Staging is the process of analyzing information about a tumor to find out how far the cancer has spread. The stage of a uterine sarcoma is the most important factor in choosing treatment. Ask your health care team to explain your cancer's stage so that you can make fully informed choices about your treatment.

The 2 systems used for staging uterine sarcoma, the FIGO (International Federation of Gynecology and Obstetrics) system and the American Joint Committee on Cancer TNM staging system, are the same. Staging is based on 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). Uterine sarcoma is staged based on examination of tissue removed during an operation. This, known as surgical staging, means that doctors can't tell for sure what stage the cancer is in until after surgery is done (in most cases). The staging system classifies the cancer in stages I through IV, with each of these stages being further divided by letters (for example, stages IIA and IIB).

The staging system looks at how far the cancer has spread. It can spread locally to other parts of the uterus. It can also spread regionally to nearby lymph nodes (bean-sized organs that are part of the immune system). The regional lymph nodes are found in the pelvis and farther away along the aorta (the main artery that runs from the heart down along the back of the abdomen and pelvis). The lymph nodes along the aorta are called para-aortic nodes. Finally, the cancer can spread (metastasize) to distant lymph nodes or organs such as lung, liver, bone, brain, and others.

Tumor extent (T)

T0: No signs of a tumor in the uterus can be found.

T1: The tumor is growing in the uterus, but has not started growing outside the uterus.

T1a: The cancer is only in the uterus and is no larger than 5 cm across (5 cm is about 2 inches).

T1b: The cancer is only in the uterus and is larger than 5 cm across.

T2: The tumor is growing outside the uterus but is not growing outside of the pelvis.

T2a: The tumor is growing into the adnexa (the ovaries and fallopian tubes).

T2b: The tumor is growing into tissues of the pelvis other than the adnexa.

T3: The tumor is growing into tissues of the abdomen.

T3a: The tumor is growing into tissues of the abdomen in one place only.

T3b: The tumor is growing into tissues of the abdomen in 2 or more places.

T4: The tumor is growing into the bladder or rectum.

Lymph node spread (N)

NX: Spread to nearby lymph nodes cannot be assessed.

N0: No spread to nearby lymph nodes.

N1: Cancer has spread to nearby lymph nodes.

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues.

M1: The cancer has spread to distant organs (such as the lungs or liver).

Stage grouping

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters.

Stage I (T1, N0, M0): The cancer is only in the uterus. It has not spread to lymph nodes or distant sites.

Stage IA (T1a, N0, M0): The cancer is only in the uterus and is no larger than 5 cm across. It has not spread to nearby lymph nodes or distant sites.

Stage IB (T1b, N0, M0): The cancer is only in the uterus and is larger than 5 cm across. It has not spread to nearby lymph nodes or distant sites.

Stage II (T2, N0, M0): The cancer is growing outside the uterus but is not growing outside of the pelvis. The cancer has not spread to nearby lymph nodes or distant sites.

Stage IIA (T2a, N0, M0): The cancer is growing into the adnexa (the ovaries and fallopian tubes). It has not spread to nearby lymph nodes or distant sites.

Stage IIB (T2b, N0, M0): The cancer is growing into tissues of the pelvis other than the adnexa. It has not spread to nearby lymph nodes or distant sites.

Stage III: Any of the following:

Stage IIIA (T3a, N0, M0): The cancer is growing into tissues of the abdomen in one place only. It has not spread to nearby lymph nodes or distant sites.

Stage IIIB (T3b, N0, M0): The cancer is growing into tissues of the abdomen in 2 or more places. It has not spread to lymph nodes or distant sites.

Stage IIIC (T1 to T3, N1, M0): The cancer in the uterus can be any size and may have grown into tissues in the pelvis and/or abdomen. It has not spread to the bladder or rectum. The cancer has spread to lymph nodes near the uterus (pelvic and/or para-aortic lymph nodes). It has not spread to distant sites.

Stage IV: The cancer has spread to the urinary bladder or the rectum (lower part of the large intestine), and/or to distant organs, such as the bones or lungs.

Stage IVA (T4, any N, M0): The cancer has spread to the rectum or urinary bladder. It may also be in the lymph nodes but has not spread to distant sites.

Stage IVB (any T, any N, M1): The cancer has spread to organs that are not next to the uterus (such as the bones or lungs) or it has spread to distant lymph nodes (such as those in the groin area).

Survival rates by stage

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about the survival statistics below for uterine sarcoma is up to you.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).

Five-year relative survival rates compare the survival of people with the cancer to the survival for people without the cancer. Since some people will die of causes other than cancer, this is a way to look only at deaths from the specific cancer. The 5-year relative survival rate is a more accurate way to describe the outlook for patients with a particular type and stage of cancer.

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with uterine sarcoma.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors may affect a person's outlook, such as their general health and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.

The outlook for survival (prognosis) for women with a uterine sarcoma depends on many factors. These include

• The stage of the cancer
• The type of sarcoma (leiomyosarcoma or endometrial stromal sarcoma)
• The grade of the sarcoma (low grade versus high grade)
• The patient's general state of health

The survival statistics noted below come from the National Cancer Institute's SEER program. They are based on women diagnosed with uterine sarcomas from 1988 to 2001. The stages listed reflect the staging system that was in place at the time -- staging has changed since then. What was then stage II would now be included with stage I. Many of the cancers that were stage III in the older system would now be classified as stage II. Some of the cancers that were stage IV in the older system would now be stage III. These differences in staging may make it more difficult to apply these numbers to your own situation.

The 5-year relative survival rates for leiomyosarcoma are:

The 5-year relative survival rates for endometrial stromal sarcoma are:

Last Medical Review: 11/18/2009
Last Revised: 11/18/2009