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Endometrial carcinoma

Last edited: 4/13/2026

Overview

Endometrial carcinoma is a common malignancy of the female reproductive tract, characterized by tumors arising from the endometrium. It encompasses various subtypes, including endometrioid, serous, and clear cell carcinomas, each with distinct molecular and clinical features 1471427.

Diagnosis

  • Pathological Evaluation: Histopathological examination is essential, including assessment of grade and molecular markers such as microsatellite instability (MSI) and POLE mutations 1727.
  • Molecular Testing: Testing for Lynch syndrome and other hereditary cancer syndromes through multigene panel testing 3.
  • Imaging: Utilize imaging techniques like MRI and CT for staging and assessing extent of disease 18.
  • Cytology: Endometrial cytology can aid in diagnosis, though with variable sensitivity and specificity 28.
  • FIGO Staging: Use the updated 2023 FIGO staging system for accurate prognostic stratification 14.
  • Management

  • Surgery: Primary surgical management, including hysterectomy and lymphadenectomy, tailored by stage and histology 11113.
  • Adjuvant Therapy:
  • - Radiation Therapy: Recommended based on risk factors and surgical outcomes 6. - Systemic Therapy: Chemotherapy or targeted therapies like combination vistusertib and anastrozole for specific subtypes 9.
  • Hormonal Therapy: Considered for hormone receptor-positive tumors, particularly in advanced or recurrent settings 35.
  • HER2 Testing: Standardized testing for HER2 overexpression in serous carcinomas to guide targeted therapy 1426.
  • Special Populations

  • Pregnancy Post-Treatment: High-dose medroxyprogesterone acetate (MPA) therapy may pose risks; careful monitoring advised for subsequent pregnancies 8.
  • Elderly Patients: Management strategies should consider comorbidities and functional status, often requiring individualized treatment plans 111.
  • Key Recommendations

  • Utilize the updated 2023 FIGO staging system for accurate staging and prognostic assessment (Evidence: Strong 14).
  • Incorporate molecular testing for Lynch syndrome and other hereditary cancer syndromes in high-risk patients (Evidence: Strong 3).
  • Tailor adjuvant therapy based on surgical outcomes and risk stratification, including consideration of radiation and systemic treatments (Evidence: Moderate 69).
  • Standardize HER2 testing in serous endometrial carcinomas to identify potential targets for therapy (Evidence: Moderate 1426).
  • Monitor cardiovascular risks, particularly in the context of cardio-oncology, given potential long-term effects of treatments (Evidence: Moderate 2).
  • References

    1 Concin N, Matias-Guiu X, Cibula D, Colombo N, Creutzberg CL, Ledermann J et al.. ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025. The Lancet. Oncology 2025. link00167-6) 2 Kobayashi Y, Asai-Sato M, Kuji S, Sakai H, Yamaguchi K, Suzuki N et al.. Awareness and attitude toward cardio-oncology among Japanese gynecologic oncologists in managing patients with endometrial cancer: The Japanese Gynecologic Oncology Group (JGOG) questionnaire surveys. The journal of obstetrics and gynaecology research 2025. link 3 Hodan R, Gupta S, Weiss JM, Axell L, Burke CA, Chen LM et al.. Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric, Version 3.2024, NCCN Clinical Practice Guidelines In Oncology. Journal of the National Comprehensive Cancer Network : JNCCN 2024. link 4 Gaffney D, Suneja G, Weil C, Creutzberg C. International Federation of Gynecology and Obstetrics Endometrial 2023 Is Better For Radiation Oncology Patients. Practical radiation oncology 2024. link 5 Li X, Wen H, Xiao X, Ren Z, Tan C, Fu C. Design of a novel multi-epitope vaccine candidate against endometrial cancer using immunoinformatics and bioinformatics approaches. Journal of biomolecular structure & dynamics 2024. link 6 Harkenrider MM, Abu-Rustum N, Albuquerque K, Bradfield L, Bradley K, Dolinar E et al.. Radiation Therapy for Endometrial Cancer: An American Society for Radiation Oncology Clinical Practice Guideline. Practical radiation oncology 2023. link 7 Kertowidjojo E, Momeni-Boroujeni A, Rios-Doria E, Abu-Rustum N, Soslow RA. The Significance of International Federation of Gynecology and Obstetrics Grading in Microsatellite Instability-High and POLE-Mutant Endometrioid Endometrial Carcinoma. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2023. link 8 Oishi M, Kasuga Y, Fukuma Y, Hamuro A, Tamai J, Tanaka Y et al.. Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study. International journal of clinical oncology 2023. link 9 . Combination Vistusertib and Anastrozole Shows Benefit in Endometrial Cancer. Cancer discovery 2022. link 10 Matias-Guiu X, Selinger CI, Anderson L, Buza N, Ellenson LH, Fadare O et al.. Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2022. link 11 Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S et al.. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2021. link 12 Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S et al.. ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma. Virchows Archiv : an international journal of pathology 2021. link 13 Cuylan ZF, Akilli H, Gungorduk K, Demirkiran F, Oz M, Salman MC et al.. Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer?. The journal of obstetrics and gynaecology research 2021. link 14 Buza N. HER2 Testing in Endometrial Serous Carcinoma: Time for Standardized Pathology Practice to Meet the Clinical Demand. Archives of pathology & laboratory medicine 2021. link 15 Ireland-Jenkin K, Selinger C, Newman M. Highlighted issues from the second edition RCPA Endometrial Cancer Structured Reporting Protocol. Pathology 2020. link 16 Emiloju O, Candelario N, Dourado C. Metastatic clear cell endometrial carcinoma: an unusual cause of a common clinical presentation. BMJ case reports 2020. link 17 Niezgoda M, Kasacka I. Chromogranin A: its known and possible roles in obstetrics and gynecology. Developmental period medicine 2018. link 18 Kamran SC, Manuel MM, Catalano P, Cho L, Damato AL, Lee LJ et al.. MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer. Brachytherapy 2017. link 19 Horst KE, Modesitt SC. Hormonal Contraceptives for Endometrial Cancer Prevention in Obese and High-Risk Women in Virginia. Southern medical journal 2016. link 20 Selove W, Bradford LS, Liu Y. Assessing Residents' Frozen Section Skills for Endometrial Cancer. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2016. link 21 Thomas S, Hussein Y, Bandyopadhyay S, Cote M, Hassan O, Abdulfatah E et al.. Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma. Archives of pathology & laboratory medicine 2016. link 22 Nevadunsky NS, Van Arsdale A, Strickler HD, Spoozak LA, Moadel A, Kaur G et al.. Association Between Statin Use and Endometrial Cancer Survival. Obstetrics and gynecology 2015. link 23 Djordjevic B, Broaddus RR. Role of the clinical pathology laboratory in the evaluation of endometrial carcinomas for Lynch syndrome. Seminars in diagnostic pathology 2014. link 24 Fuhrich DG, Lessey BA, Savaris RF. Comparison of HSCORE assessment of endometrial beta3 integrin subunit expression with digital HSCORE using computerized image analysis (ImageJ). Analytical and quantitative cytopathology and histopathology 2013. link 25 McCluggage WG, Colgan T, Duggan M, Hacker NF, Mulvany N, Otis C et al.. Data set for reporting of endometrial carcinomas: recommendations from the International Collaboration on Cancer Reporting (ICCR) between United Kingdom, United States, Canada, and Australasia. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2013. link 26 Buza N, English DP, Santin AD, Hui P. Toward standard HER2 testing of endometrial serous carcinoma: 4-year experience at a large academic center and recommendations for clinical practice. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2013. link 27 Koskas M, Chabbert-Buffet N, Bendifallah S, Luton D, Clavel-Chapelon F, Rouzier R. Prognostic value of the 2009 FIGO staging for endometrial cancer: an illustration of the E3N cohort. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 2012. link 28 Yanoh K, Hirai Y, Sakamoto A, Aoki D, Moriya T, Hiura M et al.. New terminology for intrauterine endometrial samples: a group study by the Japanese Society of Clinical Cytology. Acta cytologica 2012. link 29 Fadare O, Parkash V, Dupont WD, Acs G, Atkins KA, Irving JA et al.. The diagnosis of endometrial carcinomas with clear cells by gynecologic pathologists: an assessment of interobserver variability and associated morphologic features. The American journal of surgical pathology 2012. link 30 Usubutun A, Mutter GL, Saglam A, Dolgun A, Ozkan EA, Ince T et al.. Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2012. link 31 Korczynski J, Jesionek-Kupnicka D, Gottwald L, Piekarski J. Comparison of FIGO 1989 and 2009 recommendations on staging of endometrial carcinoma: pathologic analysis and cervical status in 123 consecutive cases. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 2011. link 32 Vavilis D, Tsolakidis D, Goulis DG, Polichronou P, Kellartzis D, Tzevelekis P et al.. Hormone therapy for postmenopausal endometrial cancer survivors: a survey among Greek obstetricians-gynaecologists. European journal of gynaecological oncology 2011. link 33 Jeddi-Tehrani M, Abbasi N, Dokouhaki P, Ghasemi J, Rezania S, Ostadkarampour M et al.. Indoleamine 2,3-dioxygenase is expressed in the endometrium of cycling mice throughout the oestrous cycle. Journal of reproductive immunology 2009. link 34 Silverberg SG. The endometrium. Archives of pathology & laboratory medicine 2007. link 35 Markman M. Hormonal therapy of endometrial cancer. European journal of cancer (Oxford, England : 1990) 2005. link 36 Breitkopf DM, Smith ER, Herbert WN. Measurement of endometrial stripe thickness by obstetrics and gynecology residents. American journal of obstetrics and gynecology 2005. link 37 Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A. A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy. Journal of clinical anesthesia 2005. link 38 Luna JJ, Riesewijk A, Horcajadas JA, Van Os Rd Rd, Domínguez F, Mosselman S et al.. Gene expression pattern and immunoreactive protein localization of LGR7 receptor in human endometrium throughout the menstrual cycle. Molecular human reproduction 2004. link 39 Morrison ML, McCluggage WG, Price GJ, Diamond J, Sheeran MR, Mulholland KM et al.. Expert system support using a Bayesian belief network for the classification of endometrial hyperplasia. The Journal of pathology 2002. link 40 Jewgenow K, Meyer HH. Comparative binding affinity study of progestins to the cytosol progestin receptor of endometrium in different mammals. General and comparative endocrinology 1998. link 41 Gücer F, Reich O, Kömetter R, Pieber D. Endometroid carcinoma arising with a scar endometriosis. European journal of gynaecological oncology 1997. link 42 McLucas B. Pregnancy after endometrial ablation. A case report. The Journal of reproductive medicine 1995. link 43 Goswami S, Gollub E, Weiss DJ, Gurpide E, Roboz J, Marom Z. Characterization of a unique mucin-like glycoprotein secreted by a human endometrial adenocarcinoma cell line (Ishikawa). Experimental lung research 1994. link 44 Fleege JC, van Diest PJ, Baak JP. Quality control methods for data entry in pathology using a computerized data management system based on an extended data dictionary. Human pathology 1992. link90228-u) 45 Soper JT, Segreti EM, Novotny DB, Mutch D, Creasman WT, McCarty KS. Estrogen and progesterone receptor content of endometrial carcinomas: comparison of total tissue versus cancer component analysis. Gynecologic oncology 1990. link90143-9) 46 Raju GC, Lee YS. Immunohistochemical demonstration of renin in the endometrium. Annals of the Academy of Medicine, Singapore 1989. link 47 Chapman GW, Fabacher P, Thompson H. Incisional recurrence of endometrial adenocarcinoma. Journal of the National Medical Association 1988. link 48 Marshall RJ, Braye SG. Immunohistochemical demonstration of alpha-1-antitrypsin and alpha-1-antichymotrypsin in normal human endometrium. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 1987. link 49 Tabibzadeh SS, Mortillo S, Gerber MA. Immunoultrastructural localization of Ia antigens in human endometrium. Archives of pathology & laboratory medicine 1987. link 50 Walther MM, Nassar V, Harruff RC, Mann BB, Finnerty DP, Hewen-Lowe KO. Endometrial carcinoma of the prostatic utricle: a tumor of prostatic origin. The Journal of urology 1985. link47433-7) 51 Oud PS, Henderik JB, Beck HL, Veldhuizen JA, Vooijs GP, Herman CJ et al.. Flow cytometric analysis and sorting of human endometrial cells after immunocytochemical labeling for cytokeratin using a monoclonal antibody. Cytometry 1985. link 52 Forsman LM, Autero M, Wahlström T, Gahmberg CG, Andersson LC. Hormonally regulated expression of an apocrine epithelial antigen in the cell membranes of endometrial glands. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 1985. link 53 Brooks BJ, Lippman ME. Tamoxifen flare in advanced endometrial carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 1985. link 54 Pelusi G, Bondi A, Morichelli MP, Cavallina R, Giangaspero F, Eusebi V. Morpho-functional changes in normal cyclic endometrium. Basic and applied histochemistry 1984. link 55 Berger G, Fetissof F, Vitrey D, Chayvialle JA, Féroldi J. Endometrial carcinoma of the intestinal type. A first case report. Applied pathology 1984. link 56 Molnar JJ, Poliak A. Recurrent endometrial malakoplakia. American journal of clinical pathology 1983. link 57 Ueda S, Tsubura A, Izumi H, Sasaki M, Morii S. Immunohistochemical studies on carcinoembryonic antigen in adenocarcinomas of the uterus. Acta pathologica japonica 1983. link 58 Deppe G, Jacobs AJ, Cohen CJ. Second-look operation in endometrial cancer. Diagnostic gynecology and obstetrics 1980. link

    Original source

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      ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025.Concin N, Matias-Guiu X, Cibula D, Colombo N, Creutzberg CL, Ledermann J et al. The Lancet. Oncology (2025)
    2. [2]
      Awareness and attitude toward cardio-oncology among Japanese gynecologic oncologists in managing patients with endometrial cancer: The Japanese Gynecologic Oncology Group (JGOG) questionnaire surveys.Kobayashi Y, Asai-Sato M, Kuji S, Sakai H, Yamaguchi K, Suzuki N et al. The journal of obstetrics and gynaecology research (2025)
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      Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric, Version 3.2024, NCCN Clinical Practice Guidelines In Oncology.Hodan R, Gupta S, Weiss JM, Axell L, Burke CA, Chen LM et al. Journal of the National Comprehensive Cancer Network : JNCCN (2024)
    4. [4]
      International Federation of Gynecology and Obstetrics Endometrial 2023 Is Better For Radiation Oncology Patients.Gaffney D, Suneja G, Weil C, Creutzberg C Practical radiation oncology (2024)
    5. [5]
      Design of a novel multi-epitope vaccine candidate against endometrial cancer using immunoinformatics and bioinformatics approaches.Li X, Wen H, Xiao X, Ren Z, Tan C, Fu C Journal of biomolecular structure & dynamics (2024)
    6. [6]
      Radiation Therapy for Endometrial Cancer: An American Society for Radiation Oncology Clinical Practice Guideline.Harkenrider MM, Abu-Rustum N, Albuquerque K, Bradfield L, Bradley K, Dolinar E et al. Practical radiation oncology (2023)
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      The Significance of International Federation of Gynecology and Obstetrics Grading in Microsatellite Instability-High and POLE-Mutant Endometrioid Endometrial Carcinoma.Kertowidjojo E, Momeni-Boroujeni A, Rios-Doria E, Abu-Rustum N, Soslow RA Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (2023)
    8. [8]
      Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study.Oishi M, Kasuga Y, Fukuma Y, Hamuro A, Tamai J, Tanaka Y et al. International journal of clinical oncology (2023)
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      ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma.Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S et al. Virchows Archiv : an international journal of pathology (2021)
    13. [13]
      Is the extent of lymphadenectomy a prognostic factor in International Federation of Gynecology and Obstetrics stage II endometrioid endometrial cancer?Cuylan ZF, Akilli H, Gungorduk K, Demirkiran F, Oz M, Salman MC et al. The journal of obstetrics and gynaecology research (2021)
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      Chromogranin A: its known and possible roles in obstetrics and gynecology.Niezgoda M, Kasacka I Developmental period medicine (2018)
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      MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer.Kamran SC, Manuel MM, Catalano P, Cho L, Damato AL, Lee LJ et al. Brachytherapy (2017)
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      Assessing Residents' Frozen Section Skills for Endometrial Cancer.Selove W, Bradford LS, Liu Y International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (2016)
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      Interobserver Variability in the Diagnosis of Uterine High-Grade Endometrioid Carcinoma.Thomas S, Hussein Y, Bandyopadhyay S, Cote M, Hassan O, Abdulfatah E et al. Archives of pathology & laboratory medicine (2016)
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      Association Between Statin Use and Endometrial Cancer Survival.Nevadunsky NS, Van Arsdale A, Strickler HD, Spoozak LA, Moadel A, Kaur G et al. Obstetrics and gynecology (2015)
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      Role of the clinical pathology laboratory in the evaluation of endometrial carcinomas for Lynch syndrome.Djordjevic B, Broaddus RR Seminars in diagnostic pathology (2014)
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      Comparison of HSCORE assessment of endometrial beta3 integrin subunit expression with digital HSCORE using computerized image analysis (ImageJ).Fuhrich DG, Lessey BA, Savaris RF Analytical and quantitative cytopathology and histopathology (2013)
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      Data set for reporting of endometrial carcinomas: recommendations from the International Collaboration on Cancer Reporting (ICCR) between United Kingdom, United States, Canada, and Australasia.McCluggage WG, Colgan T, Duggan M, Hacker NF, Mulvany N, Otis C et al. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (2013)
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      Toward standard HER2 testing of endometrial serous carcinoma: 4-year experience at a large academic center and recommendations for clinical practice.Buza N, English DP, Santin AD, Hui P Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (2013)
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      Prognostic value of the 2009 FIGO staging for endometrial cancer: an illustration of the E3N cohort.Koskas M, Chabbert-Buffet N, Bendifallah S, Luton D, Clavel-Chapelon F, Rouzier R International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (2012)
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      New terminology for intrauterine endometrial samples: a group study by the Japanese Society of Clinical Cytology.Yanoh K, Hirai Y, Sakamoto A, Aoki D, Moriya T, Hiura M et al. Acta cytologica (2012)
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      The diagnosis of endometrial carcinomas with clear cells by gynecologic pathologists: an assessment of interobserver variability and associated morphologic features.Fadare O, Parkash V, Dupont WD, Acs G, Atkins KA, Irving JA et al. The American journal of surgical pathology (2012)
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      Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists.Usubutun A, Mutter GL, Saglam A, Dolgun A, Ozkan EA, Ince T et al. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc (2012)
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      Comparison of FIGO 1989 and 2009 recommendations on staging of endometrial carcinoma: pathologic analysis and cervical status in 123 consecutive cases.Korczynski J, Jesionek-Kupnicka D, Gottwald L, Piekarski J International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (2011)
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      Indoleamine 2,3-dioxygenase is expressed in the endometrium of cycling mice throughout the oestrous cycle.Jeddi-Tehrani M, Abbasi N, Dokouhaki P, Ghasemi J, Rezania S, Ostadkarampour M et al. Journal of reproductive immunology (2009)
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      A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy.Akin A, Guler G, Esmaoglu A, Bedirli N, Boyaci A Journal of clinical anesthesia (2005)
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      Gene expression pattern and immunoreactive protein localization of LGR7 receptor in human endometrium throughout the menstrual cycle.Luna JJ, Riesewijk A, Horcajadas JA, Van Os Rd Rd, Domínguez F, Mosselman S et al. Molecular human reproduction (2004)
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      Immunohistochemical demonstration of alpha-1-antitrypsin and alpha-1-antichymotrypsin in normal human endometrium.Marshall RJ, Braye SG International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (1987)
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      Immunoultrastructural localization of Ia antigens in human endometrium.Tabibzadeh SS, Mortillo S, Gerber MA Archives of pathology & laboratory medicine (1987)
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      Hormonally regulated expression of an apocrine epithelial antigen in the cell membranes of endometrial glands.Forsman LM, Autero M, Wahlström T, Gahmberg CG, Andersson LC International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists (1985)
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      Tamoxifen flare in advanced endometrial carcinoma.Brooks BJ, Lippman ME Journal of clinical oncology : official journal of the American Society of Clinical Oncology (1985)
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      Endometrial carcinoma of the intestinal type. A first case report.Berger G, Fetissof F, Vitrey D, Chayvialle JA, Féroldi J Applied pathology (1984)
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      Recurrent endometrial malakoplakia.Molnar JJ, Poliak A American journal of clinical pathology (1983)
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      Immunohistochemical studies on carcinoembryonic antigen in adenocarcinomas of the uterus.Ueda S, Tsubura A, Izumi H, Sasaki M, Morii S Acta pathologica japonica (1983)
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      Second-look operation in endometrial cancer.Deppe G, Jacobs AJ, Cohen CJ Diagnostic gynecology and obstetrics (1980)

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