Staging and grading

Staging is the process of determining where a cancer is located and whether it has spread to other parts of the body. The stage of the cancer is an important factor in making treatment choices. Certain tests and procedures are used in the staging process. A hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus, ovaries, and fallopian tubes) and pelvic lymph node dissection will usually be done to help find out how far the cancer has spread. After looking at your test results, your doctor will tell you the stage of your cancer and discuss the best treatment for you. Treatment choices may include one or more of the following: surgery, radiation therapy, chemotherapy, and hormone therapy.

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The grade of the cancer refers to the appearance of the cells in the tumor and gives an idea of how aggressive the cancer is. Grade 1 cancers are made up mostly of normal-looking cells; grade 2 cancers have more abnormal-looking cells; and less than half of the cells in a grade 3 cancer appear normal.

In stage I endometrial cancer, the cancer is found in the uterus only. Stage I is divided into stages IA, IB, and IC, based on how far the cancer has spread. Stage IA is in the endometrium only. Stage IB has spread into the inner half of the myometrium (muscle layer of the uterus). Stage IC has spread into the outer half of the myometrium. Stage I endometrial cancer is often curable with a hysterectomy and bilateral salpingo-oophorectomy surgery. If your cancer is in a very early stage and grade and you want to preserve your ability to have children, you may be able to have hormone therapy rather than a hysterectomy. However, it is not considered a standard treatment for stage I cancer. If you choose this form of treatment, your physician will probably recommend a hysterectomy when you are done having children. If cancer is found deep in the uterine muscle (myometrium), a hysterectomy may be followed by radiation therapy. The five-year survival rate for stage I is 90 to 95 percent, meaning 90 to 95 percent of women with stage I endometrial cancer survive for at least five years after diagnosis.

In stage II, cancer has spread from the uterus to the cervix, but has not spread outside the uterus. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread into the cervix. Stage IIA has spread to the glands where the cervix and uterus meet. Stage IIB has spread into the connective tissue of the cervix. Stage II may be treated with a radical hysterectomy (which removes the uterus, cervix, ovaries, and structures that support the uterus) and pelvic lymph node removal (lymphadenectomy). In some cases, radiation therapy may be given after surgery. Because other medical problems may prevent surgery from being a treatment option, women with Stage II endometrial cancer may be treated with primary radiation therapy only. The five-year survival rate for stage II is 75 percent.

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 has spread to one or more of the following: the outermost layer of the uterus; tissue just beyond the uterus; or the peritoneum (the lining that covers the abdominal cavity and organs). Stage IIIB has spread beyond the uterus and cervix, into the vagina. Stage IIIC has spread to lymph nodes near the uterus. Stage III is treated with surgery to remove the uterus, ovaries, fallopian tubes, cervix and all visible tumors. Chemotherapy or radiation may be used after surgery. Hormonal therapy using progesterone is also an option. Women with stage III endometrial cancer may be candidates for clinical trials of new treatment options. The five-year survival rate for stage III is 60 percent.

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 has spread to the bladder and/or bowel wall. Stage IVB has spread to other parts of the body beyond the pelvis, including lymph nodes in the abdomen or groin. Stage IV is treated with surgery to remove the uterus, ovaries, fallopian tubes, cervix and all visible tumors. Chemotherapy or radiation therapy may be used after surgery. Hormonal therapy using progesterone is also an option. The five-year survival rate for stage IV is 15 to 26 percent.

Other considerations in choosing the best treatment plan include your age, overall health, childbearing plans, and other personal concerns.