Endometrial Cancer Stage I
Stage 1 endometrial cancer is confined to the uterus and has an excellent outlook, with around 95 percent of people surviving at least five years after diagnosis.
Table of contents
- What Is Stage 1 Endometrial Cancer?
- Substages of Stage 1 Endometrial Cancer
- Symptoms of Stage 1 Endometrial Cancer
- How Stage 1 Endometrial Cancer Is Diagnosed
- Treatment Options for Stage 1 Endometrial Cancer
- Outlook and Survival
What Is Stage 1 Endometrial Cancer?
Stage 1 endometrial cancer begins in the endometrium, the inner lining of the uterus, and remains confined to the uterus.[1] At this stage, the tumor is limited only to the uterus and sometimes the ovaries. The cancer has not spread to the lymph nodes (immune system structures) or other parts of the body.[1]
There are several types of endometrial cancer. Pathologists — doctors who specialize in analyzing tissues — diagnose the type of cancer by looking closely at cancer cells collected during a biopsy (tissue sampling) or surgery under a microscope. The type of cancer you have and how aggressive it is will determine the exact substage of stage 1 endometrial cancer.[1]
The National Cancer Institute notes that 66.8 percent of people with endometrial cancer have stage 1 or stage 2 disease at the time of diagnosis.[1] This is helpful, because the earlier the stage at which cancer is diagnosed, the better your outlook.
Substages of Stage 1 Endometrial Cancer
Oncologists (cancer specialists) stage endometrial cancer using two systems: the American Joint Committee on Cancer TNM system and the International Federation of Gynecology and Obstetrics (FIGO) system.[1] Both systems use three key pieces of information to stage endometrial cancers, known as TNM. These letters stand for: T — Tumor size and extent (what tissues and organs it affects); N — Whether it has spread into nearby lymph nodes; M — Metastasis, or spread, to other parts of the body.[1]
Your doctor will determine your endometrial cancer stage and substage using tissue collected during surgery. The tissue will be sent to a laboratory and examined for cancer cells under a microscope. This is known as surgical staging. If you cannot have surgery yet, your doctor will determine your clinical stage based on the results of your physical exam, imaging tests, and biopsy.[1]
Stage 1A Endometrial Cancer
To be considered a stage 1A tumor, at least one of the following must be true: the tumor is found only in the endometrium; the tumor is nonaggressive and has grown less than halfway into the muscle layer; or the tumor is nonaggressive and affects only the uterus and ovaries.[1]
Stage 1B Endometrial Cancer
Stage 1B tumors are nonaggressive but have grown at least halfway into the muscle layer of the uterus.[1]
Stage 1C Endometrial Cancer
Stage 1 endometrial cancer is broken down into three substages depending on how aggressive it is.[1] The cancer may have spread to the deeper, muscular layer of the uterus.
Symptoms of Stage 1 Endometrial Cancer
Signs of uterine cancer can resemble those of many conditions, especially other conditions affecting reproductive organs.[6] If you notice unusual pain or irregular vaginal bleeding, talk to your healthcare provider. An accurate diagnosis is important so you can get the proper treatment.
Symptoms of endometrial cancer include vaginal bleeding after menopause; bleeding between periods; and pelvic pain.[8] Vaginal bleeding after menopause is often the first symptom.[8] Other symptoms may include vaginal bleeding between periods before menopause, lower abdominal pain or cramping in your pelvis, thin white or clear vaginal discharge if you are postmenopausal, and extremely prolonged, heavy or frequent vaginal bleeding if you are older than 40.[6]
How Stage 1 Endometrial Cancer Is Diagnosed
Tests and procedures used to diagnose endometrial cancer include examining the pelvis, imaging tests, and looking inside the uterus using a thin device called a hysteroscope.[10]
During a pelvic exam, a health care professional carefully inspects the outer genitals. Two fingers of one hand are inserted into the vagina and the other hand presses on the abdomen to feel the uterus and ovaries. A device called a speculum is inserted into the vagina to open the vaginal canal so the health professional can look for signs of cancer or other problems.[10]
Imaging tests make pictures of the inside of the body. They can tell your health care team about your cancer’s location and size. One imaging test might be a transvaginal ultrasound, in which a wandlike device called a transducer is inserted into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs.[10]
Treatment Options for Stage 1 Endometrial Cancer
Surgery is the main treatment for stage 1 endometrial cancer.[4][11] Your surgeon removes your womb and cervix. This is a simple or total hysterectomy. They usually also remove both of your fallopian tubes and ovaries. They may also remove nearby lymph nodes to check for cancer cells. This is called a sentinel lymph node biopsy. The surgeon who does the surgery is usually a specialist surgeon called a gynaecological oncologist.[4]
Most people with early-stage endometrial carcinoma will have a total hysterectomy (removal of the uterus and cervix) and a bilateral salpingo-oophorectomy (removal of the two fallopian tubes and ovaries).[11] The surgeon may also remove lymph nodes in the pelvis and around the aorta in early-stage endometrial carcinomas if they are high grade, are an aggressive type of cancer, or have grown more than halfway into the muscle layer of the uterus wall.[11]
Traditionally, surgical staging has been performed by laparotomy. However, advances in minimally invasive surgery have made it the preferred approach for endometrial cancer surgical staging.[13]
Treatment After Surgery
Treatment after surgery is called adjuvant treatment. It lowers the chance of the cancer coming back.[4] Treatment is usually with chemotherapy or radiotherapy. Radiotherapy uses high energy rays similar to x-rays to kill cancer cells. Chemotherapy uses anti-cancer drugs to destroy cancer cells.[4]
You might not need adjuvant treatment if you have a very early cancer that has a low risk of coming back. This is generally stage 1A, and the cells do not look very abnormal. This means it is grade 1 or 2 cancer.[4]
If you have an intermediate risk cancer and your cancer is stage 1A grade 3 cancer or stage 1B grade 1 to 2 cancer, you usually have internal radiotherapy (brachytherapy).[4]
If you have a high-intermediate risk stage 1A, or stage 1B grade 3 cancer, you may have one of the following treatments after surgery: external radiotherapy, chemotherapy with radiotherapy or chemotherapy followed by radiotherapy, or both internal radiotherapy instead of external.[4]
Treatment for Patients Who Cannot Have Surgery
If you are not fit enough for surgery, you might be able to have other treatments. The type of treatment will depend on your situation. You might have vaginal hysterectomy for a low grade cancer, external and internal radiotherapy (brachytherapy) for a high grade cancer or internal radiotherapy only for a low grade cancer, or hormone therapy for a low grade cancer to postpone surgery or if you cannot have surgery or radiotherapy.[4]
Fertility-Sparing Treatments
Women who have low risk disease (stage 1A grade 1), have not been through the menopause and would like to have children may be able to have treatment that preserves their fertility. This means having treatment with hormone therapy. You will need to have treatment in a specialist centre.[4] Young women who desire future fertility may be candidates for medical management via oral progestin therapy or progestin intrauterine device. Potential candidates should have low-risk disease (grade 1 or 2, limited to the uterus), be willing to adhere to progestin therapy and surveillance, and understand the risk of progressive disease.[13]
Outlook and Survival
Stage 1 endometrial cancer has an excellent prognosis (outlook). Around 95 percent of people with this cancer are still alive five years after diagnosis when compared to the general population.[1] Treatment of endometrial cancer usually includes surgery and close monitoring over time.[1]
Stage 1 cancers are early cancers and the easiest to treat. The cancer is within the womb.[4] Because the majority of women will survive their diagnosis of endometrial cancer, they remain at risk for breast and colorectal cancer, so these women should be counselled about screening for these cancers.[22]
