Endometrial cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Apr 2025

Last updated: 08 May 2025

Endometrial cancer is a common malignancy, usually an adenocarcinoma.

Obesity and being overweight are associated with an increased incidence and poorer outcome.

Patients typically present with post-menopausal vaginal bleeding and often have surgically curable disease.

Diagnosis is confirmed by biopsy, or dilation and curettage; staging and histology is confirmed at surgery.

Screening for Lynch syndrome in women with a significant relevant family history can enable surgical prevention of a subset of endometrial cancers.

Adjuvant vaginal brachytherapy and pelvic external beam radiotherapy can improve progression-free survival in patients with high-intermediate risk or high-risk disease, but they do not improve overall survival.

Chemotherapy, with or without immunotherapy, and chemoradiotherapy are options for patients with stages III and IV disease at presentation. Hormonal treatment, chemotherapy, and immunotherapy offer palliation in patients with recurrent disease and non-endometrioid carcinomas (e.g., serous, clear-cell, undifferentiated carcinoma, carcinosarcoma).

Definition

An epithelial malignancy of the uterine corpus mucosa, usually an adenocarcinoma.

History and exam

Key diagnostic factors

post-menopausal vaginal bleeding (PVB)

Full details

Other diagnostic factors

uterine mass, fixed uterus, or adnexal mass indicating extra-uterine disease
abnormal menstruation or vaginal bleeding in a pre-menopausal woman
pain (abdominal or pelvic) and weight loss
symptoms of metastatic disease
signs of metastatic disease

Full details

Risk factors

overweight and obesity
age >50 years
endometrial hyperplasia
unopposed endogenous oestrogen
unopposed exogenous oestrogen
tamoxifen use (post-menopausal women)
insulin resistance
family history of endometrial or colorectal cancer
family history of breast cancer or ovarian cancer
family history of Lynch syndrome (hereditary non-polyposis colorectal cancer)
family history of PTEN syndromes
polycystic ovary syndrome
radiotherapy
inactivity
diet
nulliparity and infertility

Full details

Diagnostic investigations

1st investigations to order

pelvic (transvaginal) ultrasound
outpatient endometrial biopsy (with or without outpatient hysteroscopy) and histopathology
hysteroscopy, dilation and curettage (D&C), and histopathology
cervical cytology (liquid-based cytology or Pap smear)
FBC

Full details

Investigations to consider

tumour molecular analysis
genetic evaluation
serum CA-125 level
saline infusion sonohysterogram
urea and creatinine (renal function testing)
LFTs
chest x-ray
CT scan of chest, abdomen, and pelvis
MRI of uterus, pelvis, and abdomen
PET/CT scan

Full details

Treatment algorithm

ACUTE

stage IA endometrioid carcinoma not considering fertility preservation

stage IA endometrioid carcinoma considering fertility preservation

stage IB or II endometrioid carcinoma

stages III to IV endometrioid carcinoma; all non-endometrioid carcinomas (high risk)

ONGOING

recurrent or incurable disease

Contributors

Authors

Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS

Associate Professor

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology, and Reproductive Sciences

Magee-Womens Hospital of UPMC

University of Pittsburgh School of Medicine

Pittsburgh

Disclosures

ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.

Richard T. Penson, MD, MRCP

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital

Boston

Disclosures

RTP declares that his institution has received research funding from Array BioPharma Inc., AstraZeneca, Genentech, and Vascular Biogenics Ltd on his behalf. RTP has received research funding from Genentech Inc., ImClone Systems Inc., Endocyte Inc., AstraZeneca, Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. He has been paid for participating in scientific advisory boards for AbbVie, AstraZeneca, Baxalta Oncology, Clovis Oncology, Curio Science, Eisai Inc., Endocyte Inc., Genentech, Janssen Oncology (J&J), Merck & Co., Mersana Therapeutics Inc., NewLink Genetics, Nexus Global Group, Pieris Pharma Inc., Roche Inc., Sutro Biopharma, Syndax Pharmaceuticals, Tesaro Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. vs. Apotex Inc. in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion.

Acknowledgements

Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.

Disclosures

NSH and AHR declare that they have no competing interests.

Peer reviewers

Susan A. Davidson, MD

Associate Professor/Chief

Gynecologic Oncology

S/M Obstetrics & Gynecology (UCD)

University of Colorado Health Sciences Center

Aurora

Disclosures

SAD declares that she has no competing interests.

Svetlana Mironov, MD

Attending Radiologist

Assistant Professor of Radiology

Memorial Sloan-Kettering Cancer Center

New York

Disclosures

SM declares that she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: uterine neoplasms [internet publication].Full text

Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39.Full text Abstract

Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Sep;33(9):860-77.Full text Abstract

Amant F, Mirza MR, Koskas M, et al. Cancer of the corpus uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:37-50.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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