Stage 1 womb cancer
The stage of a cancer tells you how big the tumour is and how far it has spread. It helps your doctor decide which treatment you need.
Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system for womb cancer. There are four stages, numbered 1 to 4.
Although a 2023 version of the FIGO system is available, doctors in the UK generally use the 2021 version.
Stage 1 cancers are early cancers and the easiest to treat. The cancer is within the womb. Stage 1 is divided into stage 1A and 1B.
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1A means that the cancer may have grown into the muscle wall (myometrium) of the womb, but less than halfway
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1B means the cancer has grown halfway or more into the muscle wall of the womb
Treatment
The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:
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the type of womb cancer you have
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how the cancer is likely to behave (the grade)
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the risk of your cancer coming back after surgery (low, intermediate, high-intermediate, high)
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whether your cancer has any gene changes (mutations)
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your general health
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your preferences
Surgery
Surgery is the main treatment for stage 1 womb cancer.
Your surgeon removes your womb and cervix. This is a simple or total hysterectomy. They usually also remove both of your fallopian tubes and ovaries. They may also remove nearby lymph nodes to check for cancer cells. This is called a 
biopsy.
The surgeon who does the surgery is usually a specialist surgeon called a gynaecological oncologist.
Preserving fertility
Women who have low risk disease (stage 1A grade 1), have not been through the menopause and would like to have children may be able to have treatment that preserves their fertility. This means having treatment with hormone therapy.
You will need to have treatment in a specialist centre. This might not be your nearest hospital. This is not standard treatment so it is important to talk to your specialist about your options and the possible risks.
If you're not fit enough for surgery
If you are not fit enough for surgery, you might be able to have other treatments. The type of treatment will depend on your situation. You might have one of the following treatments:
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vaginal hysterectomy for a low grade cancer
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external and internal radiotherapy (brachytherapy) for a high grade cancer or internal radiotherapy only for a low grade cancer
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hormone therapy for a low grade cancer to postpone surgery or if you can't have surgery or radiotherapy
Treatment after surgery
Treatment after surgery is called adjuvant treatment. It lowers the chance of the cancer coming back.
Treatment is usually with chemotherapy or radiotherapy. Radiotherapy uses high energy rays similar to x-rays to kill cancer cells. Chemotherapy uses anti cancer drugs to destroy cancer cells.
Low risk
You might not need adjuvant treatment if you have a very early cancer that has a low risk of coming back. This is generally stage 1A, and the cells don't look very abnormal. This means it is grade 1 or 2 cancer.
Intermediate risk
You usually have internal radiotherapy (brachytherapy) if you have an intermediate risk cancer and your cancer is one of the following:
- stage 1A grade 3 cancer
- stage 1B grade 1 to 2 cancer
High-intermediate risk
If you have a high-intermediate risk stage 1A, or stage 1B grade 3 cancer, you may have one of the following treatments after surgery;
- external radiotherapy – this is the most common treatment after surgery
- chemotherapy with radiotherapy or chemotherapy followed by radiotherapy, or both
- internal radiotherapy instead of external - this is sometimes considered if the risk is lower and lymph nodes that were removed during surgery are clear of cancer
High risk
After surgery you may have one of the following:
- external radiotherapy with chemotherapy and then more chemotherapy
- chemotherapy followed by radiotherapy
- chemotherapy on its own
If you have a carcinosarcoma, your treatment is the same as treatment for high-risk womb cancer.
