Endometrial (Uterine) Cancer Treatments: Stage, Risk Features, and Modern Systemic Options

Endometrial cancer (sometimes called uterine cancer) is often diagnosed earlier than many other cancers, but treatment still varies widely based on stage, tumor grade, and pathology risk features. This guide explains how teams build a plan and why molecular testing is increasingly part of care.

Important: This is educational information, not medical advice. Your plan depends on tumor type, grade, stage, molecular features, overall health, and your preferences.

60-second orientation

Many endometrial cancers are found early because abnormal bleeding prompts evaluation.
Surgery is often the first step and can be curative in early-stage disease.
Some patients need additional therapy after surgery based on risk features:
- radiation (local control),
- systemic therapy (medicines) in higher-risk situations.
Molecular testing is increasingly used to refine risk and guide treatment in selected settings.

Key terms (defined once)

Endometrium: the lining of the uterus; endometrial cancer starts here.
Grade: how aggressive the tumor looks under a microscope.
Stage: how far the cancer has spread.
Adjuvant therapy: treatment after surgery to reduce recurrence risk.
Systemic therapy: medicine that treats the whole body.
MMR (mismatch repair): a DNA repair system; tumors with deficiency can behave differently and may respond better to immunotherapy.

Step 1: stage and pathology drive the plan

Common early-stage pathway

Many patients have:

surgery first (often hysterectomy and staging assessment)
then a decision about whether additional therapy is needed based on pathology findings

Higher-risk or advanced disease

Some patients need:

combinations of radiation and systemic therapy
careful sequencing based on spread pattern and tumor biology

Ask: “Based on my stage and pathology, am I low-risk or higher-risk for recurrence?”

Step 2: surgery (often foundational)

Surgery can:

remove the primary tumor
provide staging information
guide whether additional therapy is beneficial

A useful question: “What did surgery/pathology show that changes what we do next?”

Step 3: radiation (local control tool)

Radiation may be used:

to reduce local recurrence risk after surgery in selected cases
for symptom relief or local control in certain advanced settings

Ask: “What is radiation trying to prevent or treat in my case?”

Step 4: systemic therapy (when risk is higher or disease is advanced)

Systemic therapy may include:

chemotherapy in selected higher-risk settings
targeted and immune approaches in biomarker-defined contexts

The exact plan depends on tumor subtype, grade, stage, and molecular features.

Molecular testing: why it’s showing up more

Endometrial cancer is increasingly described not only by microscope features but also by molecular categories that can influence:

prognosis discussions
intensity of adjuvant therapy decisions
systemic therapy options in advanced disease

Ask: “Was molecular testing done, and does it change my risk category or treatment options?”

What’s changing now (the themes)

More biology-driven treatment: molecular features are increasingly used to refine treatment intensity.
Modern immunotherapy roles: immunotherapy is especially relevant in selected biomarker-defined groups, and combinations are actively evolving.
Better survivorship planning: managing long-term effects and follow-up is getting more standardized.

Questions to ask your care team (high value)

What type and grade of endometrial cancer do I have?
What stage is it, and what’s the goal right now?
What pathology risk features were found (and what do they imply)?
Do I need radiation and/or systemic therapy after surgery?
Was MMR or other molecular testing done, and does it change options?
How will we monitor for recurrence, and what symptoms should prompt a call?
If the cancer returns, what are the next 2–3 options?