Uterine & Endometrial Cancer Staging

  • Shashikant Lele, MD, FACOG, Clinical Chief of Gynecologic Oncology, discusses uterine cancer staging to determine the best course of action for his patient.

Your Cancer Status

Prior to planning your treatment regimen, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. A pathologist assigns the grade (1 to 3) to describe how abnormal the cancer cells look under a microscope. Grade 1 cancer cells are not as likely to grow and spread as Grade 3 cells. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.

Your doctor may rely on the following to determine whether the cancer has spread:

  • Blood tests: A CBC, or complete blood count, will measure your red and white blood cells and platelets. A CA-125 test measures the level of CA-125 in your blood, which is a substance that is released into the bloodstream by some endometrial cancers.
  • CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
  • MRI (Magnetic Resonance Imaging): Uses a large magnet, a computer, and radio waves to create detailed images that help determine how far the cancer has grown into the body of the uterus.
  • Chest x-ray: X-rays of the chest can show tumors or fluid.
  • Colonoscopy: Your doctor inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
  • Surgery: In many cases, surgery to remove the uterus (hysterectomy) is necessary to determine the actual stage of your cancer. The surgeon may take many samples of tissue from the pelvis and abdomen to look for cancer. After the uterus has been removed, the surgeon can look for obvious signs that the cancer has invaded the muscle of the uterus. The surgeon also can check the lymph nodes and other organs in the pelvic area for signs of cancer.

The Stages of Uterine Cancer

  • Stage I: The cancer is only in the body of the uterus. It is not in the cervix.
  • Stage II: The cancer has spread from the body of the uterus to the cervix.
  • Stage III: The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells.
  • Stage IV: The cancer has spread into the bladder or rectum. Or it has spread beyond the pelvis to other body parts.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if uterine cancer spreads to the liver, the cancer cells in the liver are actually uterine cancer cells. The disease is metastatic uterine cancer, not liver cancer. For that reason, it is treated as uterine cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.