One of the first questions many people have after a uterine (endometrial) cancer diagnosis is, “How advanced is it?” That’s where staging comes in. Staging helps your care team understand how far the cancer has grown, whether it has spread beyond the uterus, and which treatments are likely to be most effective.

To figure out the stage, doctors usually rely on several approaches:

• Imaging tests, such as ultrasound, CT scans, PET scans, or MRI, to look at the uterus and surrounding tissues.
• Biopsy and surgical pathology, often after removing the uterus, ovaries, and fallopian tubes, to check how deeply the cancer has invaded and whether lymph nodes are involved.
• Blood tests, including to detect markers like CA-125, can sometimes help monitor the disease.

Knowing the stage is important because it helps guide decisions and gives you a clearer picture of your treatment journey.

Stage I

Uterine (endometrial) cancer is confined to the uterus in stage I. There are two sub-stages in stage I.

• Stage IA: The cancer is limited to the lining of the uterus (endometrium) or has grown less than halfway into the muscle wall (myometrium).
• Stage IB: Cancer has grown more than halfway into the myometrium but is still contained within the uterus.

Common early symptoms include abnormal vaginal bleeding, especially after menopause, or unusual discharge. If possible, surgery to remove the uterus and ovaries (hysterectomy with bilateral salpingo-oophorectomy) is usually the primary treatment. Depending on your personal risk factors, radiation or hormone therapy may also be recommended.

Stage II

In stage II, the cancer has reached the cervix but hasn’t spread outside the uterus.

Symptoms may include abnormal bleeding, discharge, or discomfort during intercourse. Treatment usually combines surgery with radiation therapy, hormone therapy, or chemotherapy to lower the risk of recurrence.

Stage III

The cancer has extended beyond the uterus and cervix, but not to distant organs. In this stage, there are three different sub-stages that can help your care team better understand your diagnosis.

• Stage IIIA: Spread to the outer uterus layer, fallopian tubes, ovaries, or lining of the abdomen.
• Stage IIIB: Spread to the vagina or nearby pelvic tissues.
• Stage IIIC: Spread to nearby lymph nodes in the pelvis or around the aorta (an artery).

Patients with stage III disease may notice pelvic pain, bloating, changes in urination or bowel habits, or vaginal bleeding. Treatment usually includes surgery followed by another form of therapy. Depending on your diagnosis, this could include chemotherapy, hormone therapy, radiation therapy, or a combination of therapies.

Stage IV

Stage IV indicates the cancer has spread to distant organs.

• Stage IVA: Spread to the bladder or rectum.
• Stage IVB: Spread to distant organs such as the lungs, liver, or bones.

Symptoms may include abdominal swelling, persistent pain, shortness of breath, or unexplained weight loss. Treatment focuses on controlling cancer, improving quality of life, and may involve chemotherapy, targeted therapy, hormone therapy, immunotherapy (in select cases), and sometimes surgery or radiation to relieve symptoms.

Why staging matters

Staging is a roadmap. It helps your doctors personalize treatment and monitor how the cancer is responding. Your care team will use this information to choose the safest, most effective plan for you.

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