Endometrial cancer

Last updated: October 19, 2023

Summarytoggle arrow icon

Endometrial cancer is the most common cancer of the female genital tract in the US, with a peak incidence between 55 and 64 years of age. It is divided into two types based on histological characteristics; type I cancers account for 80% of all endometrial cancers and are of endometrioid origin, while type II cancers primarily originate from serous or clear cells. Although several risk factors are associated with the development of endometrial cancer, the most important of these is long-term exposure to unopposed estrogen levels, especially in type I cancer. Painless, abnormal uterine bleeding (AUB) is the main symptom and often manifests in the early stages of the disease. In later stages, pelvic pain and a palpable mass may be present. Most patients with suspected endometrial cancer undergo transvaginal ultrasound followed by an endometrial biopsy to confirm the diagnosis; however, an endometrial biopsy may also be performed as the initial study. Additional imaging studies (e.g., CT, MRI, or PET/CT scan) may be ordered by a specialist for the detection of metastases. Treatment and surgical staging typically involve a total hysterectomy with bilateral salpingo-oophorectomy, lymphadenectomy, and peritoneal washings. In patients with cancer confined to the endometrium and myometrium, further treatment is generally not required; if cancer has advanced, surgery is combined with radiotherapy, hormone therapy, and/or chemotherapy. The prognosis is usually favorable in cancers diagnosed at an early stage.

Definitiontoggle arrow icon

Etiologytoggle arrow icon

Type I endometrial cancer

Type II endometrial cancer

Risk factors for estrogen-dependent tumors

Protective factors

Low estrogen and high progestin or progesterone levels have a protective effect.

In patients who have a history of smoking, studies have shown a decreased incidence of type I endometrial cancer but an increased incidence of type II endometrial cancer. [4]

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Clinical featurestoggle arrow icon

Localized disease [4]

The majority of endometrial cancers are diagnosed at an early stage and have a good prognosis. [4]

Regional extension [4][8]

  • Pelvic pain
  • Vaginal mass and/or bleeding
  • Abnormalities on cervix
  • Abdominal distension
  • Changes in bowel and/or bladder function

Endometrial cancer may have both locoregional extension and contiguous spread to the cervix, vagina, fallopian tubes, and/or ovaries. [8]

Metastatic disease [4][8]

Diagnosticstoggle arrow icon

Approach [4][6][9]

Transvaginal ultrasonography [4][10]


Potential findings

Endometrial biopsy with histology [4][12]


Procedures for endometrial sampling [4][13]

Potential findings

30–40% of women with endometrial hyperplasia with atypia have a concomitant adenocarcinoma. [6]

Genetic studies [18]

Staging studies [4][8]

  • All patients: MRI pelvis (with and without IV contrast) to determine locoregional extension and assess for myometrial invasion
  • Patients with high-grade tumors or symptoms suggestive of metastatic disease: Further imaging is recommended. [4][8]
    • MRI abdomen with and without IV contrast
    • CT chest, abdomen, and pelvis with IV contrast
    • PET/CT scan
  • Patients who undergo surgery: surgical staging including lymphadenectomy [4]

More than 70% of cases of endometrial cancer are detected when the disease is confined to the uterus. [4]

Pathologytoggle arrow icon

Endometrioid adenocarcinoma [5]

Tumors of nonendometrioid histology

Stagestoggle arrow icon

2023 International Federation of Gynecology and Obstetrics (FIGO) surgical staging of endometrial cancer [22]
FIGO stage Anatomical involvement


  • IIA: Infiltration of the cervix with no evidence of extrauterine extension
  • IIB: Extensive lymphovascular space involvement
  • IIC: aggressive histology in a cancer that has invaded myometrium



Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

General principles [4][25]

Disease confined to the endometrium and myometrium

Postmenopausal patients and patients who do not wish to preserve fertility [4][18][25]

Adjuvant treatment is not normally required for this group, but radiotherapy should be considered for high-risk patients (i.e., those with high-grade disease, invasion of the lymphovascular space or outer third of the myometrium). [4]

Patients wishing to preserve fertility [4][18][25]

  • Uterine preservation may be possible for women who wish to carry a pregnancy in the future. ; [4]
    • May be considered for early-stage endometrial carcinoma
    • Usually consists of progestins
    • After childbearing is complete, definitive surgical therapy is usually recommended because of the risk of disease recurrence.
  • Hysterectomy with ovarian preservation can be used for patients willing to use a surrogate. [18]

Treatment with progestins may also be considered for patients who are not suitable candidates for surgery because of medical comorbidities. [4][25]

Lymph node involvement or locally advanced disease [4][18][25]

Metastatic disease [4][18][25]

Follow uptoggle arrow icon

  • Follow-up visits should occur: [4]
    • Every 3–6 months for the first 2 years
    • Every 6 months for the next 3 years
    • Then annually
  • At each visit obtain: [4]
  • Imaging is not required as part of routine screening but should be requested if disease recurrence is suspected. [4]
  • Address underlying risk factors (see “Prevention of endometrial cancer”) and provide postcancer treatment care. [4]

A Pap smear should not be used to assess for endometrial cancer recurrence, as it has not been shown to improve the detection of local recurrence and may yield false-positive results. [26]

Complicationstoggle arrow icon

  • Pyometra [27]

We list the most important complications. The selection is not exhaustive.

Prognosistoggle arrow icon

Preventiontoggle arrow icon

Referencestoggle arrow icon

  1. Burke, William MD et al.. ACOG Practice Bulletin No. 149 Endometrial Cancer. Obstetrics & Gynecology. 2015; 125 (4): p.1006-1026.doi: 10.1097/ . | Open in Read by QxMD
  2. Temkin SM, Tanner EJ, Dewdney SB, Minasian LM. Reducing Overtreatment in Gynecologic Oncology: The Case for Less in Endometrial and Ovarian Cancer. Front Oncol. 2016; 6: p.118.doi: 10.3389/fonc.2016.00118 . | Open in Read by QxMD
  3. Berek JS, Matias‐Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet. 2023; 162 (2): p.383-394.doi: 10.1002/ijgo.14923 . | Open in Read by QxMD
  4. National Cancer Institute Cancer Stat Facts: Uterine Cancer. Updated: January 1, 2020. Accessed: October 4, 2020.
  5. Braun MM, Overbeek-Wagner EA, Grumbo RJ. Diagnosis and management of endometrial cancer. Am Fam Physician. 2016; 93 (6): p.468-474.
  6. Setiawan VW, Yang HP, Pike MC, et al. Type I and II Endometrial Cancers: Have They Different Risk Factors?. Journal of Clinical Oncology. 2013; 31 (20): p.2607-2618.doi: 10.1200/jco.2012.48.2596 . | Open in Read by QxMD
  7. Xu WH, Zheng W, Xiang YB, et al. Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study. BMJ. 2004; 328 (7451): p.1285.doi: 10.1136/ . | Open in Read by QxMD
  8. Shifren JL, Gass MLS. The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Menopause. 2014; 21 (10): p.1038-1062.doi: 10.1097/gme.0000000000000319 . | Open in Read by QxMD
  9. Reinhold C, Ueno Y, Akin EA, et al. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer. JACR. 2020; 17 (11): p.S472-S486.doi: 10.1016/j.jacr.2020.09.001 . | Open in Read by QxMD
  10. American Congress of Obstetricians and Gynecologists. Committee Opinion No. 557: Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women. Obstet Gynecol. 2013.doi: 10.1097/01.AOG.0000428646.67925.9a . | Open in Read by QxMD
  11. Burke WM, Orr J, Leitao M, et al. Endometrial cancer: A review and current management strategies: Part I. Gynecol Oncol. 2014; 134 (2): p.385-392.doi: 10.1016/j.ygyno.2014.05.018 . | Open in Read by QxMD
  12. ACOG COMMITTEE OPINION. ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstetrics & Gynecology. 2018; 131 (5): p.e124-e129.doi: 10.1097/aog.0000000000002631 . | Open in Read by QxMD
  13. Buchanan EM, Weinstein LC, Hillson C. Endometrial Cancer. Am Fam Physician. 2009; 80 (10): p.1075-1080.
  14. Sorosky JI. Endometrial Cancer. Obstet Gynecol. 2012; 120 (2, Part 1): p.383-397.doi: 10.1097/aog.0b013e3182605bf1 . | Open in Read by QxMD
  15. Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women.. Am Fam Physician. 2019; 99 (7): p.435-443.
  16. Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Updated: January 1, 2014. Accessed: February 21, 2018.
  17. Parkash V, Fadare O, Tornos C, McCluggage WG. Committee Opinion No. 631: Endometrial Intraepithelial Neoplasia. Obstet Gynecol. 2015; 126 (4): p.897.doi: 10.1097/aog.0000000000001071 . | Open in Read by QxMD
  18. Buhtoiarova TN, Brenner CA, Singh M. Endometrial Carcinoma. Am J Clin Pathol. 2015; 145 (1): p.8-21.doi: 10.1093/ajcp/aqv014 . | Open in Read by QxMD
  19. Brooks RA, Fleming GF, Lastra RR, et al. Current recommendations and recent progress in endometrial cancer. CA Cancer J Clin. 2019.doi: 10.3322/caac.21561 . | Open in Read by QxMD
  20. Ismail MS, Ismael R, Ikram I, Alkhalifa M, Hsu S, et al.. A comparison of various endometrial cancer management guidelines. Cancer Rep Rev. 2021.doi: 10.15761/CRR.1000228 . | Open in Read by QxMD
  21. Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022; 33 (9): p.860-877.doi: 10.1016/j.annonc.2022.05.009 . | Open in Read by QxMD
  22. Lawrence J, Richer L, Arseneau J, et al. Mismatch Repair Universal Screening of Endometrial Cancers (MUSE) in a Canadian Cohort. Curr Oncol. 2021; 28 (1): p.509-522.doi: 10.3390/curroncol28010052 . | Open in Read by QxMD
  23. Koskas M, Amant F, Mirza MR, Creutzberg CL. Cancer of the corpus uteri: 2021 update. Int J Gynaecol Obstet. 2021; 155 (S1): p.45-60.doi: 10.1002/ijgo.13866 . | Open in Read by QxMD
  24. Lien W-C, Ong A-W, Sun J-T, et al. Pyometra: a potentially lethal differential diagnosis in older women. Am J Emerg Med. 2010; 28 (1): p.103-105.doi: 10.1016/j.ajem.2009.08.024 . | Open in Read by QxMD
  25. Smith RA, von Eschenbach AC, Wender R, et al. American Cancer Society Guidelines for the Early Detection of Cancer: Update of Early Detection Guidelines for Prostate, Colorectal, and Endometrial Cancers. CA Cancer J Clin. 2001; 51 (1): p.38-75.doi: 10.3322/canjclin.51.1.38 . | Open in Read by QxMD
  26. Munro MG, Critchley HOD, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011; 113 (1): p.3-13.doi: 10.1016/j.ijgo.2010.11.011 . | Open in Read by QxMD
  27. Gale A, Dey P. Postmenopausal bleeding. Menopause Int. 2009; 15 (4): p.160-164.doi: 10.1258/mi.2009.009039 . | Open in Read by QxMD
  28. Skeel RT, Khleif SN. Handbook of Cancer Chemotherapy. Lippincott Williams & Wilkins ; 2011

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