Uterine cancer (also called endometrial cancer) begins in the lining of the uterus—the organ where a baby grows during pregnancy. It's one of the most common gynecologic cancers, and many cases are caught early because abnormal bleeding is an early warning sign. Treatment often involves surgery, and many people have excellent outcomes when diagnosed early.

What This Is

The uterus has an inner lining called the endometrium. Uterine cancer usually starts in these lining cells. Most cases (about 80%) are adenocarcinomas. Rarer types include sarcomas (which start in the muscle layer). About 66,200 new cases are diagnosed in the US each year, making it the fourth most common cancer in women.

Key Terms to Know

  • Endometrium: The inner lining of the uterus.
  • Adenocarcinoma: Cancer that starts in gland-like cells; most common type of uterine cancer.
  • Hysterectomy: Surgical removal of the uterus.
  • Salpingo-oophorectomy: Surgical removal of the fallopian tubes and ovaries.
  • MSI-H/dMMR: Genetic markers that can predict response to immunotherapy.
  • Hormone therapy: Treatment with hormones like progestin to slow or stop cancer growth.

Risk Factors

  • Obesity and overweight: Excess body fat increases estrogen levels; highest risk factor.
  • Unopposed estrogen: Estrogen without progestin increases risk.
  • Type 2 diabetes: Associated with obesity and hormonal changes.
  • Polycystic ovary syndrome (PCOS): Chronic hormonal condition increases risk.
  • Tamoxifen: Breast cancer treatment can increase uterine cancer risk.
  • Lynch syndrome: Hereditary condition that increases cancer risk.
  • Age: Risk increases with age; most cases occur after age 50.

Symptoms and Diagnosis

Early signs:

  • Abnormal vaginal bleeding or spotting (especially after menopause)
  • Abnormal vaginal discharge
  • Pelvic pain or pressure

Abnormal bleeding after menopause is not normal and should always be evaluated.

Diagnosis involves:

  • Pelvic exam and ultrasound: To visualize the uterus and endometrium.
  • Endometrial biopsy: A small tissue sample is taken and examined.
  • Imaging (CT or MRI): To check if cancer has spread.

Staging

Uterine cancer is staged I–IV:

  • Stage I: Cancer is in the uterus only.
  • Stage II: Cancer has spread to the cervix but not beyond the uterus.
  • Stage III: Cancer has spread to nearby tissues or lymph nodes.
  • Stage IV: Cancer has spread to distant organs.

Five-year survival rates are approximately 95% for stage I, 70% for stage II, 60% for stage III, and 17% for stage IV. Your individual prognosis depends on specific factors—discuss this with your oncology team.

Treatment Options

Surgery

Hysterectomy (removal of the uterus) is usually the first treatment. Depending on stage and grade:

  • Total hysterectomy: Removal of uterus and cervix.
  • Bilateral salpingo-oophorectomy: Removal of fallopian tubes and ovaries; reduces estrogen and hormone-receptor cancer recurrence.
  • Lymph node removal or sampling: To stage the cancer.

Chemotherapy

Used for more advanced or high-risk cancers:

  • Carboplatin + paclitaxel: Standard regimen for advanced uterine cancer.
  • Chemotherapy may be given before surgery or after to reduce recurrence risk.

Radiation Therapy

Used alone or with chemotherapy for intermediate-risk or advanced disease to reduce recurrence.

Hormone Therapy

Progestin therapy may be used for early-stage, low-grade cancers or for advanced disease.

Immunotherapy

For tumors with MSI-H (microsatellite instability high) or dMMR (deficient mismatch repair) status, immunotherapy drugs like pembrolizumab are increasingly used.

Common Side Effects and Management

  • Hot flashes and night sweats: Common after ovary removal; managed with medications or lifestyle approaches.
  • Vaginal dryness: Use vaginal lubricants; topical estrogen may be safe in some cases.
  • Fatigue: Very common; pacing, exercise, and rest help.
  • Nausea and vomiting (from chemotherapy): Anti-nausea medications prevent most cases.
  • Nerve pain (neuropathy): May occur with certain chemotherapy drugs; usually improves over time.

Questions to Ask Your Doctor

  • What is the grade and stage of my cancer?
  • Do I need a hysterectomy? If yes, should my ovaries be removed?
  • Will I need chemotherapy or radiation? Why or why not?
  • Can my tumor be tested for MSI-H or dMMR status?
  • What are my recurrence risks?
  • What side effects should I expect?
  • How will we monitor for recurrence?
  • Are there clinical trials available?

When to Seek Urgent Care

  • Severe abdominal pain or bloating
  • Heavy vaginal bleeding or large blood clots
  • Signs of infection (fever ≥101.5°F, chills)
  • Severe shortness of breath

Sources and References

  • National Cancer Institute. "Uterine Cancer—Patient Version." PDQ. cancer.gov
  • American Cancer Society. "Uterine Cancer (Endometrial Cancer)." cancer.org
  • NCCN Clinical Practice Guidelines in Oncology: "Uterine Neoplasms." Version 2.2024.
  • SGO Clinical Practice Statement. "Management of Endometrial Cancer." Gynecologic Oncology. 2024.

Last reviewed: February 2026. This page is not medical advice. Always discuss diagnosis, treatment, and prognosis with your healthcare team.