Endometrial (Uterine) Cancer 2025 UPDATE

Two Onc Docs, hosted by Samantha A. Armstrong, MD, and Karine Tawagi, MD, is a podcast dedicated to providing current and future oncologists and hematologists with the knowledge they need to ace their boards and deliver quality patient care. Dr Armstrong is a hematologist/oncologist and assistant professor of clinical medicine at Indiana University Health in Indianapolis. Dr Tawagi is a hematologist/oncologist and assistant professor of clinical medicine at the University of Illinois in Chicago.

In this episode, OncLive On Air® partnered with Two Onc Docs, Tawagi and Armstrong reviewed key principles in the diagnosis and management of uterine and endometrial cancers, incorporating updates in surgical approaches, adjuvant therapy selection, molecular testing, and the management of rare uterine sarcomas. The discussion outlined the epidemiology, risk factors, clinical presentation, diagnostic evaluation, staging, histologic classification, and treatment algorithms relevant to board preparation and clinical practice.

They discuss how uterine cancer most commonly presents with postmenopausal vaginal bleeding, which occurs in approximately 90% of patients. Other symptoms may include vaginal discharge, pelvic pain or pressure, and altered bowel habits. Established risk factors include obesity, unopposed estrogen exposure, tamoxifen use, polycystic ovarian syndrome, infertility, prior pelvic radiation, and hereditary cancer syndromes such as Lynch syndrome. Endometrial biopsy remains the diagnostic gold standard, and staging is based on the extent of uterine involvement, regional spread, and distant metastasis.

The majority of endometrial cancers are endometrioid carcinomas (type 1), whereas type 2 cancers—such as uterine serous carcinoma, clear cell carcinoma, and grade 3 endometrioid carcinoma—are typically more aggressive and require more intensive treatment. Surgery, generally total hysterectomy with bilateral salpingo-oophorectomy, is the mainstay for localized disease. Adjuvant therapy is determined by stage, histology, and risk category: low-risk patients may not require additional treatment, while higher-risk cases may receive brachytherapy, external beam radiation therapy (EBRT), chemotherapy, or combined-modality approaches.