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Stage 1 endometrial cancer affects only the uterus and sometimes the ovaries. Since the cancer hasn’t spread at this stage, the prognosis (outlook) is usually excellent. In fact, around 95 percent of people with this cancer are still alive five years after diagnosis when compared to the general population. Treatment of endometrial cancer usually includes surgery and close monitoring over time.
In this article, we’ll cover the basics of stage 1 endometrial cancer. We’ll explain how doctors break this type of cancer down into substages and what symptoms to expect. We’ll also discuss the treatments and your outlook after a stage 1 diagnosis of endometrial cancer.
Stage 1 endometrial cancer begins in the endometrium, the inner lining of the uterus, and remains confined to the uterus. There are several types of endometrial cancer. Pathologists — doctors who specialize in analyzing tissues — diagnose the type of cancer by looking closely at the cancer cells collected during a biopsy (tissue sampling) or surgery under a microscope. The type of cancer you have and how aggressive it is will determine the exact substage of stage 1 endometrial cancer.
The National Cancer Institute (NCI) notes that 66.8 percent of people with endometrial cancer have stage 1 or stage 2 disease at the time of diagnosis. This is helpful, because the earlier the stage at which cancer is diagnosed, the better your outlook.
Oncologists (cancer specialists) stage endometrial cancer using two systems:
Both systems use three key pieces of information to stage endometrial cancers, known as TNM. These letters stand for:
Your doctor will determine your endometrial cancer stage and substage using tissue collected during surgery. The tissue will be sent to a laboratory and examined for cancer cells under a microscope. This is known as surgical staging. If you can’t have surgery yet, your doctor will determine your clinical stage based on the results of your physical exam, imaging tests, and biopsy.
People with stage 1 endometrial cancer have a tumor growing inside their uterus. At this stage, the tumor is limited only to the uterus and sometimes the ovaries. The cancer hasn’t spread to the lymph nodes or other parts of the body.
Stage 1 endometrial cancer is broken down into three substages depending on how aggressive it is. The cancer may have spread to the deeper, muscular layer of the uterus.
To be considered a stage 1A tumor, at least one of the following must be true:
Stage 1B tumors are nonaggressive but have grown at least halfway into the muscle layer. They haven’t spread outside the uterus.
Stage 1C tumors are aggressive cancers that affect only the endometrium.
The most common symptom of endometrial cancer is abnormal vaginal bleeding. For people who menstruate, this might look like bleeding between cycles or unusually heavy or irregular periods. These changes can sometimes be early warning signs of stage 1 endometrial cancer.
People who have started menopause no longer have a regular period. If you notice any new vaginal bleeding or spotting during menopause, talk to your doctor. This could be a sign of endometrial cancer or another health problem. Abnormal discharge of any color or consistency is also a concerning sign — even if there isn’t any blood.
Your endometrial cancer treatment plan depends on several factors. These include your age, overall health, presence of other comorbid (co-occurring) conditions, and whether you want to become pregnant in the future. Your doctor will discuss your options and help you weigh the benefits, risks, and side effects of different treatment options.
Researchers are working to develop new treatments for endometrial cancer. Ask your doctor whether any of them may be right for you.
Surgery is typically the first treatment for nearly everyone diagnosed with endometrial cancer, according to the American Cancer Society. This operation involves removing the uterus, fallopian tubes, and ovaries — a procedure known as a total hysterectomy with bilateral salpingo-oophorectomy (TH/BSO). The goal is to remove the cancer and help prevent it from spreading further.
For most people with stage 1 endometrial cancer, surgery is enough to treat their cancer. Doctors will continue monitoring over time to look for any signs that the cancer has returned (known as a recurrence).
If you’re younger and haven’t started menopause, your doctor may recommend removing your uterus while leaving your ovaries. It’s important to know that leaving the ovaries raises the risk of your cancer returning. However, studies show there’s no higher risk of dying if the tumor does grow back.
Radiation therapy uses powerful X-ray beams or radioactive materials to kill any cancer cells left after surgery. People with stage 1B and 1C endometrial cancer usually receive radiation therapy to improve their outcomes.
There are two types of radiation therapy used to treat endometrial cancer — external beam radiation therapy (EBRT) and brachytherapy.
EBRT uses machines similar to X-ray machines to create targeted radiation beams that reach the body’s deeper tissues. Providers target the radiation to the pelvis, where the cancer is located. Radiation therapy with EBRT is typically given five days a week for four to six weeks.
Doctors use brachytherapy in the upper part of the vagina to prevent cancer spread after surgery. This technique uses a radioactive source in an applicator — similar to a tampon. The applicator is inserted in the vagina to deliver radiation therapy only to nearby tissues.
High-dose rate brachytherapy is the most common approach. You’ll receive the radiation for 10 to 20 minutes in your doctor’s office. Most people receive at least three doses of brachytherapy, either daily or weekly.
If you have stage 1 endometrial cancer but you’d still like to become pregnant in the future, your doctor may recommend certain treatments. One option involves taking progestin — a synthetic (lab-made) form of the hormone progesterone. Progestin can temporarily shrink endometrial tumors, giving you a chance to try for pregnancy.
Throughout this treatment, your doctor will monitor you closely. They’ll check for any new cancer growth every three to six months. If there’s no cancer for six months, you may be able to try getting pregnant. Unfortunately, this treatment isn’t often successful. It’s likely that your cancer can keep growing. There’s also a risk of your cancer spreading if you put off surgery for too long.
Remember that you can always get a second opinion about your endometrial cancer. A gynecologic oncologist (a doctor who specializes in cancers of the female reproductive system), will help you decide whether progestin therapy is a safe option for you. A fertility specialist can also help support you through the decision-making process.
The NCI collects data from thousands of people with endometrial cancer to estimate survival rates. They break cancer down into different stages and analyze the available data. Stage 1 endometrial cancer is considered “localized” — meaning it hasn’t spread beyond the uterus.
According to the NCI, the five-year relative survival rate for localized endometrial cancer is 95 percent. This means that five years after diagnosis, a person with endometrial cancer is 95 percent as likely to be alive as someone who doesn’t have cancer.
It’s important to remember that survival rates are only estimates. They can’t predict your exact prognosis. The statistics are also several years old — collected from 2014 to 2020. Treatments have improved since then, helping people with endometrial cancer live longer, healthier lives. Your doctor can help give you a better idea of your outlook, based on your unique situation.
If you’ve been diagnosed with stage 1 endometrial cancer, staying engaged with your healthcare team is one of the most important steps you can take. This early stage of cancer often has an excellent prognosis, especially when treatment is started promptly and followed closely. Be sure to stick with your treatment plan, attend all follow-up appointments, and talk to your doctor about any new or unusual symptoms. Ongoing monitoring helps catch any changes early and supports your long-term health and recovery.
On MyBCTeam — the social network for people living with breast and gynecologic cancers and their loved ones — members come together to ask questions, offer advice, and share their stories with others who understand life with endometrial cancer.
Have you or a loved one been diagnosed with stage 1 endometrial cancer? What helped you feel more in control during treatment or recovery? Share your experiences in the comments below, or start a conversation by posting on your Activities page.
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