Staging and grading of womb cancer
The stage and grade of womb cancer helps you and your doctor make decisions about your treatment.
Staging and grading of womb cancer
Knowing the stage and grade of the womb cancer is important. It helps you and your doctor make decisions about your treatment.
The stage and grade of the cancer can usually be confirmed after surgery.
Staging systems
Endometrial womb cancers are usually staged using a number system. Endometrial womb cancer is divided into 4 number stages and then further divided into letter stages.
It may also be called FIGO staging (The International Federation for Gynaecology and Obstetrics). FIGO staging guidelines are regularly reviewed and updated by experts to include any new developments.
In 2023, a new FIGO staging system was developed to update guidelines from 2009. As well as looking at how far the cancer has spread, the new 2023 guidelines look at:
- the grade of the cancer
- other specific changes that can be identified in the cancer cells.
When there is a new update to the FIGO staging system, both the old and new stages may be given.
The descriptions of number stages in this information reflect the 2009 guidelines. Your doctor can explain if your cancer has a different stage based on the new guidelines.
Staging of endometrial womb cancer
The stage of the womb cancer describes:
- how far the cancer has grown
- if it has spread from where it started.
Stage 1 womb cancer
The cancer is contained in the womb.
Stage 1 can be divided into:
- stage 1A – the cancer is only in the lining of the womb, or has grown less than halfway into the muscle
- stage 1B – the cancer has grown halfway or more into the muscle wall.
Stage 2 womb cancer
The cancer has spread to the cervix (the neck of the womb).
Stage 3 womb cancer
The cancer has spread outside of the womb but has not spread beyond the pelvis.
Stage 3 can be divided into:
- stage 3A – the cancer has spread to the outer surface of the womb or the ovaries and fallopian tubes, or both
- stage 3B – the cancer has spread into the vagina or into the tissues around the womb (parametrium), or both
- stage 3C – the cancer has spread to pelvic lymph nodes, or to lymph nodes in the tummy (abdomen).
How womb cancer stages are described
Your doctor or nurse may use some of the following terms to describe the cancer:
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Early stage womb cancer
This usually means stage 1 and stage 2 womb cancers.
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Locally advanced womb cancer
This usually means stage 3 and stage 4A womb cancers
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Advanced, metastatic or secondary womb cancer
This usually means stage 4B womb cancer.
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Recurrent cancer
This means a cancer that has come back after treatment and is not given a stage.
Grading of womb cancer
Grading is based on how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to decide about your treatment. Womb cancer can be graded as:
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Grade 1 or low grade or well differentiated
The cancer cells look like normal cells, usually grow slowly and are less likely to spread.
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Grade 2 or moderate or intermediate grade
The cancer cells look more abnormal and are slightly faster growing.
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Grade 3 or high grade or poorly differentiated
The cancer cells look very different from normal cells and may grow more quickly.
Other tests for womb cancer
The doctor that examines the womb cells is called a pathologist. They are specialist doctors who look at cells or body tissue under a microscope to diagnose and grade cancer. The pathologist will also look for specific changes in the womb cancer cells. This is called molecular classification. Having some of these changes may affect the stage of the cancer.
Molecular classification
The womb cancer will be classified into the following 4 groups:
- POLE
- MMR
- NSMP
- P53.
There may also be some sub-types of these groups. Along with the grade, knowing the group can help the doctors know how quickly or slowly the cancer might grow and spread. It can also help your doctor decide what type of treatment may be suitable for you.
Risk groups for womb cancer
Womb cancer is divided into risk groups. To work out the risk group, doctors look at the type, stage, grade and molecular classification of the cancer cells. They can then describe the endometrial cancer as:
- low risk
- intermediate risk
- high-intermediate risk
- high risk
Knowing the risk group can help the doctors know how quickly or slowly the cancer might grow and spread. It can also help your doctor decide what type of treatment may be suitable for you.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We are here if you need someone to talk to. You can:
- call the Macmillan Support Line on 0808 808 00 00
- use our online form to email us and we will respond within 2 working days
- chat to our specialists online.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our womb cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Oaknin, A. et al. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology, Volume 33, Issue 9, 860 - 877
https://www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-gynaecological-cancers/endometrial-cancer (accessed January 2024).Berek JS, Matias-Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. Int J Gynecol Obstet. 2023; 162: 383-394. doi:10.1002/ijgo.14923 (accessed January 2024).
Suspected cancer: recognition and referral. NICE guideline [NG12] Published: 23 June 2015 Last updated: 02 October 2023 Overview | Suspected cancer: recognition and referral | Guidance | NICE (accessed January 2024).
Miss Eva Myriokefalitaki
Reviewer
Consultant Gynaecological Oncology Surgeon
Date reviewed
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