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Stages of Endometrial Cancer

Key Points

  • After endometrial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the uterus or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The following stages are used for endometrial cancer:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV

After endometrial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the uterus or to other parts of the body.

The process used to find out whether the cancer has spread within the uterus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Certain tests and procedures are used in the staging process. A hysterectomy (an operation in which the uterus is removed) will usually be done to help find out how far the cancer has spread.

The following procedures may be used in the staging process:

  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
    Pelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
    Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood :

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if endometrial cancer spreads to the lung, the cancer cells in the lung are actually endometrial cancer cells. The disease is metastatic endometrial cancer, not lung cancer.

The following stages are used for endometrial cancer:

Stage I

Stage IA and stage IB endometrial cancer shown in two cross-section drawings of the uterus and cervix. Drawing on the left shows stage IA, with cancer in the endometrium and myometrium of the uterus. Drawing on the right shows stage IB, with cancer more than halfway through the myometrium. Also shown are the fallopian tubes, ovaries, and vagina.
Stage IA and stage IB endometrial cancer. In stage IA, cancer is in the endometrium only or less than halfway through the myometrium (the muscle layer of the uterus). In stage IB, cancer has spread halfway or more into the myometrium.

In stage I, cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread.

Stage II

Stage II endometrial cancer shown in a cross-section drawing of the uterus, cervix, fallopian tubes, ovaries, and vagina. Cancer is shown in the endometrium and myometrium of the uterus and in the cervix.
Stage II endometrial cancer. Cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.

In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.

Stage III

In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.

  • Stage IIIA : Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, and ligaments of the uterus.
    Stage IIIA endometrial cancer shown in a cross-section drawing of the uterus, ligaments of the uterus, cervix, fallopian tubes, ovaries, and vagina. Cancer is shown in the endometrium of the uterus, the outer layer of the uterus, a fallopian tube, an ovary, and a ligament of the uterus.
    Stage IIIA endometrial cancer. Cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, or ligaments of the uterus.
  • Stage IIIB : Cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus).
    Stage IIIB endometrial cancer shown in a cross-section drawing of the uterus, cervix, fallopian tubes, ovaries, and vagina. Cancer is shown in the endometrium of the uterus, the parametrium, the cervix, and the vagina.
    Stage IIIB endometrial cancer. Cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus and cervix).
  • Stage IIIC : Cancer has spread to lymph nodes in the pelvis and/or around the aorta (largest artery in the body, which carries blood away from the heart).
    Stage IIIC endometrial cancer shown in a cross-section drawing of the uterus, cervix, fallopian tubes, ovaries, and vagina. Also shown are the lymph nodes in the pelvis and the aorta with nearby lymph nodes. Cancer is shown in the endometrium and myometrium of the uterus and in lymph nodes in the pelvis and near the aorta.
    Stage IIIC endometrial cancer. Cancer has spread to lymph nodes in the pelvis and/or around the aorta (the largest artery in the body, which carries blood away from the heart).

Stage IV

In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.

  • Stage IVA : Cancer has spread to the bladder and/or bowel wall.
    Stage IVA endometrial cancer shown in a side-view cross-section drawing of the uterus, bladder, cervix, vagina, small intestine, and large intestine. Cancer is shown in the bladder, uterus, and bowel.
    Stage IVA endometrial cancer. Cancer has spread into the bladder and/or bowel.
  • Stage IVB : Cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.
    Stage IVB endometrial cancer; drawing shows cancer has spread to parts of the body outside the pelvis, including the abdomen and/or lymph nodes in the groin. An inset shows cancer cells spreading from the endometrium, through the blood and lymph system, to another part of the body where metastatic cancer has formed.
    Stage IVB endometrial cancer. The cancer has spread to parts of the body outside the pelvis, such as the abdomen and/or lymph nodes in the groin.

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