherapy drugs administered separately from radiation.

Stage 4

What it means: The cancer has spread more widely, says ACS. It may involve the bladder, bowels, liver, lungs, and/or the omentum (abdominal tissue that encases the stomach, large intestine, and other abdominal organs, per Moffitt Cancer Center).

Symptoms: All of the above symptoms, plus changes to bowel or bladder habits (think diarrhea or constipation), generally feeling unwell, and unintentional weight loss or gain, says Dr. Schram.

Treatment options: If the cancer is in local structures like the bladder and the bowel, it is typically treated with chemotherapy and radiation, says Dr. Schram. If the cancer has spread to distant organs, like the lungs or liver, treatment is typically chemotherapy plus immunotherapy (a type of cancer treatment that helps your immune system fight cancer) and targeted therapy (a treatment that "targets proteins that control how cancer cells grow, divide, and spread," per the NCI.) Chemotherapy, immunotherapy and targeted therapy are used for recurrent or persistent uterine cancer, says Dr. Schram.

Speaking to your doctor about uterine cancer staging

The symptoms and treatment options listed here are what you might experience at each stage, but uterine cancer is not a one-size-fits-all disease. Other factors can influence symptoms and treatment options. These include:

  • the type of uterine cancer you have
  • the grade of the tumor, meaning how abnormal those cells look under the microscope, per the NCI

If you have uterine cancer, speak to your doctor about the stage of your cancer and the treatment regimen that makes the most sense for you.

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