Uterine cancer stages

Making an educated treatment decision begins with the stage, or progression, of your uterine cancer. Using the results from your diagnostic tests, your care team at Cancer Treatment Centers of America^® (CTCA) will develop an appropriate treatment plan for you.

If you have been recently diagnosed, we will review your pathology to confirm you have received the correct diagnosis and staging information, and develop a personalized treatment plan. If you have a recurrence, we will perform comprehensive testing and identify a treatment approach that is suited to your needs.

Uterine cancer is staged using the American Joint Committee on Cancer TNM system:

• T (tumor): This describes the size of the original tumor.
• N (node): This indicates whether the cancer is present in the lymph nodes.
• M (metastasis): This refers to whether cancer has spread to other parts of the body, usually the liver, bones or brain.

Once the T, N and M scores have been assigned, an overall stage is assigned.

The International Federation of Gynecology and Obstetrics has a similar staging system known as FIGO. Unlike the TNM system, the FIGO system does not include stage 0.

Stage 0: This stage is also known as carcinoma in situ. Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below. The cancer has not spread to nearby lymph nodes or distant sites. This is a precancerous lesion. This stage is not included in the FIGO staging system.

Stage 1 uterine cancer: The cancer is only growing in the body of the uterus. It may also be growing into the glands of the cervix but is not growing into the supporting connective tissue of the cervix. The cancer has not spread to lymph nodes or distant sites. This stage has two subcategories:

• Stage 1A: In this earliest form of stage 1, the cancer is in the endometrium (inner lining of the uterus) and may have grown from the endometrium less than halfway through the underlying muscle layer of the uterus (the myometrium). It has not spread to lymph nodes or distant sites.
• Stage 1B: The cancer has grown from the endometrium into the myometrium, growing more than halfway through the myometrium. The cancer has not spread beyond the body of the uterus.

Stage 2 uterine cancer: The cancer has spread from the body of the uterus and is growing into the supporting connective tissue of the cervix (called the cervical stroma). The cancer has not spread outside of the uterus. The cancer has not spread to lymph nodes or distant sites.

Stage 3 uterine cancer: The cancer has either spread outside of the uterus or into nearby tissues in the pelvic area. This stage has four subcategories:

• Stage 3A: The cancer has spread to the outer surface of the uterus (called the serosa) and/or to the fallopian tubes or ovaries (the adnexa). The cancer has not spread to lymph nodes or distant sites.
• Stage 3B: The cancer has spread to the vagina or to the tissues around the uterus (the parametrium). The cancer has not spread to lymph nodes or distant sites.
• Stage 3C1: The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to pelvic lymph nodes but not to lymph nodes around the aorta or distant sites.
• Stage 3C2: The cancer is growing in the body of the uterus. It may have spread to some nearby tissues, but is not growing into the inside of the bladder or rectum. The cancer has spread to lymph nodes around the aorta (peri-aortic lymph nodes) but not to distant sites.

Stage 4 uterine cancer: The cancer has spread to the inner surface of the urinary bladder or the rectum (lower part of the large intestine), to lymph nodes in the groin, and/or to distant organs, such as the bones, omentum or lungs. Stage 4 uterine cancer has two subcategories:

• Stage 4A: The cancer has spread to the inner lining of the rectum or urinary bladder (called the mucosa). It may or may not have spread to nearby lymph nodes but has not spread to distant sites.
• Stage 4B: The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or to organs away from the uterus, such as the bones, omentum, or lungs. The cancer can be any size and it may or may not have spread to lymph nodes.

Cancer grades

In addition to stage, tumors are “graded.” To grade tumors, a sample is taken and sent to a pathology laboratory, where it’s examined under a microscope. Different “G” grades are assigned based on comparisons between healthy, normal cells and cancerous cells. How much do they differ? The grades suggest how likely the cancer is to spread and how quickly, and may help determine the best treatment plan for you.

Below is a breakdown of the different cancer grades.

• GX: The grade couldn’t be determined.
• G1: The cancer cells look much like normal cells. If the cells are G1, it suggests they may be slow-growing and less likely to spread quickly.
• G2: The cells look somewhat abnormal. This is considered moderate risk, or called “moderately differentiated.” They’re more likely to spread than cells with a lower grade.
• G3: These cells aren’t normal. Chances are they may grow and spread quickly. You may hear your doctor say they’re “poorly differentiated.” Doctors also may use the term “high grade.”

Recurrence

Cancer may return after treatment. This is known as recurrent cancer. In some cases, it recurs in the same part of the body where it was originally discovered. Other times, it comes back elsewhere.

Recurrent uterine cancer is most likely to return within three years of a diagnosis, and is most likely to present in the:

• Uterus
• Pelvis
• Abdominal lymph nodes

Should your cancer return, you and your care team can determine an informed course of treatment.

Second cancer

It’s possible to not only have a recurrence but to develop a second cancer (a cancer that is new). Indeed, depending on the type of uterine cancer you had and how it was treated, you may be at greater risk for a second cancer than patients who never had cancer.

Those who survive uterine cancer are at higher risk of developing cancer of the:

• Breast
• Colon
• Rectum
• Lung
• Lymphatic system
• Kidney
• Bladder
• Vagina
• Soft tissue

They’re also at higher risk of developing a type of blood cancer known as acute leukemia.

Of these, breast cancer and colon cancer are the most common.

If you were treated with radiation, you’re also at greater risk for acute myeloid leukemia (AML) and cancer of the colon, rectum, bladder, vagina and soft tissue.

Survival rates

Survival rates are based on whether the uterine cancer has not spread (localized), spread to nearby organs or lymph nodes (regional) or gone beyond the uterus to other body parts (distant). The more localized, the greater the survival rate. Other factors that determine survival rates include:

• Age when diagnosed
• Overall health and other conditions
• How well the cancer responds to treatment

The five-year survival rate tells you how many people with the same type of cancer are alive five years or more after a diagnosis. The overall five-year survival rate for uterine cancer is 81 percent, according to the American Cancer Society.

More specifically, the five-year survival rates are broken down between localized, regional and distant uterine cancer:

• Localized uterine cancer: 95 percent
• Regional uterine cancer: 69 percent
• Distant uterine cancer: 17 percent

Race also plays a role in survival rates, according to the American Society of Clinical Oncology.

• Black women have a lower survival rate than white women, largely because they’re more often diagnosed with more aggressive cancers.
• Nearly 70 percent of white women are diagnosed with uterine cancer when it’s localized and the survival rate is 95 percent. Only 54 percent of black women are diagnosed at this stage.