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Nurse talking to endometrial cancer patient

Endometrial (uterine) cancer staging provides a uniform way for physicians to describe the location of the cancer and the extent to which it has spread to other areas of the body. This information is vital for creating effective treatment plans and achieving a positive quality of life for patients. Most commonly, people refer to the standard numerical system when discussing stages, with stages numbered from one through four. Stage 1 is the earliest stage of disease, and stage 4 is the most advanced.

How is endometrial cancer staging determined?

One method that is often used to classify the stages of endometrial cancer is the tumor, node and metastasis (TNM) system:

  • T represents the size and location of the primary (original) tumor in the uterus.
  • N specifies whether the cancer has spread to the lymph nodes surrounding the uterus.
  • M indicates whether the cancer has metastasized (spread) from the uterus to distant areas of the body.

Additionally, endometrial cancer staging includes a grade (G) that describes the degree to which the cancer cells resemble healthy cells when viewed under a microscope. This information can be helpful to a physician in determining how quickly the cancer can be expected to spread. 

The T, N and M classifications can be determined through tests such as physical exams, imaging, biopsies and surgical procedures. Once confirmed, this information is viewed collectively to establish the various endometrial cancer stages:

Stage 0 (carcinoma in situ)

Endometrial cancer may be recognized as “stage 0” if cancer cells are present in the very top layer of the endometrium and have not grown into the cells below. Stage 0 endometrial cancer is sometimes referred to as carcinoma in-situ or a precancerous lesion.

Stage 1 (stage 1 endometrial cancer)

Stage 1 endometrial cancer is confined to the uterus. It may also be growing into the glands of the cervix, but it has not reached any supporting connective cervical tissues. No lymph nodes are affected.

Stage 1 endometrial cancer can be separated into two subcategories:

  • Stage 1A – Cancer is found in the endometrium—the innermost lining of the uterus—and may have spread slightly through the underlying layer of muscle, called the myometrium.
  • Stage 1B – The cancer has spread further into the myometrium (more than halfway), but it remains confined to the uterus.

In this stage, the recommended treatment is surgery to remove the uterus and, quite often, the ovaries. It may be followed up with radiation therapy or vaginal brachytherapy. 

Stage 2 (stage 2 endometrial cancer)

Stage 2 endometrial cancer has spread from the main body of the uterus to the cervical stroma—the supporting connective tissues of the cervix. It is still considered to be confined to the uterus, and no lymph nodes are affected.

Most often, the recommended treatment for stage 2 endometrial cancer is surgery to remove the uterus, ovaries, fallopian tubes, upper portion of the vagina, lymph nodes in the pelvis and surrounding tissues. Radiation therapy and chemotherapy may be given after surgery to destroy lingering cancer cells.

Stage 3 (stage 3 endometrial cancer)

Stage 3 endometrial cancer has spread outside of the uterus, possibly to nearby organs in the pelvic area such as the vagina, ovaries and/or lymph nodes. It has not reached the bladder or the inner lining of the rectum. This stage can be divided into four subcategories:  

  • Stage 3A – The cancer has reached the serosa—the outer layer of the uterus—and/or the ovaries or fallopian tubes, but has not spread to surrounding lymph nodes.
  • Stage 3B – The cancer has spread to the tissues surrounding the uterus (the parametrium) or the vagina, but has not traveled to surrounding lymph nodes.
  • Stage 3C1 – The cancer continues to grow inside the uterus and has reached the pelvic lymph nodes. It has not traveled to distant organs or the lymph nodes around the aorta.
  • Stage 3C2 – The cancer continues to grow inside the uterus and has spread to lymph nodes around the aorta (para-aortic lymph nodes). It has not affected distant organs.

The ideal treatment recommendation for stage 3 endometrial cancer is surgery to remove as much of the cancer as possible. However, sometimes the cancer is too advanced for surgery. A combination of radiation therapy and chemotherapy are also used, even if surgery was successful.

Stage 4 (stage 4 endometrial cancer)

Stage 4 endometrial cancer has spread to the rectum and/or the inner layer of the bladder (mucosa). It may have metastasized and traveled to other parts of the body, such as the omentum, bones or lungs. This stage can also be separated into two subcategories:

  • Stage 4A – The cancer has spread to the mucosa or the inner lining of the rectum. It has not reached distant organs.
  • Stage 4B – The cancer has traveled to the upper abdomen, the inguinal lymph nodes in the groin area, the omentum or distant organs, such as the liver or lungs.

For most patients with stage 4 endometrial cancer, surgery is not an option. Some physicians may still recommend removing the fallopian tubes, ovaries and uterus to help with excessive bleeding. Most patients undergo a combination of chemotherapy, radiation therapy and hormone therapy. 

Is endometrial cancer genetic?

Endometrial cancer is not commonly passed from mother to daughter, but one factor can increase a family’s chances of passing this disease through the generations: Lynch syndrome. Also known as hereditary nonpolyposis colorectal cancer (HNPCC), Lynch syndrome is a hereditary condition that increases one’s risk of colon cancer, endometrial cancer and many other types of cancer. Families with Lynch syndrome have higher instances of both colon cancer and endometrial cancer.

There are other risk factors that can increase a woman’s risk of getting endometrial cancer, such as:

  • Menstruating before age 12
  • Menstruating after age 55
  • Having polycystic ovarian syndrome (PCOS)
  • Having an instance of breast or ovarian cancer
  • Having diabetes (endometrial cancer is four times more common in women with diabetes)
  • Being overweight or obese 
  • Being older (the risk of endometrial cancer increases as women age)

How is endometrial cancer diagnosed?

If you are experiencing abnormal symptoms, such as unusual vaginal bleeding (bleeding either between periods or after menopause), painful urination, pelvic pain, unexplained weight loss or unusual vaginal discharge, speak to your gynecologist right away. After discussing your symptoms and performing a pelvic examination, your physician may order one of more of the following tests:

  • A pelvic or transvaginal ultrasound, which gathers images of the uterus, ovaries and fallopian tubes
  • An endometrial biopsy, which uses a small tube to suction a piece of endometrial tissue to examine
  • A hysteroscopy, which uses a tiny telescope inserted through the cervix to view the uterus and identify any abnormalities
  • A dilation and curettage (D&C) procedure, which uses a special instrument to collect a sample of a small amount of tissue within the uterus

Our approach to endometrial cancer  

Moffitt Cancer Center excels in the diagnosis, staging and comprehensive treatment of endometrial cancer in any stage. Patients in our Gynecologic Oncology Program benefit from the world-class expertise of a multispecialty team that focuses exclusively on cancers of the female reproductive system. As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt spearheads ambitious research initiatives and clinical trials to improve the way endometrial cancers are diagnosed and treated. We are the only Florida-based cancer center to have earned this prestigious designation.

Women who visit Moffitt with potential symptoms of endometrial cancer have access to a full spectrum of diagnostic care in one location. Here, our specialists perform endometrial biopsies, hysteroscopies, imaging procedures and various other minimally invasive techniques to efficiently confirm diagnoses and stage cancers. Once a patient is diagnosed, she receives an individualized treatment plan that is routinely evaluated and refined by an endometrial cancer treatment team that includes highly experienced surgeons, medical oncologists, radiation oncologists, fertility preservation specialists and several other experts.

Moffitt welcomes women who would like to consult with oncologists regarding their symptoms or seek second opinions. If you would like to discuss an endometrial (uterine) cancer diagnosis and possible treatment options with the experts at Moffitt, call 1-888-663-3488 or complete a new patient registration form online. We offer every new patient rapid access to a cancer expert.