Endometrial Cancer Diagnosis and Management

Endometrial cancer is the most common gynaecological malignancy in high-income regions and presents most often in post-menopausal women with abnormal uterine bleeding. Initial assessment relies on transvaginal ultrasound to evaluate endometrial thickness, followed by diagnostic endometrial biopsy or hysteroscopic sampling to obtain histopathological confirmation. Tumours are classified by histological subtype, grade and depth of myometrial invasion, with the presence of lymphovascular space invasion and cervical stromal involvement guiding risk stratification. Recent advances have integrated molecular classification—based on POLE exonuclease‐domain mutations, mismatch repair deficiency and p53 abnormalities—into traditional staging systems to refine prognostic groups and personalise adjuvant therapy. Primary management for early-stage disease remains total hysterectomy with bilateral salpingo-oophorectomy, often supplemented by sentinel lymph node mapping to reduce surgical morbidity. Adjuvant radiotherapy or chemoradiotherapy is directed by stage and risk factors, while progestin therapy offers a fertility-sparing option in selected low-grade tumours. In advanced or recurrent disease, systemic chemotherapy and targeted agents tailored to molecular alterations are under investigation. Multidisciplinary teams now incorporate imaging, pathology, molecular diagnostics and patient factors to balance oncological control with preservation of quality of life.

Research from Nature Portfolio

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Endometrial Cancer Diagnosis and Management publication trend

The graph below shows the total number of articles in endometrial cancer diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Cervicovaginal lavage (CVL): A minimally invasive method of collecting fluid from the cervix and vagina for biomarker analysis.

α-Ketoglutarate (αKG): A central metabolic intermediate that can modulate chromatin-associated enzyme activity and gene expression.

Progestin resistance: The failure of endometrial cancer cells to respond to progesterone-based hormonal therapy.

Lymphovascular space invasion (LVSI): Presence of tumour cells within lymphatic or blood vessel channels, indicating higher risk of spread.

Molecular classification: Categorisation of endometrial cancers based on genomic features such as POLE mutations, mismatch repair deficiency and p53 status to inform prognosis and treatment.

References

1. Phosphorylation of IDH1 Facilitates Progestin Resistance in Endometrial Cancer. Advanced Science (2024).
2. Cervicovaginal lavages uncover growth factors as key biomarkers for early diagnosis and prognosis of endometrial cancer. Molecular Biomedicine (2024).
3. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Gynecological Cancer (2020).
4. FIGO staging of endometrial cancer: 2023. International Journal of Gynecology & Obstetrics (2023).
5. Assessment of Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging. JAMA Surgery (2021).
6. Pathologic Prognostic Factors in Endometrial Carcinoma (Other Than Tumor Type and Grade). International Journal of Gynecological Pathology (2018).
7. Adjuvant therapy for endometrial cancer in the era of molecular classification: radiotherapy, chemoradiation and novel targets for therapy. International Journal of Gynecological Cancer (2020).