Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a woman's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
- How large is the primary tumor and where is it located? (Tumor, T)
- Has the tumor spread to the lymph nodes? (Node, N)
- Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. The Roman numerals in parentheses are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO. The FIGO system is standard system used by most doctors to stage uterine cancer.
TX: The primary tumor cannot be evaluated due to lack of information. More tests may be needed.
T0 (T plus zero): There does not seem to be a primary tumor in the uterus.
Tis: This condition is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the uterus and has not spread to deeper tissues of the uterus.
T1/FIGO I: The tumor is found only in the corpus uteri (the body of the uterus).
T1a/FIGO IA: The tumor is found only in the endometrium.
T1b/FIGO IB: The tumor has spread to less than one-half of the myometrium.
T1c/FIGO IC: The tumor has spread to more than one-half of the myometrium.
T2/FIGO II: The tumor has spread to the cervix but has not grown beyond the uterus.
T2a/FIGO IIA: The tumor has spread to glands near the cervix.
T2b/FIGO IIB: The tumor has spread to the cervical stroma (the connective tissue of the endometrium).
T3/FIGO III: The tumor has spread to the following areas:
T3a/FIGO IIIA: The tumor involves the serosa (the layer of tissue that covers the outer surface of some parts of the large intestine) and/or adnexa; and/or cancer cells were found in the ascites (abnormal fluid in the abdomen) or peritoneal fluid (fluid from the inner lining of the pelvis and abdomen).
T3b/FIGO IIIB: The tumor has spread to the vagina.
T4/FIGO IVA: The tumor has spread to the lining of the bladder mucosa (lining of the bladder) and/or the bowel mucosa (lining of the bowel).
FIGO IVB (M1, see below): There is distant metastasis to other parts of the body.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the uterus are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be evaluated.
N0 (N plus zero): There is no spread to regional lymph nodes.
N1: The cancer has spread to the regional lymph node(s).
Distant metastasis. The "M" in the TNM system describes whether the cancer has spread to other parts of the body.
MX: The distant metastasis cannot be evaluated.
M0 (M plus zero): The cancer has not metastasized.
M1: There is distant metastasis.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in one layer of cells and has not spread (Tis, N0, M0).
Stage I: The cancer is found only in the uterus or womb and has not spread to other parts of the body (T1, N0, M0).
Stage IA: The cancer is found only in the endometrium (T1a, N0, M0).
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Stage IB: The tumor has spread to less than one-half of the myometrium (T1b, N0, M0).
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Stage IC: The tumor has spread to more than one-half of the myometrium (T1c, N0, M0).
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Stage II: The tumor has spread from the uterus to the cervix (T2, N0, M0).
Stage IIA: The tumor has spread to the lining of the opening of the cervix (T2a, N0, M0).
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Stage IIB: The tumor has spread throughout the cervix (T2b, N0, M0).
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Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area.
IIIA: The cancer has spread to the serosa of the uterus (the layer of tissue on the outer surface of the uterus) or to the tissue immediately around the uterus. Or, cancer cells were found in the peritoneal fluid (T3a, N0, M0).
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Stage IIIB: The cancer has spread beyond the uterus to the vagina (T3b, N0, M0).
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Stage IIIC: The cancer has invaded the lymph nodes near the uterus (T3c, N0, M0).
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Stage IV: The cancer has spread to the mucosa (inner surface) of the bladder or rectum (the lower part of the large intestine); and/or it has spread to lymph nodes in the groin; and/or it has spread to distant organs of the body, such as the lungs or bones:
Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).
Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).
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In addition to identifying the type and stage of uterine cancer, the tumor's grade is determined. The grade is based on how the tumor cells appear under the microscope. If they look like normal tissue, the cancer is called a low-grade tumor. If the cells do not look like normal cells, the cancer is classified as a high-grade tumor. Knowing the grade is important in determining whether treatment is needed after surgery. For instance, a low grade-tumor usually grows slowly and is less likely to spread than a high-grade tumor.
Recurrent uterine cancer
Recurrent cancer is cancer that comes back after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. Approximately 70% of recurrent uterine cancer happens within three years of initial treatment. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.
- Vaginal bleeding or discharge
- Pain in the pelvic area, abdomen, or back of the legs
- Difficulty or pain when urinating
- Weight loss
- Chronic cough
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
Last Updated: December 23, 2008
