Endometrial Cancer Stage III

Stage 3 endometrial cancer means the cancer has grown beyond the uterus but remains within the pelvis, requiring specialized treatment to give patients the best chance of recovery.

Table of contents

• What Is Stage 3 Endometrial Cancer?
• Understanding the Substages
• How Cancer Stage Is Determined
• Treatment Options
• Treatment After Surgery

What Is Stage 3 Endometrial Cancer?

Stage 3 endometrial cancer is described as locally advanced cancer because it has spread outside of the uterus but is still confined to the pelvic area^[2]. This means the cancer has moved beyond where it started, but it hasn’t reached distant parts of the body.

At this stage, cancer may have spread to tissues or organs near the uterus, such as the vagina, but it hasn’t spread to the bladder, rectum, intestines, or distant parts of the body^[2]. When cancer spreads to these areas, it’s classified as stage 4 endometrial cancer.

Doctors use a staging system called the International Federation of Gynecology and Obstetrics (FIGO) system to classify womb cancer^[3]. There are four stages, numbered 1 to 4. Your doctor may call stage 3 endometrial cancer “locally advanced womb cancer.”

Understanding the Substages

Stage 3 endometrial cancer is divided into three substages: stage 3A, stage 3B, and stage 3C, with 3C further split into 3C1 and 3C2^[2]. Earlier letters and numbers represent less advanced cancer, so stage 3C1 is less advanced than stage 3C2.

Stage 3A

In stage 3A, the tumor has spread to the ovaries or fallopian tubes (tubes that connect the ovaries to the uterus) or the outer surface of the uterus, called the serosa^[2]. The serosa is a thin membrane that covers the outside of the uterus. In this stage, cancer hasn’t spread to lymph nodes (small glands that are part of your immune system) or other parts of the body.

Stage 3B

Stage 3B can develop in different ways. The cancer may have spread to the vagina, the connective tissue surrounding the uterus called the parametrium, or the membrane that surrounds the pelvic organs^[2][3]. In stage 3B, cancer hasn’t spread to lymph nodes or other parts of the body.

Stage 3C

Stage 3C describes cancer that has spread to regional (nearby) lymph nodes but hasn’t spread to distant parts of the body^[2]. In stage 3C1, cancer has spread to the pelvic lymph nodes. In stage 3C2, the cancer has spread to lymph nodes around a major blood vessel called the aorta^[3].

How Cancer Stage Is Determined

The stage of your endometrial cancer is determined using information from your diagnostic tests^[2]. An endometrial biopsy or dilation and curettage (D&C) provides a tissue sample. A biopsy is a procedure where a small piece of tissue is removed, and D&C involves widening the cervix and removing tissue from inside the uterus. Cancer cells are then examined under a microscope.

Genetic testing helps determine details about cancer cells, and imaging tests show whether endometrial cancer has spread to lymph nodes or other tissues^[2]. Cancer staging may not be final until after surgery because doctors need to remove the entire tumor and nearby lymph nodes to examine them closely.

Endometrial cancer staging is based on three main factors^[2]:

• T — The size of the tumor
• N — If cancer has spread to the lymph nodes
• M — If cancer has metastasized (spread) to distant parts of the body

Treatment Options

The stage of your cancer helps your doctor decide which treatment you need^[3]. Treatment also depends on the type of womb cancer you have, how the cancer is likely to behave (the grade), the risk of your cancer coming back after surgery, whether your cancer has any gene changes, your general health, and your preferences.

Surgery

Surgery is the main treatment for stage 3 womb cancer if you are otherwise fit and well^[3]. Your surgeon will aim to remove all of the cancer. This usually means they will remove your womb and cervix (called a simple or total hysterectomy), both ovaries, and fallopian tubes.

They may also remove the top of your vagina and some of the surrounding tissue, as well as lymph nodes in your pelvis^[3]. This is called a radical hysterectomy. The surgeon who performs this surgery is a specialist called a gynaecological oncologist.

If You Can’t Have Surgery

Some people might not be able to have surgery for stage 3 womb cancer^[3]. This might be because you are not fit enough for surgery, your cancer is too difficult to remove completely, or you have chosen not to have surgery.

You might be able to have other treatments. The type of treatment will depend on your situation. You might have one of the following treatments^[3]:

• Chemotherapy to shrink the cancer first, followed by surgery
• External and internal radiotherapy (brachytherapy) for a high grade cancer
• Hormone therapy if you can’t have surgery or radiotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. Radiotherapy uses radiation to destroy cancer cells. Brachytherapy is a type of radiation therapy where the radiation source is placed inside or very close to the area being treated. Hormone therapy uses medications that affect hormone levels to help control cancer growth.

Treatment After Surgery

Stage 3 womb cancer has a high risk of coming back^[3]. After surgery you may have one of the following treatments:

• External radiotherapy with chemotherapy and then more chemotherapy
• Chemotherapy followed by radiotherapy
• Chemotherapy on its own

Some people may have treatment with immunotherapy or a targeted cancer drug^[3]. Immunotherapy helps your immune system fight cancer. Targeted cancer drugs are designed to attack specific features of cancer cells. This will depend on your situation and whether you’ve had other treatments before. Possible treatments include:

• Immunotherapy with chemotherapy
• Immunotherapy on its own
• Immunotherapy and a targeted cancer drug

Research has shown that for women with stage III uterine cancer, different combinations of chemotherapy, radiation, or both can be used depending on the specific characteristics of the cancer^[12]. Your cancer care team will work with you to determine the best treatment plan for your individual situation.