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Endometrial cancer (also known as uterine cancer) is highly treatable, especially when it’s found early. However, your prognosis (outlook) depends on many factors, including how far the cancer has spread. During the diagnosis process, your oncology team will assess the spread of cancer and assign it a number. This number is known as the stage of the cancer.
Your prognosis isn’t set in stone. It’s a calculated guess based on many other similar cases of endometrial cancer. It’s also important to keep in mind that treatment keeps improving, and those recently diagnosed may have a better outlook than the people whose data was included in past studies.
Understanding your cancer prognosis can help you and your family make decisions and prepare for the future. In this article, we’ll review the outlook and life expectancy for people with each stage of endometrial cancer.
The stage of endometrial cancer is an important factor to help your cancer care team determine your prognosis. Endometrial cancer is staged using two different systems — the American Joint Committee on Cancer TNM staging system and the International Federation of Gynecology and Obstetrics (FIGO) system.
Endometrial cancer stages range from stage 1 to stage 4 (sometimes written with Roman numerals, as stage I through stage IV). In general, lower stages haven’t spread as far as higher stages. Both systems classify endometrial cancer based on:
The cancer stage isn’t the only consideration. Other factors that can help predict your prognosis include:
The TNM and FIGO staging systems help you and your doctor determine the best endometrial cancer treatment options. However, researchers and cancer registries typically use a different staging system to record statistics, such as survival rates. The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) stage is a simpler staging system that also describes how far cancer has spread. The SEER system stages cancers as follows:
SEER stages don’t exactly match with the TNM and FIGO endometrial cancer stages. However, these statistics are useful in predicting endometrial cancer prognoses.
Earlier stages of cancer generally have a better prognosis since cancer hasn’t spread from the original tumor in the endometrium (lining of the uterus).
In stage 1 endometrial cancer, the cancer is only found in the uterus. This stage correlates to the localized SEER stage. About 67 percent of people with endometrial cancer are diagnosed in the localized stage.
Most people with localized endometrial cancer have a good prognosis. According to SEER survival statistics, 95 percent of people diagnosed with localized endometrial cancer live at least five years, known as the five-year relative survival rate.
Certain genetic mutations (changes) in cancer cells can also affect the prognosis for people with stage 1 endometrial cancer. Your cancer care team can use molecular testing to check for these gene changes to determine your cancer’s molecular subgroup. These subgroups have recently been incorporated into the FIGO staging system for people with stage 1 and stage 2 endometrial cancer.
A 2024 study found that people who have stage 1 endometrial cancer with what is known as a POLE mutation had the best outcomes. On the other hand, those with a genetic change known as a p53 abnormality often had a poorer outcome. Your cancer care team can help you understand the molecular subgroup of your cancer.
In stage 2 endometrial cancer, the cancer is still found only in the uterus and hasn’t spread to lymph nodes or nearby tissues. However, at stage 2, the cancer has begun to spread to the connective tissue of the cervix (cervical stroma). Since the cancer hasn’t spread outside of the uterus, stage 2 endometrial cancer is also considered to be localized in the SEER staging system. Based on this system, stage 2 endometrial cancer is also considered to have a 95 percent five-year survival.
Studies have found that the prognosis for people with stage 2 endometrial cancer with a low risk of spreading is similar to the prognosis of stage 1. Endometrial cancer is considered low-risk if the tumor is low grade and the cancer has spread less than halfway through the myometrium (muscle wall of the uterus).
However, people with intermediate- or high-risk stage 2 endometrial cancer may have a worse prognosis. Intermediate-risk endometrial cancer may have a low-grade tumor with spread that’s more than halfway through the myometrium, or they may have a high-grade tumor that has spread less than halfway through the myometrium. High-risk endometrial cancer involves a high-grade tumor that’s spread more than 50 percent through the myometrium.
You may not know your risk category until after a biopsy or surgery where a tissue sample or the whole tumor is removed so the tumor grade can be determined. Talk to your cancer care team to learn more about your risk category.
Stage 3 endometrial cancer is usually called the regional stage in the SEER system. In regional stages of endometrial cancer, the prognosis is usually not as good as it is in early endometrial cancer.
In stage 3 endometrial cancer, the cancer has spread to nearby tissues and organs, which may include:
In the SEER staging system, stage 3 endometrial cancer correlates to regional endometrial cancer, because the cancer has spread to nearby tissues. The five-year survival rate for regional endometrial cancer is 70 percent. About 18 percent of people are first diagnosed with regional endometrial cancer.
Treatment decisions may affect the prognosis for people with stage 3 endometrial cancer. Treatment for stage 3 endometrial cancer often involves a radical hysterectomy (surgery to remove the uterus, fallopian tubes, and ovaries). After surgery, adjuvant treatments can help reduce the risk of cancer coming back (recurrence).
A 2023 study found that people who have adjuvant therapy that involves chemotherapy and radiation (chemoradiation) may have a lower risk of recurrence and better outcomes compared to chemotherapy alone.
Stage 4 endometrial cancer is also known as advanced or distant stage. Prognosis for this stage is worse compared to other stages.
In stage 4 endometrial cancer, the cancer has spread to distant parts of the body. This stage is also known as metastatic endometrial cancer because the cancer has metastasized (spread) to other parts of the body, such as the:
Based on the SEER staging system, stage 4 correlates to distant endometrial cancer. This type of endometrial cancer has a five-year survival of 19 percent. Advances in endometrial cancer mean that most people are diagnosed with endometrial cancer before it metastasizes. However, about 11 percent of people are first diagnosed with distant endometrial cancer.
The prognosis of metastatic endometrial cancer may differ based on where the cancer has spread. A 2023 study of SEER data found that the prognosis was better for people who had metastatic endometrial cancer that spread to the lungs compared to other organs. The prognosis with the shortest survival time was associated when cancer spread to the brain. Another study found that about 34 percent of people with cancer that spread to the bones lived longer than one year.
While surgery is a common treatment that improves outcomes in other stages, a study published in Frontiers in Surgery found that it does not improve prognosis for people with stage 4 endometrial cancer. However, chemotherapy and radiation therapy have been shown to improve survival in this stage.
No matter what stage of endometrial cancer you have, there are pros and cons for each treatment option. The process of shared decision-making means working as a team with your oncologist to choose the best treatment plan for you. Your cancer specialist can help you weigh the potential benefits against the potential risks of each treatment. Your role is to share your preferences and priorities, which carry equal weight. Together, you’ll decide on a treatment plan you feel confident about and can stick with.
On MyEndometrialCancerTeam, the site for people with endometrial cancer and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with the condition.
Did you discuss your prognosis with your cancer care team? How did it affect your decision-making? What advice do you have for others going through a similar situation? Share your experiences in the comments below or by posting to your Activities page.
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