Endometrial Cancer Stage II

Stage 2 endometrial cancer has spread beyond the innermost lining of the uterus but remains confined within the uterus itself, offering a strong chance of successful treatment through surgery and additional therapies.

Table of contents

• What Is Stage 2 Endometrial Cancer?
• Understanding the Substages
• Symptoms to Watch For
• Treatment Approaches
• Outlook and Prognosis

What Is Stage 2 Endometrial Cancer?

Stage 2 endometrial cancer affects the endometrium, which is the inner lining of the uterus. At this stage, the cancer has grown beyond stage 1, but it remains confined to the uterus and has not spread outside the womb^[1][2]. The cancer may have spread into the cervix, which is the lower part of the uterus that connects to the vagina, or into deeper muscle layers of the uterus called the myometrium^[1].

Stage 2 tumors can also be found in the supportive connective tissue in the cervix, called the cervical stroma. At this stage, there are cancer cells present in tissues outside the main tumor, but they have not reached nearby lymph nodes or distant parts of the body^[1].

Doctors use staging systems to determine the best treatment approach for each patient. The two main staging systems for endometrial cancer are the American Joint Committee on Cancer TNM system and the International Federation of Gynecology and Obstetrics (FIGO) system. These systems help doctors understand how big the tumor is and where it has spread^[1][2].

Understanding the Substages

Stage 2 endometrial cancer can be divided into substages A, B, and C. Stage 2A is the least severe of the substages, while stage 2C is the most severe. How doctors classify these substages depends not only on where the cancer has spread, but also on how fast the tumor is likely to grow^[1].

Stage 2A refers to nonaggressive cancer that grows and spreads slowly. At this substage, the cancer has spread to the uterus and surface of the cervix^[1].

Stage 2B also involves nonaggressive cancer, but with cancer cells found outside the main tumor or spread to the deeper layers of the cervix^[1].

Stage 2C is classified as aggressive cancer, meaning it grows and spreads more quickly. In this substage, the cancer has spread into the myometrium, the muscular wall of the uterus^[1].

Doctors also consider the grade of the cancer, which describes how abnormal the cancer cells look under a microscope. This information, combined with the stage, helps doctors determine the risk of the cancer coming back after surgery. Risk categories include low, intermediate, high-intermediate, and high risk^[2].

Symptoms to Watch For

Abnormal vaginal bleeding is often the first sign of endometrial cancer. For people who still get their period, this may appear as changes in their menstrual cycle. They may bleed between periods or have a shorter cycle than normal^[1].

If you have gone through menopause, any vaginal bleeding or spotting is considered abnormal and should be checked by a doctor. Even a slight amount of bleeding after menopause can be a warning sign^[1].

Other symptoms that may occur include lower abdominal pain or cramping in the pelvis, just below the belly. Some people may also experience thin white or clear vaginal discharge if they are postmenopausal^[1].

If you are older than 40 and experience extremely prolonged, heavy, or frequent vaginal bleeding, this should also be evaluated by your healthcare provider^[1].

Treatment Approaches

Surgery

Surgery is the main treatment for stage 2 endometrial cancer. The surgeon removes the womb and cervix in a procedure called a simple or total hysterectomy. They usually also remove the fallopian tubes and ovaries^[2].

In some cases, the surgeon may need to remove the top of the vagina and some surrounding tissue, as well as lymph nodes in the pelvis to check for cancer cells. This more extensive procedure is called a radical hysterectomy. The surgeon who performs this operation is usually a specialist called a gynaecological oncologist^[2].

Research has shown that women with stage 2 endometrial cancer do not appear to benefit from routine radical hysterectomy. Almost 11% of patients underwent radical hysterectomy in one large study, but there was no difference in survival between surgical types, even when adjusted for additional treatment after surgery^[8].

If you are not fit enough for surgery, you might be able to have other treatments depending on your situation. Options may include vaginal hysterectomy for a low grade cancer, external and internal radiation therapy (brachytherapy) for a high grade cancer, or hormone therapy for a low grade cancer^[2].

Treatment After Surgery

Treatment given after surgery is called adjuvant treatment. This additional treatment lowers the chance of the cancer coming back. Most stage 2 cancers are treated with adjuvant treatment^[2].

The type of adjuvant treatment depends on the risk category assigned to your cancer. Stage 2 cancers are rarely classified as low risk^[2].

For intermediate risk stage 2 grade 1 cancer, you usually have internal radiation therapy, also called brachytherapy^[2].

If you have high-intermediate risk stage 2 grade 1 or stage 2 grade 2 to 3 cancer, you may have one of several treatment options. External radiation therapy is the most common treatment after surgery. Other options include chemotherapy with radiation therapy, chemotherapy followed by radiation therapy, or both. Sometimes internal radiation therapy is considered instead of external radiation if the risk is lower and lymph nodes removed during surgery are clear of cancer^[2].

For high risk cancers, treatment after surgery may include external radiation therapy with chemotherapy followed by more chemotherapy, chemotherapy followed by radiation therapy, or chemotherapy on its own^[2].

Research has demonstrated that all patients with stage 2 endometrial cancer appear to benefit from receiving radiation therapy, regardless of the specific type used. Compared to no additional treatment, radiation therapy alone was associated with a lower risk of death. The combination of radiation and chemotherapy was associated with an even greater survival benefit^[8].

Outlook and Prognosis

Stage 2 endometrial cancer still has a strong chance of successful treatment. Your oncologist, a cancer specialist, will create a treatment plan based on the specific details of your cancer^[1].

According to the National Cancer Institute, 66.8 percent of endometrial cancers are diagnosed at the localized stage, meaning the cancer is still confined to the uterus and hasn’t spread to nearby tissues. This early detection contributes to better outcomes^[1].

Your individual outlook depends on several factors, including the grade of your cancer, whether it has spread to lymph nodes, the specific type of cancer cells, and your overall health. Your treatment team will work with you to develop the best approach for your situation^[2].