Types and grades of womb cancer
The type of womb cancer you have depends on the type of cell the cancer started in. The grade gives doctors an idea of how fast growing the cancer is.
Knowing the type and grade of your cancer helps your doctor to decide what treatment you need.
Endometrial cancer
The most common type of womb cancer is endometrial cancer. Endometrial means that the cancer starts in the lining of the womb. This lining is called the endometrium.
Most womb cancers start in specific cells in the womb lining, the endometrium. Most endometrial cancers are adenocarcinomas.
Adeno means that the cells that have become cancerous are the cells of glandular tissue. So for the most common type of womb cancer, the cancer is in the glands of the endometrium. Carcinoma means that the cancer has started in a surface or lining layer of cells (the epithelium).
There are 3 types of adenocarcinoma:
Endometrioid is pronounced endo-mee-tree-oyd. Adeno means that the cancerous cells are of glandular tissue. Carcinoma means the cancer has started in tissues lining or covering internal organs.
Most endometrial cancers are adenocarcinomas. So, for the most common type of womb cancer, the cancer is in the glands of the endometrium.
These cancers are often diagnosed at an early stage and so are usually treated successfully.
Endometrioid adenocarcinoma can be one of the following:
- low grade (grade 1 and 2), meaning they grow and spread slower
- high grade (grade 3), meaning they grow and spread faster
This type is much less common than endometrioid cancers. It also develops from the lining of the womb. This is called a non endometrioid cancer. It is a type 2 endometrial cancer.
Serous carcinomas are high grade (grade 3) cancers. They tend to grow and spread faster.
Clear cell carcinoma of the womb lining is very rare. These cells are also in the lining of the womb and get their name from looking clear under a microscope.
This is also called a non endometrioid cancer and is a type 2 endometrial cancer.
Clear cell carcinomas are also high grade (grade 3) cancers that tend to grow and spread faster.
Type 1 and type 2 endometrial cancer
Doctors sometimes divide endometrial cancers into 2 types.
Type 1 cancers are the most common type. They are usually endometrioid adenocarcinomas, and are linked to excess oestrogen in the body. They are generally slow growing and less likely to spread.
Type 2 cancers are not linked to excess oestrogen. They are generally faster growing and more likely to spread. They include uterine serous carcinomas and clear cell carcinomas.
Sarcoma of the womb (uterine sarcoma)
These are cancers that develop from cells in the muscle layer of the womb, rather than the lining. They are a type of soft tissue sarcoma and are much less common than endometrial cancer.
Soft tissue sarcomas are cancers of the supporting tissues of the body. There are many subtypes and they can develop from any type of soft tissue such as muscle or blood vessels. They tend to spread in the bloodstream to other parts of the body especially the lungs. The treatment you need for this type of womb cancer is not the same as other types of womb cancer.
Leiomyosarcoma is the most common sarcoma of the womb. It is a cancer of the muscle wall.
Because sarcomas are different and need different treatments we have separate information about them.
Carcinosarcoma of the womb (uterine carcinosarcoma)
Carcinosarcoma is a rare type of womb cancer. It has features of both endometrial cancer and sarcoma when looked at under a microscope.
Doctors class carcinosarcomas as a type of endometrial cancer as they have similar risk factors and behave in a similar way. They generally treat them as a type 2 endometrial cancer.
Cancer of the neck of the womb (cervix)
Although the cervix is part of the womb, cervical cancer is very different from womb cancer.
Grading of your cancer
Grading is a way of dividing cancer cells into groups depending on how much the cells look like normal cells. This gives your doctor an idea of how quickly or slowly the cancer might grow and whether it is likely to spread.
Grade 1
The cells look very like normal cells. They are also called low grade or well differentiated. They tend to be slow growing and are less likely to spread than higher grade cancer cells.
Grade 2
The cells look more abnormal and are more likely to spread. This grade is also called moderately differentiated or moderate grade.
Grade 3
The cells look very abnormal and not like normal cells. They tend to grow quickly and are more likely to spread. They are called poorly differentiated or high grade.
Risk groups for endometrial cancer
When your doctor takes a sample of cells, a biopsy, it is sent to the laboratory. They also test the cancer they remove during surgery. A specialist doctor does various tests on the cells. This can help to diagnose cancer and show which type of cancer it is.
Some womb cancers have changes in genes (mutations) that make the cancer grow and divide. The doctor may test the cancer for changes in these genes:
- MMR – mismatch repair gene
- p53
They will also look for hormone receptors. The hormones oestrogen and progesterone can help the cancer to grow. If your cancer is positive to hormones your doctor might suggest hormone treatment if you have advanced disease.
When you have surgery, they also look at the cancer to find out:
- how fast growing your cancer is
- how far it has grown into the womb wall
- whether it has spread into any lymph or blood vessels
This information might help to describe womb cancer as:
- low risk
- intermediate
- high-intermediate
- high risk
- advanced metastatic
These groups describe how likely it is that your cancer will spread further, or come back after treatment. It will also help your doctor decide about the best treatment for you.
More information
To decide about what treatment you need your doctor looks at your type, grade and stage of your cancer.