Endometrial Cancer Stage IV

Stage IV endometrial cancer represents the most advanced form of this disease, where cancer has spread beyond the uterus to nearby organs or distant parts of the body. While this diagnosis presents significant challenges, understanding your condition and the available treatment options can help you make informed decisions about your care.

Table of contents

• What Is Stage IV Endometrial Cancer?
• Understanding Stages 4A and 4B
• Symptoms of Stage IV Endometrial Cancer
• Treatment Options for Stage IV Disease

What Is Stage IV Endometrial Cancer?

Stage IV endometrial cancer means the cancer has spread from the inner lining of the uterus to other parts of the body. This is also called metastatic cancer, which means the disease has traveled to organs or tissues beyond where it started^[2]. Doctors sometimes refer to stage IV cancer as advanced cancer^[5].

Only 10 percent to 30 percent of endometrial cancer cases are diagnosed during stage IV. Early-stage cancers typically have a better outlook and survival rates^[2]. The stage of your cancer is one of the most important factors your doctor will consider when deciding which treatments will be most effective^[15].

• Uterus
• Bladder
• Bowel
• Lungs
• Liver
• Lymph nodes
• Omentum
• Peritoneum
• Bones
• Brain

Understanding Stages 4A and 4B

Stage IV endometrial cancer is divided into two subcategories based on where the cancer has spread^[2].

In stage 4A endometrial cancer, the cancer has metastasized (spread) into the bladder, bowel, or both. This means the cancer has grown into nearby pelvic organs but has not yet reached distant parts of the body^[2]. Stage 4A means the cancer has grown into the bowel or bladder, or both^[5].

If your endometrial cancer is at stage 4B, it has spread further, beyond the pelvis. It can spread into organs like your lungs or liver. Your doctor might discover cancer cells in lymph nodes far away from your uterus^[2]. Stage 4B means the cancer has spread to lymph nodes further away, or to other parts of the body, such as the omentum, peritoneum, lungs, liver, bones or brain, or both^[5].

Stage IVB endometrial cancer encompasses a diverse group of patients with a wide-ranging distribution of disease, including intra- and extra-abdominal metastasis. The presence of peritoneal carcinomatosis (cancer spread throughout the abdominal lining) and distant or parenchymal metastasis (cancer in organ tissue) complicates the establishment of definitive recommendations regarding the optimal primary treatment^[3].

Symptoms of Stage IV Endometrial Cancer

The symptoms of stage IV endometrial cancer depend on how far the cancer has spread and which areas it has spread into^[2]. The further endometrial cancer progresses, the more likely you are to notice symptoms^[2].

Vaginal Bleeding or Discharge

Vaginal bleeding between periods or after menopause is the most common endometrial cancer symptom at any stage. When abnormal vaginal bleeding comes from endometrial cancer, the consistency of the blood is usually watery at first and gets thicker with time. A major change in your menstrual cycle can also be a warning sign of stage IV endometrial cancer^[2].

Bleeding that’s unrelated to menstruation doesn’t automatically mean you have endometrial cancer. Abnormal uterine bleeding can also be a sign of hormone imbalances, endometriosis, and some sexually transmitted infections. Always talk to your gynecologist if you experience abnormal bleeding between periods or after menopause^[2].

Unexplained Weight Loss

Losing weight when you’re not trying to lose weight may be a sign of stage IV endometrial cancer. No matter how you feel about this weight loss, it’s important to bring it up with your doctor if you don’t have a reasonable explanation like a diet change, lifestyle change, or weight loss medication^[2].

Pelvic Pain or Cramping

Pelvic pain, pressure, and cramping can be a sign of stage IV endometrial cancer. It’s also fairly common to experience pain during sexual intercourse if endometrial cancer has spread through your pelvis. Along with pelvic pain, you might feel a mass or lump in your pelvis, which may be a source of discomfort^[2]. Stage IV endometrial cancer may cause pelvic pain or a lump or mass in the pelvic area that you can feel with your hand^[2].

Treatment Options for Stage IV Disease

The stage of your cancer helps your doctor decide which treatment you need. Treatment also depends on the type of endometrial 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 (mutations), your general health, and your preferences^[5].

Surgery

Depending on how far your cancer has spread, it may be possible to remove as much of the cancer as possible. Current guidelines advocate for primary cytoreductive surgery (surgery to remove as much of the tumor as possible) when feasible^[3].

There are several reasons why you might not have surgery, including: your cancer is too difficult to remove, it has spread to areas further away in your body such as the liver and lungs, you are not fit enough for surgery, or you choose not to have it^[5].

Chemotherapy

Chemotherapy is one of the main treatment options for stage IV endometrial cancer. You may have chemotherapy to try to slow the growth of the cancer and to relieve symptoms^[5]. After surgery, you may have chemotherapy on its own or chemotherapy followed by radiotherapy^[5].

Radiation Therapy

You might have one or more treatments including radiotherapy. After surgery, you may have external radiotherapy with chemotherapy and then more chemotherapy^[5].

Immunotherapy and Targeted Therapy

Some people may have treatment with immunotherapy or a targeted cancer drug. This will depend on your situation and whether you’ve had other treatments before. Possible treatments include immunotherapy with chemotherapy, immunotherapy on its own, or immunotherapy combined with a targeted cancer drug^[5].

Hormone Therapy

Hormone therapy may be an option for some patients with stage IV endometrial cancer. Your doctor might suggest this as one of the available treatments^[5].

Palliative Care

You will also have other more specific treatments that help with any symptoms you have. This might include pain killers for pain or medicines for sickness^[5]. Palliative care can help manage symptoms of endometrial cancer at stage IV^[2].

Clinical Trials

Your doctor might also suggest you take part in a clinical trial. There might be trials of experimental treatments which you could take part in. These might be looking at new treatments or ways to improve existing treatments such as radiotherapy or chemotherapy and when you have them^[5].

Meanwhile, neo-adjuvant chemotherapy (chemotherapy given before surgery) is increasingly employed, primarily due to the growing reassuring evidence in ovarian cancer. However, evidence in the context of advanced-stage endometrial cancer mainly derives from retrospective case series^[3].