Uterine cancer, also known as endometrial cancer, begins when abnormal cells grow uncontrollably in the lining of the uterus. Like most cancers, uterine cancer develops in stages — each stage describing how far the disease has spread and what organs it affects.

Understanding these stages is essential because they guide treatment decisions, predict outcomes, and help patients and families make informed choices. Let’s explore the four main stages of uterine cancer, how doctors determine them, and what each one means for a patient’s care plan.

How Staging Works

Doctors use a process called staging to describe how advanced the cancer is at diagnosis. The most common system used for uterine cancer is from the International Federation of Gynecology and Obstetrics (FIGO).

Staging is based on:

  • The depth of invasion into the uterine wall.

  • Whether the cancer has spread to nearby organs like the cervix or ovaries.

  • Whether it has reached lymph nodes or distant parts of the body.

Accurate staging often requires a combination of surgical findings, imaging studies, and pathology reports.

The TNM Classification System

Before assigning a FIGO stage, doctors often describe uterine cancer using the TNM system, which evaluates three components:

  • T (Tumor): How deeply the tumor has invaded the uterine wall and surrounding structures.

  • N (Nodes): Whether the cancer has spread to nearby lymph nodes.

  • M (Metastasis): Whether the cancer has spread to distant organs like the lungs or liver.

For example:

  • T1N0M0 means the cancer is confined to the uterus.

  • T3N1M0 means it has spread to nearby tissues and lymph nodes but not to distant organs.

This classification is then converted into a stage (I–IV) to simplify treatment planning.

Stage I: Cancer Confined to the Uterus

At Stage I, uterine cancer is limited to the body of the uterus and has not spread beyond it. It is the most treatable stage, with an excellent prognosis.

Stage I is further divided into:

Stage IA

  • Cancer is confined to the endometrium or invades less than half of the myometrium (uterine muscle).

  • It has not spread to the cervix, lymph nodes, or other organs.

  • Five-year survival rate: >95%.

Stage IB

  • Cancer invades more than half of the myometrium but remains within the uterus.

  • Lymph nodes are still unaffected.

  • Five-year survival rate: around 85–90%.

Treatment:
Most women undergo a total hysterectomy (removal of uterus, fallopian tubes, and ovaries). Depending on tumor grade and patient health, doctors may recommend:

  • Radiation therapy to prevent recurrence.

  • Hormone therapy for hormone-sensitive tumors.

Because Stage I cancers are localized, they are often curable with surgery alone.

Stage II: Spread to the Cervix

In Stage II, the cancer has spread from the body of the uterus into the cervix, but it hasn’t reached beyond the uterus.

Key characteristics:

  • Tumor invades the cervical stroma (the connective tissue of the cervix).

  • No spread to lymph nodes or distant organs.

Symptoms:
Women may experience postmenopausal bleeding, pelvic pain, or watery discharge.

Treatment:

  • Hysterectomy with removal of surrounding cervical tissue.

  • Pelvic radiation therapy before or after surgery.

  • Chemotherapy may be added if the cancer cells are high-grade or aggressive.

Prognosis:
Five-year survival rate ranges between 70–80%, depending on how deeply the tumor has invaded.

Stage III: Local and Regional Spread

At Stage III, uterine cancer extends beyond the uterus but remains within the pelvic area. It may involve the ovaries, fallopian tubes, vagina, or nearby lymph nodes — but not distant organs.

Stage III is divided into sub-stages:

Stage IIIA

  • Cancer spreads to the serosa (outer surface of the uterus) or fallopian tubes and ovaries.

  • No lymph node or distant spread.

Stage IIIB

  • Cancer spreads to the vagina or parametrium (tissues beside the uterus).

  • Still no distant metastasis.

Stage IIIC

  • Cancer involves pelvic or para-aortic lymph nodes.

  • It may or may not invade nearby organs.

  • Subdivided into:

    • Stage IIIC1: Pelvic lymph node involvement.

    • Stage IIIC2: Para-aortic lymph node involvement.

Symptoms:
Persistent pelvic or back pain, abnormal discharge, bloating, and sometimes urinary or bowel changes.

Treatment:
A multimodal approach is required:

  • Surgery to remove the uterus and affected tissue.

  • Radiation therapy to treat the pelvic region.

  • Chemotherapy (usually carboplatin and paclitaxel).

Prognosis:
Five-year survival rate averages 50–65%, depending on tumor grade and nodal involvement.

Stage IV: Distant Metastasis

Stage IV uterine cancer is the most advanced stage, where cancer has spread beyond the pelvis to distant organs.

It’s classified into two sub-stages:

Stage IVA

  • Cancer has invaded the bladder or rectum.

  • It remains confined to the pelvic region.

Stage IVB

  • Cancer spreads to distant sites such as the lungs, liver, or bones.

Symptoms:
Fatigue, weight loss, pain in the abdomen or pelvis, and symptoms related to affected organs (e.g., coughing if lungs are involved).

Treatment:
Treatment focuses on controlling disease progression and improving quality of life:

  • Surgery may still be performed to remove visible tumors.

  • Chemotherapy and radiation therapy are used to shrink or manage tumors.

  • Hormone therapy for estrogen- or progesterone-receptor-positive cancers.

  • Immunotherapy (e.g., pembrolizumab) may be effective for advanced or recurrent cases.

Prognosis:
Five-year survival rate drops to 15–20%, depending on how far the disease has spread and how well it responds to therapy.

How Doctors Determine the Stage

Accurate staging is essential for creating a personalized treatment plan. Doctors rely on several diagnostic tools and procedures, including:

  • Imaging tests such as CT, MRI, and PET scans to identify tumor spread.

  • Endometrial biopsy or D&C for tissue confirmation.

  • Surgical staging, where the uterus, ovaries, and nearby lymph nodes are examined during surgery.

  • Pathology reports to assess depth of invasion and cell grade.

In many cases, final staging can only be confirmed after surgery, when tissues are analyzed under a microscope.

Grading vs. Staging

While staging describes how far the cancer has spread, grading indicates how abnormal the cancer cells look under a microscope.

  • Grade 1: Cells look similar to normal cells (slow growth).

  • Grade 2: Moderately abnormal.

  • Grade 3: Very abnormal, fast-growing, and aggressive.

Both stage and grade together help predict outcomes and guide treatment intensity.

Recurrent and Metastatic Uterine Cancer

Even after successful treatment, uterine cancer can recur — either locally in the pelvis or distantly in the lungs, liver, or bones.

Common recurrence signs:

  • New or persistent vaginal bleeding

  • Pelvic or abdominal pain

  • Weight loss or fatigue

  • Coughing or chest pain (if spread to lungs)

Treatment for recurrence depends on where the cancer returns and what prior therapies were used. Options include:

  • Surgery (if localized)

  • Radiation for symptom relief

  • Chemotherapy or targeted therapy

  • Immunotherapy for advanced cases

Regular follow-up visits help detect recurrence early, improving long-term survival.

Prognosis by Stage

Survival outcomes vary significantly by stage:

Stage Five-Year Survival Rate Description
I 90–95% Confined to uterus
II 70–80% Spread to cervix
III 50–65% Spread within pelvis
IV 15–20% Distant metastasis

 

Early detection dramatically improves prognosis, emphasizing the importance of routine gynecologic care.

Factors Affecting Progression

Several factors influence how fast uterine cancer progresses and how well it responds to treatment:

  • Tumor grade and subtype

  • Hormone receptor status (ER/PR positive cancers respond better to hormone therapy)

  • Age and general health

  • Genetic mutations such as TP53 or PTEN

  • Timeliness of diagnosis

Adopting healthy habits — maintaining a balanced diet, managing weight, and avoiding smoking — can improve treatment outcomes and recovery.

Emotional Impact and Coping

A cancer diagnosis can be overwhelming. Patients often face emotional distress during staging and treatment planning.
Support is available through:

  • Counseling or therapy to manage anxiety.

  • Support groups connecting survivors and caregivers.

  • Mindfulness practices such as meditation or yoga to reduce stress.

Emotional resilience and strong support systems contribute significantly to recovery and quality of life.

Life After Treatment

After completing treatment, most patients continue follow-up visits every 3–6 months for the first few years. These visits may include:

  • Physical and pelvic exams

  • Imaging tests (if needed)

  • Blood work or tumor marker evaluation

Healthy lifestyle choices, regular exercise, and proper nutrition help lower recurrence risk and improve long-term wellbeing.

Conclusion

Understanding the stages of uterine cancer helps patients and families grasp the disease’s progression, treatment options, and outcomes.
From Stage I, where cancer is confined to the uterus, to Stage IV, where it spreads to distant organs, each stage requires a specific, personalized care plan.

Early detection remains the strongest weapon — through regular checkups, recognizing abnormal bleeding, and seeking prompt medical attention. With modern medical advances and growing awareness, many women survive uterine cancer and lead healthy, fulfilling lives.