Uterine Cancer Stages

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on July 20, 2023
5 min read

If you get a diagnosis of uterine cancer, your doctor may tell you what stage it is. It's a way to figure out how advanced your cancer is and what kind of treatment works best.

Before your doctor decides your stage, they'll use tests, such as a biopsy and ultrasound, to find what type of uterine cancer you have. Also called the womb, the uterus is a pear-shaped organ where babies grow.

There are two kinds of uterine cancer. Endometrial cancer, the most common form, begins in the inner lining of the uterus. Uterine sarcoma is a rare type that starts in the muscles in the uterus or the surrounding tissue.

Doctors use two ways to decide the stage of uterine cancer. One is a method created by the International Federation of Gynecology and Obstetrics (FIGO). The other is the American Joint Committee of Cancer TNM staging system. The two methods are almost the same.

Both systems are based on three categories: tumor, lymph nodes, and metastasis (the spread of cancer). In the TNM staging system, the categories are assigned letters:

Tumor (T). How big is the main tumor, and has it spread to nearby organs?

Lymph nodes (N). Has the disease moved into nearby lymph nodes? These are the small, bean-shaped glands found throughout the body that are part of your immune system -- your body's defense against germs.

Metastasis (M). Has the cancer spread to far-away lymph nodes or other organs? This is called metastasis.

In TMN staging, doctors also assign numbers after the letters T, M, N that explain how advanced your cancer is.

Once your doctor works out the TMN staging, they'll also figure out a broader set of stages that use Roman numerals. There are four stages of endometrial cancer: I, II, III, and IV.

Lower numbers mean that the cancer hasn't spread as much. If you have stage IV, the cancer cells have spread to parts of the body that are farther away.

At this point, the cancer hasn't spread past your uterus. It may also affect the glands of your cervix -- the narrow passage at the bottom of your uterus -- but not the tissues. Within this stage are:

  • Stage 1A: This means the cancer is in the inner lining of your uterus, called the endometrium. It may have spread less than halfway into the underlying muscle.
  • Stage 1B: The cancer is in the endometrium and more than halfway through the underlying muscle.

Symptoms. The most common sign is unusual bleeding, such as spotting and bleeding between your menstrual periods. You may also have watery or blood-tinged discharge from your vagina. If you've gone through menopause, any vaginal bleeding may be a symptom. The average age of women diagnosed with uterine cancer is 62, so it is unusual in women who are still menstruating.

Treatments. The standard treatment is surgery called a total hysterectomy to remove the uterus and cervix, as well as the fallopian tubes and ovaries.

The surgeon may also do a pelvic washing. That's when a saltwater solution flushes your abdomen. Then it's checked for cancer cells.

For some women, surgery may be enough. But if you have bigger tumors or a fast-spreading cancer, you may need more treatment. Tiny cancer cells may have spread outside the uterus. To avoid a return of your cancer, you may need treatments like radiation therapy, chemotherapy, or vaginal brachytherapy, which delivers radioactive material to cancer cells.

If you have stage 1A endometrial cancer and still want to have children, you may be able to use progestin therapy. These hormones may help the cancer shrink or go away for a period so you can become pregnant. This option can be dangerous if you aren't watched closely. There's a risk that the hormones don't work and the cancer will spread.

In this phase, the cancer has spread from the uterus into the tissue of the cervix, but it still hasn't grown outside of the uterus.

Symptoms. Like stage I, unusual bleeding, spotting, or discharge are the most common signs.

Treatment. In most cases, you'll get surgery called radical hysterectomy to remove your uterus, the tissues next to it, and the upper part of your vagina. The surgeon may also remove your fallopian tubes and ovaries. You may also need radiation therapy or vaginal brachytherapy.

The cancer has spread to the ovaries, fallopian tubes, vagina, or lymph nodes. But it hasn't affected your bladder or the inner lining of the rectum.

  • Stage IIIA: Cancer is in the outer layer of your uterus or the fallopian tubes and ovaries.
  • Stage IIIB: It has spread to the tissues around the uterus or vagina.
  • Stage IIIC1: The cancer has spread outside of the uterus and to the pelvic lymph nodes.
  • Stage IIIC2: Cancer cells are inside the body of the uterus and the lymph nodes around the aorta.

Symptoms. Along with unusual vaginal bleeding or discharge, you may have pelvic or belly pain. Other signs include bloating, pain during sex, feeling full quickly when eating, and changes in your bowel or bladder habits. You may also lose weight or feel the tumor in your belly.

Treatment. If your doctor thinks that the cancer can be taken out with surgery, a surgeon may do a total or radical hysterectomy and remove your fallopian tubes and ovaries. They may also do a pelvic washing. This is followed by chemotherapy or radiation.

If the surgeon thinks that your cancer is too widespread, you may get radiation. This may help shrink the tumor enough for surgery.

The cancer is in the bladder, rectum, or organs far from the uterus, such as the lungs.

  • Stage IVA: The cancer has spread to the bladder or rectum, and possibly nearby lymph nodes.
  • Stage IVB: It's found in the upper abdomen, the fat that supports your lower abdomen (called the omentum), or organs like your lungs, liver, and bones. It may have spread to the groin lymph nodes.

Symptoms. They're the same as stage III. You may also have symptoms in the areas where the cancer has spread, such as pain in your bones or shortness of breath.

Treatment. For most people with stage IV endometrial cancer, the cancer has spread too far for a surgeon to remove it all, but you may still get surgery similar to the kind in earlier stages, as well as radiation, to keep you from bleeding too much.

Hormone therapy, targeted therapy, chemotherapy, and immunotherapy may also help. Talk to your doctor about whether it's a good idea for you to join clinical trial, where researchers are studying new treatments that aren't yet available to everyone.