This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science.
This page was updated on May 23, 2022.
Making an educated treatment decision begins with the stage, or progression, of uterine cancer. Using the results from diagnostic tests, the care team will develop an appropriate treatment plan tailored to each patient's needs and goals.
Following a uterine cancer diagnosis, the care team will review the patient's pathology to confirm the diagnosis and staging information, and develop a personalized treatment plan. If the patient has a recurrence, the care team will perform comprehensive testing and identify a treatment approach that is suited to her needs.
Uterine cancer is staged using the American Joint Committee on Cancer TNM system as detailed below.
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 uterine cancer 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.
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 considered a precancerous lesion. This stage is not included in the FIGO staging system.
In stage 1, 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, detailed below.
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.
In stage 2, 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.
In stage 3, the cancer has either spread outside of the uterus or into nearby tissues in the pelvic area. This stage has four subcategories, listed below.
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 is also known as metastatic uterine cancer. In this stage, 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, detailed below.
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 may be any size and it may or may not have spread to lymph nodes.
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 each patient.
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. The doctor may say they’re “poorly differentiated.” Doctors also may use the term “high grade.”
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:
Should the patient's cancer return, she and her care team can determine an informed course of treatment.
It’s possible to not only have a recurrence but to develop a second cancer (a cancer that is new). Depending on the type of uterine cancer the patient had and how it was treated, she 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:
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.
Patients who were treated with radiation are also at greater risk for acute myeloid leukemia (AML) and cancer of the colon, rectum, bladder, vagina and soft tissue.
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:
The five-year relative survival rate indicates how many people with the same type of cancer are alive five years or more after a diagnosis, compared to people who don't have that cancer type. The overall five-year relative survival rate for uterine cancer is 81 percent, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.
More specifically, the five-year survival rates are broken down between localized, regional and distant uterine cancer, as listed below.
Localized uterine cancer: 95 percent
Regional uterine cancer: 70 percent
Distant uterine cancer: 18 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. While 25 percent of white women are diagnosed after uterine cancer has spread to other body areas, approximately 38 percent of black women are diagnosed at this stage, when the survival rate is lower.
Survival rates are further analyzed based on the uterine cancer type, as listed below.
The five-year relative survival rate of all combined stages of endometrial cancer is 84 percent, according to the American Cancer Society (ACS). This data is broken down based on how far the cancer has spread.
Localized endometrial cancer: 96 percent
Regional endometrial cancer: 72 percent
Distant endometrial cancer: 20 percent
The ACS reports the five-year relative survival rate for all stages of uterine sarcoma as 38 percent. Survival rates are based on how far the cancer has spread, as shown below.
Localized uterine sarcoma: 60 percent
Regional uterine sarcoma: 37 percent
Distant uterine sarcoma: 12 percent
Keep in mind that the survival rate for uterine cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so the patient should always talk to his or her care team about his or her individual prognosis.