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Uterine Cancer Stages
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:
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.
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.
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.
Basking Ridge Mom Diagnosed With Stage 3 Cancer, Son Starts Fundraiser
BASKING RIDGE, NJ — A recent Ridge High School graduate is asking the community for help as his mom has been diagnosed with stage 4 cervical cancer.
"This devastating diagnosis has brought immense emotional and financial challenges to my 3-year-old little brother and me. If my mother passes away my little brother and I will have no parents or help," wrote Joey Ricciardi, who graduated in 2022.
Ricciardi launched a GoFundMe campaign earlier this month to seek support and help.
"My mother, a source of strength and love in our lives, has always been the epitome of resilience and optimism. Her unwavering determination to overcome this battle has inspired us all. However, the financial burden of her medical treatment and our daily living expenses has become overwhelming. As a college student, I am unable to cover these costs on my own, which is why I turn to you, our compassionate community, for assistance," said Ricciardi.
Funds raised would be used to cover costs of daily living such as meeting basic needs including rent, utilities, groceries, and transportation.
"The financial implications of extensive cancer treatment are profound. Coping with the overwhelming medical bills adds an additional layer of stress and anxiety to our already challenging situation. Your donations will alleviate this burden, allowing my mother to receive the best care possible without the constant worry of financial strain," said Ricciardi.
For more information or to donate click here.
Patient Profile: A 50-Year-Old Woman With Cervical Cancer
Ritu Salani, MD, presents the case of a patient with cervical cancer and describes the typical disease presentation and risk factors.
Case: A 50-Year-Old Woman With Cervical Cancer
Initial Presentation
Follow-Up
Treatment for Recurrence
Transcript:
Ritu Salani, MD: Hello, I'm Ritu Salani. I'm a gynecologic oncologist at UCLA [University of California, Los Angeles] in California. I'd like to welcome you to this Targeted Oncology™ program titled "Case-Based Peer Perspectives: A 50-Year-Old Woman With Cervical Cancer."
This case is a 50-year-old Black woman who's busy with family. She's raising teenage and college-aged kids, works full-time outside the home, and is helping her mother recover from a knee replacement surgery. She reports that her last cervical cytology and HPV [human papillomavirus] testing occurred approximately 6 years ago. Her gynecologist retired 2 years ago, and she hasn't connected with a new gynecologist. She reports pelvic pain during intercourse and vaginal bleeding following intercourse on her visit.
She undergoes a pelvic MRI, which shows pelvic sidewall involvement including pelvic lymph node–positive disease. She also undergoes a PET [positron emission tomography]–CT scan, which confirms the presence of pelvic disease as well as an isolated liver metastasis. Her diagnosis is consistent with stage IVB adenocarcinoma of the cervix. Immunohistochemistry testing is done on her tumor biopsy, and her tumor is noted to be PD-L1–positive with CPS [combined positive score] greater than 1.
She then undergoes treatment with pembrolizumab, cisplatin, paclitaxel, and bevacizumab as first-line therapy for 6 cycles and transitions to maintenance therapy with pembrolizumab and bevacizumab. After 6 cycles, she's noted to have a complete response. Although she was advised to continue maintenance therapy, she opts to discontinue treatment. She continues follow-up care, and 11 months later she presents with a cough. An MRI reveals metastatic nodules in her right upper lung, and this is confirmed by biopsy. For treatment, she opts to proceed with tisotumab vedotin.
This is a typical case, although most patients present with early-stage cervical cancer due to screening, which allows for early detection. About 20% of patients with recurrent or advanced disease will present with initial stage IVB disease, as this patient did, so the work-up is critical to make sure we're catching patients in the right stage of diagnosis. When we think about this case, there are known risk factors for cervical cancer, but not every patient will have known risk factors. A common risk factor for cervical cancer include HPV exposure. This is why HPV is part of the testing for cervical cancer screening, which can increase with multiple sexual partners, high-risk sexual behaviors, or not using barrier contraceptives.
We know that another risk factor can be immunosuppression, and this can be from medications such as transplant medications or diseases such as HIV and AIDS. Other risk factors may include prolonged use of birth control pills and lack of screening, which may fail to detect cancer at early stages.
Transcript edited for clarity.
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