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Health condition · Clinically reviewed

Endometrial cancer, the most common gynaecological cancer — modern molecular staging.

Postmenopausal bleeding is the classic presentation. Modern molecular classification (POLE, MMR-deficient, p53) guides treatment. Most cases caught early are curable with surgery.

Jump to treatment See red-flag symptoms
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, BGCS or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on molecular subtyping, sentinel-node biopsy and modern immunotherapy.

Key facts

Endometrial cancer at a glance.

The essentials, in plain English — what it is, how common it is, how it’s diagnosed in the UK today, and how treatment is chosen.

  • What it is

    Endometrioid adenocarcinoma is the most common — serous and clear-cell subtypes behave more aggressively.

  • How common

    Around 9,700 new cases each year in the UK — the most common gynaecological cancer.

  • Classic presentation

    Postmenopausal bleeding is the hallmark symptom and always warrants urgent 2-week-wait referral.

  • Molecular classification

    POLE, dMMR, p53-abnormal and NSMP subtypes are now standard and guide adjuvant treatment.

  • Mainstay treatment

    Total hysterectomy with bilateral salpingo-oophorectomy, with or without lymph-node assessment.

  • Advanced disease

    Immunotherapy — pembrolizumab, lenvatinib and dostarlimab — has transformed outcomes in dMMR disease.

Why this guide matters

Caught early, endometrial cancer is curable.

Postmenopausal bleeding is the earliest warning. Molecular subtyping now personalises treatment — most women diagnosed early are cured with surgery alone.

  • Postmenopausal bleeding is a red flag

    Any bleeding after the menopause needs urgent gynaecology review — always via a 2-week-wait pathway.

  • Molecular subtype changes treatment

    POLE, dMMR, p53 and NSMP tumours behave differently — subtyping decides how much adjuvant therapy is needed.

  • Immunotherapy has changed advanced disease

    Pembrolizumab, lenvatinib and dostarlimab have transformed outcomes in advanced and recurrent endometrial cancer.

How the diagnosis is made

From first bleed to a clear plan.

The 2-week-wait pathway UK gynae-oncology teams follow, in order — so you know what to expect and why.

  1. 01

    Assessing

    Symptom review

    A careful history of bleeding patterns — especially any bleeding after the menopause — starts the pathway.

  2. 02

    Assessing

    Transvaginal ultrasound

    A TVUS measures endometrial thickness — >4 mm postmenopausal is the standard threshold for further work-up.

  3. 03

    Assessing

    Endometrial biopsy (Pipelle)

    An outpatient Pipelle biopsy samples the endometrial lining and is the first tissue diagnosis in most women.

  4. 04

    Confirming

    Hysteroscopy + biopsy

    If the Pipelle is inconclusive or focal disease is suspected, hysteroscopy with directed biopsy is the next step.

  5. 05

    Confirming

    MRI pelvis (T-stage)

    A pelvic MRI shows depth of myometrial invasion and cervical or nodal involvement — key for staging.

  6. 06

    Planning

    Molecular subtyping

    Tumour tissue is tested for POLE mutations, mismatch-repair (MMR) status, p53 and NSMP — the modern molecular classification.

  7. 07

    Planning

    Gynae-oncology MDT

    A specialist multi-disciplinary team combines stage, grade and molecular subtype into a personalised treatment plan.

Typical timeline: 2–6 weeks from first bleed to a treatment plan.

Symptoms

What endometrial cancer actually shows up as.

Bleeding is the dominant symptom — especially after the menopause. Here is what to watch for and when to act urgently.

  • Postmenopausal bleeding

    Any vaginal bleeding after the menopause is endometrial cancer until proved otherwise — always seek prompt review.

  • Intermenstrual bleeding

    Bleeding between periods, particularly in women over 45, warrants gynaecological assessment.

  • Heavy menstrual bleeding

    New heavy or prolonged periods in the perimenopausal years should not be dismissed.

  • Persistent discharge

    Persistent watery, blood-stained or offensive discharge can be an early sign, especially after the menopause.

  • Pelvic pain (advanced)

    Persistent pelvic or lower-back pain can occur with locally advanced disease.

  • Weight loss

    Unexplained weight loss with bleeding or pelvic symptoms warrants urgent investigation.

  • Lynch syndrome family history

    A family history of Lynch syndrome raises endometrial cancer risk and changes surveillance.

  • Red flag

    Postmenopausal bleeding — always a 2-week-wait referral. Treat as endometrial cancer until proved otherwise.

Treatment

How endometrial cancer is treated in the UK.

Surgery is the mainstay for most women. Adjuvant radiotherapy, chemotherapy and modern immunotherapy are added based on stage, grade and molecular subtype.

  • Total hysterectomy + BSO

    Removal of the uterus, cervix, fallopian tubes and ovaries — the mainstay of curative treatment for early-stage disease.

  • Sentinel lymph-node biopsy

    Targeted sampling of the first-draining pelvic node — increasingly used in place of full lymphadenectomy.

  • Adjuvant vaginal brachytherapy

    A short course of internal radiotherapy that reduces vaginal-vault recurrence in intermediate-risk disease.

  • Adjuvant pelvic radiotherapy

    External-beam radiotherapy to the pelvis for higher-risk disease, sometimes combined with chemotherapy.

  • Adjuvant chemotherapy

    Carboplatin and paclitaxel are used for high-risk histologies and node-positive or advanced disease.

  • Progestin (fertility preservation)

    For very early, low-grade disease in women wishing to preserve fertility, high-dose progestin can be considered.

  • Pembrolizumab + lenvatinib

    A combination immunotherapy and targeted therapy used in advanced or recurrent endometrial cancer.

  • Dostarlimab (dMMR advanced)

    An anti-PD-1 immunotherapy licensed for mismatch-repair-deficient advanced or recurrent endometrial cancer.

What this guide is based on

The sources behind every number on this page.

UK and European guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynae-oncology team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Endometrial cancer guidance and 2-week-wait referral criteria.

  • British Gynaecological Cancer Society (BGCS). Uterine cancer guidelines.

  • Peaches Womb Cancer Trust. Patient information and support resources.

  • European Society for Medical Oncology (ESMO). Endometrial cancer clinical practice guidelines.

Red flags

When endometrial cancer becomes an emergency.

Most endometrial cancer is caught early and cured. These are the situations where you should act today — before, during or after treatment.

  • Postmenopausal bleeding

    Any bleeding after 12 months without periods needs urgent 2-week-wait gynaecological assessment.

  • Endometrial thickness >4 mm

    A postmenopausal endometrial thickness >4 mm on TVUS requires further work-up with biopsy.

  • Bowel or bladder invasion

    New rectal bleeding, obstructive symptoms or haematuria in known endometrial cancer needs urgent imaging.

  • Post-op VTE

    Calf swelling, chest pain or breathlessness after pelvic surgery — seek same-day assessment for DVT or PE.

  • Neutropenic sepsis

    Fever, shivering or unwell feeling during chemotherapy — call the 24-hour oncology hotline immediately.

  • Lynch syndrome cascade

    A Lynch-associated endometrial cancer should trigger genetic counselling for relatives and colonoscopic surveillance.

  • Recurrent endometrial cancer

    New vaginal bleeding, pelvic pain or unexplained symptoms after treatment — arrange urgent gynae-oncology review.

  • Post-radiotherapy complications

    New bowel, bladder or vaginal symptoms months after pelvic radiotherapy warrant specialist assessment.

  • Palliative-stage crisis

    Uncontrolled bleeding, pain or new neurological symptoms in advanced disease — contact the palliative or oncology team urgently.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — monitoring, side effects, bone health and specialist follow-up.

A quiet reminder

Ask about pelvic-health rehabilitation early.

Pelvic-floor physio, vaginal-health support and menopause management all work best when they’re set up from the start.

  1. 01 Monitoring

    Follow-up is symptom-led

    Regular clinic review with a focus on symptoms — bleeding, pain, bowel or bladder change — matters more than routine scans.

  2. 02 Side effects

    Menopause and pelvic recovery

    Surgical menopause and radiotherapy effects both need active management — ask about HRT, vaginal moisturisers and pelvic health.

  3. 03 Bone health

    Bones after early menopause

    A DEXA scan and calcium / vitamin D advice are important after early surgical or treatment-induced menopause.

  4. 04 Reviews

    Structured gynae-oncology follow-up

    Planned clinic reviews with your gynae-oncology team keep recurrence detection and side-effect care on track.

Frequently asked

Everything we get asked about endometrial cancer.

Quick answers on postmenopausal bleeding, biopsy, molecular subtyping, surgery and immunotherapy.

  • What is endometrial cancer?

    Endometrial cancer is a cancer of the lining of the womb (endometrium). Endometrioid adenocarcinoma is the most common type — serous and clear-cell subtypes are less common and behave more aggressively. It is the most common gynaecological cancer in the UK, with around 9,700 new cases each year.

  • What is the classic symptom?

    Postmenopausal bleeding — any vaginal bleeding after 12 months without periods — is the classic presentation. It should always be treated as endometrial cancer until proved otherwise, and warrants urgent 2-week-wait referral.

  • What is molecular subtyping?

    Modern endometrial cancer is now classified into four molecular groups — POLE (very good prognosis), mismatch-repair-deficient (dMMR), p53-abnormal (higher risk) and no-specific-molecular-profile (NSMP). The subtype guides how much adjuvant treatment is needed.

  • What surgery is done?

    The mainstay is total hysterectomy with bilateral salpingo-oophorectomy — removal of the womb, cervix, tubes and ovaries. Sentinel lymph-node biopsy is increasingly used to check pelvic nodes without full lymphadenectomy.

  • Can fertility be preserved?

    In very carefully selected women with very early, low-grade endometrioid disease who wish to preserve fertility, high-dose progestin therapy can be considered under specialist gynae-oncology care, with close monitoring.

  • What role does immunotherapy play?

    Immunotherapy has transformed outcomes in advanced or recurrent disease — pembrolizumab combined with lenvatinib is used in advanced endometrial cancer, and dostarlimab is licensed for mismatch-repair-deficient (dMMR) advanced or recurrent disease.

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