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Learning that you or a loved one has stage 3 endometrial cancer — the most common type of uterine cancer — can feel overwhelming. But understanding what this stage means is an important step. At stage 3, the cancer has spread beyond the uterus but remains in the pelvic area. Knowing what to expect can help you feel more informed as you consider treatment options and next steps.
The stage is one of the most important factors your cancer care team will consider when selecting your treatment and predicting your prognosis (outcome). In this article, we’ll review symptoms you may experience with stage 3 endometrial cancer, potential treatment options, and what research tells us about prognosis.
The stage of your endometrial cancer is determined using information from your diagnostic tests. An endometrial biopsy or dilation and curettage (D&C) provides a tissue sample. Cancer cells are then examined under a microscope. Genetic testing helps determine details about cancer cells, and imaging tests show whether endometrial cancer has spread to lymph nodes or other tissues. Cancer staging may not be final until after surgery because doctors need to remove the entire tumor and nearby lymph nodes to examine them closely.
Endometrial cancer staging is based on three main factors:
Based on the results of testing, your oncology team will assign a cancer stage ranging from 1 (the earliest stage) to 4 (the most advanced stage). Cancer stages are often written using Roman numerals. You may see stage 3 written as stage III. Your cancer stage may also include a letter after the stage number.
Stage 3 endometrial cancer is described as locally advanced cancer because it’s spread outside of the uterus, but is still confined to the pelvic area. In stage 3, cancer may have spread to tissues or organs near the uterus such as the vagina, but it hasn’t spread to the bladder, rectum, intestines, or distant parts of the body. When cancer spreads to these areas, it’s classified as stage 4 endometrial cancer, or metastatic endometrial cancer.
Stage 3 endometrial cancer is divided into three substages — stage 3A, stage 3B, and stage 3C, with 3C further split into 3C1 and 3C2. Earlier letters and numbers represent less advanced cancer, so stage 3C1 is less advanced than stage 3C2.
In stage 3A, the tumor has spread to the ovaries or fallopian tubes or the outer surface of the uterus, called the serosa. In this stage, cancer hasn’t spread to lymph nodes or other parts of the body.
Stage 3B can develop in different ways. The cancer may have spread to the vagina, the connective tissue surrounding the uterus, or the membrane that surrounds the pelvic organs. In stage 3B, cancer hasn’t spread to lymph nodes or other parts of the body.
Stage 3C describes cancer that has spread to regional (nearby) lymph nodes but hasn’t spread to distant parts of the body.
In stage 3C1, cancer has spread to the pelvic lymph nodes. This stage is further broken down based on the size of the metastasis on the lymph node.
In stage 3C2, cancer has spread to the lymph nodes around the aorta, the main artery that supplies blood to the rest of the body, with or without spread to the pelvic lymph nodes. As in stage 3C1, this stage is further classified based on the size of the metastasis.
Abnormal vaginal bleeding is the most common symptom of endometrial cancer at any stage. Vaginal bleeding may be considered abnormal if you have unusually heavy periods, spotting between periods, or any bleeding after menopause.
In the early stages of endometrial cancer, abnormal vaginal bleeding may be the only noticeable symptom. If cancer progresses, additional symptoms may begin to develop. You may have stomach or pelvic pain caused by the tumor. Some people also experience bloating or a feeling of fullness. Unintentional weight loss is another symptom that could be related to endometrial cancer.
Many of these symptoms can be caused by unrelated health conditions. However, it’s important to talk to your healthcare provider if you notice any new or unusual symptoms.
Stage 3 endometrial cancer treatment usually involves more than one type of treatment. Surgery is the main treatment for most people with stage 3 endometrial cancer. After surgery, additional treatments often include chemotherapy (chemo), immunotherapy, radiation therapy, or a combination of the three.
Surgery usually involves a radical hysterectomy. In this surgery, a surgeon will remove the uterus, cervix, upper vagina, ovaries, and fallopian tubes.
Surgery also allows your cancer team an opportunity to more precisely test for the spread of cancer. Your surgeon may perform a pelvic washing and remove pelvic lymph nodes to check for cancer cells. Additional biopsies of the tissues around your organs can also help show whether the cancer has spread.
If your cancer has spread too far to be fully removed with surgery, you may get radiation therapy before surgery. Radiation therapy can help shrink the tumor enough for a successful surgery.
Even if the surgeon removes as much cancer as possible, there may still be undetectable cancer cells that have spread to other tissues. Additional treatments can help prevent cancer from coming back, or recurring. These treatments are called adjuvant therapies. Most people with stage 3 endometrial cancer will need chemotherapy, immunotherapy, radiation therapy, or a combination of these to prevent recurrence. Some people may also undergo hormone therapy.
Radiation therapy may be focused on the pelvis or abdomen. Internal radiation therapy, or brachytherapy, can also be used in some cases. About half of the people treated with radiation therapy overall after surgery may be cured. You may also undergo radiation therapy as your primary treatment if you can’t have surgery.
You may receive additional treatments based on specific genetic mutations (changes) in your cancer cells. Targeted therapy drugs and HER2-targeted treatments may be treatment options. You may also be eligible to join a clinical trial testing new therapies. Ask your cancer care team about new treatments that may help improve your outlook and prevent recurrence.
National statistics of survival rates can give you an idea of how many people with stage 3 endometrial cancer are still alive five years after diagnosis. This is called the five-year relative survival rate. The five-year relative survival rate for regional endometrial cancer (which includes stage 3) is 70 percent.
Your prognosis is a prediction of how your cancer may develop over time. Although the stage of your cancer plays an important role, it’s not the only factor your cancer care team will consider. They’ll also look at your age, overall health, other health conditions, and how well you respond to treatment. Talk with your cancer care team to get a better idea of what to expect.
On MyEndometrialCancerTeam, the social network for people with endometrial cancer and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with endometrial cancer.
When were you diagnosed with stage 3 endometrial cancer? If you’ve completed treatment, what tips would you share with others who are newly diagnosed? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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