Uterine Cancer

Endometrioid carcinoma

The most common type. Often low grade, with proteins called hormone receptors that can respond to hormones. Its behaviour ranges from lower risk to high risk.

Serous carcinoma

Usually high risk, often with abnormal p53, a protein involved in controlling cell growth. Spread to the abdominal lining can occur even with a small womb tumour. Testing for human epidermal growth factor receptor 2 (HER2), a growth-related protein, may guide treatment.

Clear cell carcinoma

An uncommon type, generally treated as high risk. The stage and molecular test results help shape treatment.

Carcinosarcoma

A high-risk cancer with a mixture of cell appearances, including areas that resemble sarcoma. It is generally treated as endometrial cancer.

Undifferentiated or dedifferentiated

Rare cancers that can grow quickly. A specialist should review the tissue and molecular test results.

Uterine sarcoma

Starts in muscle or supporting tissue, such as leiomyosarcoma or stromal sarcoma. These cancers have different staging and medicine treatment from those described here.

Age and menopause

Risk rises with age; most cases are diagnosed after menopause.

Report any postmenopausal bleeding promptly.

Excess body fat

Fat tissue increases exposure to oestrogen. Higher body fat is an important risk factor that can sometimes be changed.

Avoid blame. Safe activity and weight support help overall health at any stage.

Unopposed oestrogen

Oestrogen without adequate progestogen can stimulate the endometrium.

Use menopausal hormones only with appropriate medical advice.

Irregular ovulation

Polycystic ovary syndrome (PCOS), long gaps between periods, an early first period, late menopause or never having been pregnant can increase exposure to oestrogen over a lifetime.

Persistent abnormal bleeding still needs assessment.

Diabetes and metabolic health

Diabetes and related metabolic factors are associated with higher risk.

Manage blood sugar, blood pressure and heart health with your care team.

Tamoxifen

It lowers breast-cancer recurrence but slightly raises endometrial cancer risk.

Do not stop it yourself. Report bleeding; routine ultrasound without symptoms is not usually useful.

Lynch syndrome

An inherited change in a mismatch-repair gene can greatly increase womb and bowel cancer risk.

Tumour MMR testing and genetic counselling can identify families at risk.

MRI pelvis

How deeply has cancer entered the womb muscle? Has it reached the cervix or nearby pelvic tissue?

Very small areas of cancer, including tiny deposits in lymph nodes, may be missed.

CT chest, abdomen and pelvis

Are lymph nodes enlarged? Has cancer spread to the lungs, liver, abdominal lining or other distant sites?

Normal-sized lymph nodes can contain cancer. Tiny deposits on the abdominal lining may not show up.

Positron emission tomography with CT (PET-CT)

Uses a radioactive glucose-like tracer, fluorodeoxyglucose (FDG), to highlight active areas. Often used for staging when the risk of spread is higher, and to assess suspected cancer recurrence.

Not needed for every early cancer. Very small deposits or cancers that take up little tracer may be missed.

Chest imaging

Is there lung disease when full CT is not otherwise indicated?

A plain X-ray is less sensitive than CT.

Blood count and chemistry

Is there anaemia? Are kidney and liver function, blood sugar and body salts suitable for surgery or treatment with medicines?

Blood tests cannot diagnose or stage the tumour by themselves.

Cancer antigen 125 (CA-125)

This blood protein may help monitor selected high-risk or advanced cancers if it is raised before treatment.

It can be normal despite cancer, or raised for reasons unrelated to cancer.

Histology

Endometrioid, serous, clear cell, carcinosarcoma, undifferentiated or another type. Unusual diagnoses may need expert review.

Grade

How closely the tumour resembles normal glands. Endometrioid cancers are usually graded 1, 2 or 3; high-risk histologies are treated differently.

Myometrial invasion

How far cancer has grown into the womb muscle. Growth into less than half the muscle thickness carries different risks from growth into half or more.

Cervical stromal invasion

Cancer has entered the supportive tissue of the cervix, not merely surface glands.

Lymphovascular space invasion (LVSI)

Cancer cells are seen in small lymph or blood vessels. A small amount (focal) and a larger amount (substantial) carry different risks.

Nodes

Which lymph nodes were checked and whether they contain isolated cancer cells, small deposits (micrometastases) or larger deposits (macrometastases).

Cut edges and areas outside the womb

Whether cancer reaches a cut edge (margin), the womb’s outer surface, tubes, ovaries, vagina, abdominal lining, the fatty layer covering abdominal organs (omentum), or another sampled site.

Molecular markers

MMR/MSI, p53 and POLE, with ER and HER2 when relevant. The team combines these with other findings to estimate risk.

MMR / MSI

MMR-proficient (pMMR) means the repair proteins are present; in MMR-deficient (dMMR) cancer, one or more are missing.

The related MSI test checks short, repeated DNA sequences: microsatellite-stable (MSS) means they remain stable, while MSI-high (MSI-H) means many have changed.

Helps identify who needs assessment for Lynch syndrome. A dMMR or MSI-H result predicts a greater chance of benefit from checkpoint immunotherapy in advanced cancer.

POLE

Whether a cancer-related change was found in the gene’s proofreading region

Certain POLE changes signal a very favourable early-stage outlook and may support less treatment after surgery.

p53

Normal (wild-type) or abnormal protein staining; the report may describe the specific abnormal pattern

An abnormal result usually indicates a higher risk of cancer returning and affects staging and treatment decisions.

ER / PR

How many cells show hormone receptors and how strongly they stain

Helps identify low-grade, slower-growing advanced or recurrent cancers that may respond to hormone treatment, also called endocrine therapy.

HER2

A tissue-staining (IHC) score from 0 to 3+. An unclear 2+ result often needs an in-situ hybridisation test to check for extra HER2 gene copies.

Can support HER2-targeted therapy, especially in serous carcinoma or carcinosarcoma and selected recurrent tumours.

Next-generation sequencing (NGS)

Tests many tumour genes together for changes or joined genes (fusions). Some panels also measure tumour mutational burden (TMB), the number of DNA changes in the cancer.

May find rare treatment targets, such as fusions involving neurotrophic tyrosine receptor kinase (NTRK) genes, or help identify a suitable clinical trial. Enough good-quality tissue is needed.

Treatment

A device placed inside the womb that releases levonorgestrel, a progesterone-like hormone (progestin), is often preferred. Progestin tablets may be used alone or with the device.

Response check

Repeat endometrial sampling every 3 to 6 months. Imaging and symptoms are reviewed; ultrasound alone is not enough.

Pregnancy

Once repeat tissue tests show no remaining cancer (a complete response), fertility treatment may help shorten the time to pregnancy. Work with a fertility specialist.

Definitive surgery

Removal of the womb is advised after childbearing, if cancer grows, or if tests do not show a complete response within an agreed 6 to 12 months.

Can it be removed safely?

Scans, examination, fitness for an anaesthetic and whether all cancer can be removed

Surgery through small cuts for most cancers limited to the womb; a larger operation or treatment in steps for selected advanced cancers.

How likely is the cancer to return?

FIGO stage, histology, grade, invasion, LVSI, nodes, margins, POLE, MMR, p53 and ER

Monitoring alone, internal radiation to the upper vagina (vaginal brachytherapy), radiation to the pelvis, cancer medicines or a combination.

Is fertility preservation safe?

Grade 1 endometrioid cancer, no growth into womb muscle or spread elsewhere, review of molecular and inherited risk, and reliable follow-up

Temporary treatment with a progesterone-like hormone (progestin), with repeat biopsies, then surgery after childbearing or if treatment does not work well enough.

If cancer is advanced or recurrent?

Symptoms and current fitness, how quickly and where the cancer is growing, previous treatment, and molecular markers such as MMR status, ER and HER2

Treatment directed at a limited area of returning cancer, or medicines that work throughout the body (systemic therapy), chosen using molecular results. Symptom support starts early.

First day

Pain control, clot prevention, urine catheter as needed, fluids, breathing exercises and early walking.

Tell the team if pain, nausea or dizziness prevents movement.

Going home

Wound and vaginal-discharge advice, bowel plan, activity restrictions and emergency contacts.

Walk regularly; avoid heavy lifting and driving until advised.

Next weeks

Tiredness usually improves gradually. The team reviews the final tissue report and decides whether further treatment is needed.

Ask when work, exercise and sexual activity can resume.

Low risk

No further cancer treatment; follow-up appointments and support with recovery.

Certain POLE changes and low-grade cancers limited to the womb often fall in this group.

Intermediate

Internal radiation to the upper vagina may be considered. Monitoring without further treatment is also reasonable for selected lower-risk patients.

Age, grade, LVSI, node staging, molecular group and patient preference.

High-intermediate

Radiation from a machine outside the body is often recommended to reduce the risk of cancer returning in the pelvis. Internal vaginal radiation or monitoring may suit selected people whose lymph nodes are clear.

Substantial lymphovascular space invasion (LVSI), cervical involvement, grade, nodes, MMR and the full risk assessment.

High risk

Chemotherapy and pelvic radiotherapy, given sequentially or in a combined programme; chemotherapy with or without brachytherapy is an alternative.

Stage, any cancer remaining after surgery, p53 or other high-risk findings, overall health and ability to manage treatment side effects.

Selected stage III–IVA MMR-deficient cancers after surgery

After complete removal of the cancer, chemotherapy with an immune checkpoint inhibitor may be considered, with radiotherapy according to the risk assessment.

This is a specific treatment-after-surgery recommendation. Options for advanced or recurrent cancer in both MMR groups are described below.

Tiredness, diarrhoea, cramps, frequent or burning urination, skin irritation and temporarily reduced blood cell production.

Vaginal narrowing or dryness, bowel or bladder changes, fractures in weakened pelvic bones, lymphoedema and, rarely, tissue injury.

Hydration, symptom medicines, skin care and nutrition support can keep treatment on schedule.

Vaginal moisturisers, a dilator to help keep the vagina open if advised, physiotherapy for pelvic muscles, bone-health care and prompt review of bleeding or pain.

Carboplatin

Low blood counts, infection, bruising, kidney function, nausea and allergy. Effects on blood cell production may build up over several cycles.

Paclitaxel

Nerve damage causing tingling or numbness in the hands or feet (peripheral neuropathy), hair loss, muscle or joint pain, low blood counts and reactions during an infusion.

Checkpoint inhibitor

The immune system can inflame healthy organs, including the bowel, lungs, liver, kidneys, skin and hormone-producing glands. See “Managing side effects” for symptoms that need a prompt call.

Chemoradiotherapy

Chemotherapy and radiotherapy may be given together or in a planned sequence. Bowel, bladder, blood-count and fatigue effects can overlap; the team plans monitoring and symptom support.

MMR-deficient / MSI-high

Carboplatin-paclitaxel plus dostarlimab, pembrolizumab or durvalumab, followed by checkpoint-inhibitor maintenance.

Benefit is particularly large in dMMR cancer. The suitable medicine, length of treatment and availability vary.

MMR-proficient, fit for chemotherapy

Carboplatin and paclitaxel with pembrolizumab or dostarlimab, followed by continued immunotherapy as maintenance.

MMR-proficient disease can benefit, although the benefit is generally smaller than in dMMR disease. Discuss the expected benefit and side effects for you.

Another option for MMR-proficient cancer

Durvalumab with carboplatin-paclitaxel followed by durvalumab plus olaparib maintenance.

For pMMR cancer that has not grown during initial chemotherapy with durvalumab. Maintenance includes both durvalumab and olaparib; this differs from the dMMR regimen.

HER2 3+ serous or carcinosarcoma

Carboplatin and paclitaxel with trastuzumab is an option for selected advanced or recurrent cancers.

Heart-function monitoring and checks for infusion reactions are needed. The team considers whether this or an immunotherapy-based combination is more suitable.

HER2 IHC 3+ cancer after previous treatment

Trastuzumab deruxtecan (T-DXd; Enhertu) is an option for adults whose cancer cannot be removed by surgery or has spread, after previous systemic treatment, when no satisfactory alternative is available.

The HER2 tissue-staining score must be IHC 3+. T-DXd is an antibody–drug conjugate that carries chemotherapy to target cells. It is different from trastuzumab and is not a routine treatment after curative surgery. Lung, heart and blood-count monitoring are needed.

Small amount of slow-growing, ER-positive cancer

Hormone treatment may be preferred when cancer is slow growing or causes no symptoms.

Improvement is usually slower, so check carefully for symptoms or signs that cancer is growing.

dMMR/MSI-H; no previous checkpoint immunotherapy

Dostarlimab or pembrolizumab given on its own is a preferred option after platinum chemotherapy.

Immune-related side effects. A previous organ transplant or an illness in which the immune system attacks the body may affect suitability.

pMMR/MSS; no previous checkpoint immunotherapy

Pembrolizumab plus lenvatinib is an established post-platinum option.

High blood pressure, diarrhoea, tiredness, weight loss, thyroid changes, protein leaking into the urine and immune-related side effects. Dose changes are common.

Checkpoint already used

Options may include another course of platinum chemotherapy, doxorubicin, weekly paclitaxel, hormone treatment, HER2-targeted treatment or a clinical trial, depending on previous treatment and test results.

The chance of shrinking the cancer is often modest. Discuss whether the likely benefit is worth the treatment burden, alongside care focused on symptoms and comfort.

Local or limited recurrence

Surgery, radiotherapy, stereotactic treatment or ablation can be considered by a specialist MDT.

The team needs to assess all important cancer sites and the risk of lasting treatment effects.

Progestin therapy

Low-grade, ER/PR-positive, low-volume endometrioid cancer; also used in fertility-sparing care.

Appetite or weight change, fluid retention and clot risk; response monitoring is essential.

Aromatase inhibitor

Slow-growing, ER-positive cancer after menopause; sometimes chosen because its side effects may be easier to manage.

Joint pain, bone loss, hot flushes and usually modest response rates.

Tamoxifen-based sequence

Selected hormone-sensitive disease after discussion of alternatives.

Blood clots and effects on the womb lining. The treatment schedule differs from its use in breast cancer.

Trastuzumab

HER2-positive serous carcinoma or carcinosarcoma, commonly with carboplatin-paclitaxel.

Heart-function monitoring and infusion reactions.

Trastuzumab deruxtecan (Enhertu)

Previously treated HER2 IHC 3+ advanced cancer, with the eligibility criteria described above.

Lung inflammation (interstitial lung disease) can be serious or fatal. New cough, breathlessness or fever needs urgent review. Heart function and blood counts are monitored. Nausea and infusion reactions can also occur.

Rare fusion target

A confirmed NTRK or other treatable gene fusion may allow a medicine selected by the gene change rather than where the cancer started, or a clinical trial.

These findings are very uncommon. Confirm the gene change and that the treatment’s eligibility criteria are met.

Every visit

Bleeding, pain, bowel and bladder symptoms, intake, weight, activity, neuropathy, immune symptoms, blood pressure and treatment goals.

Blood tests

Counts, kidney and liver function, electrolytes; thyroid and endocrine tests with immunotherapy; urine protein with lenvatinib.

Imaging

Usually CT at agreed intervals, or sooner if symptoms worsen. The team compares the same cancer areas over time, including changes that cannot be measured precisely.

Cancer antigen 125 (CA-125)

Useful only when elevated and informative at baseline. A trend cannot replace scans and clinical assessment.

At progression

Confirm that cancer has grown, review the treatment taken and its side effects, and re-check biomarkers when useful. Discuss further options and trials while you are well enough to consider them.

Hormone glands: thyroid, pituitary or adrenal

New severe fatigue, dizziness, headache, confusion, low blood pressure, marked weight change, heat or cold intolerance.

Lung inflammation

New cough, breathlessness, chest pain or falling oxygen level.

Bowel inflammation

Persistent diarrhoea, blood or mucus, severe cramps, fever or inability to keep fluids down.

Liver or pancreas

Yellow eyes, dark urine, severe upper-abdominal pain, vomiting or major liver-test changes.

Kidney

Reduced urine, swelling, blood-test change or unexplained dehydration.

Skin, nerves or heart

Widespread rash or blistering, weakness, numbness, drooping eyelids, chest pain, palpitations or fainting.

Infection or low counts

Check temperature as instructed; hand hygiene; do not take leftover antibiotics.

Fever at or above the centre's threshold, chills, confusion or feeling suddenly very unwell.

Nausea or poor intake

Take anti-sickness medicines on schedule; small frequent food and fluids; dietitian review.

Persistent vomiting, dehydration, very little urine or inability to take medicines.

Nerve symptoms (neuropathy)

Report tingling, numbness, pain, poor balance or difficulty with tasks such as fastening buttons before the next dose.

Rapid weakness, falls or loss of bladder/bowel control.

Clot

Stay mobile as able; use prescribed prevention after surgery; know personal risk.

One swollen painful leg, chest pain, coughing blood or sudden breathlessness.

Bleeding

Track amount and pattern; check blood count and treat the source.

Soaking pads rapidly, large clots, dizziness, fainting or shortness of breath.

Bowel or urinary change

Drink as advised, follow your bowel-care plan and ask about pelvic-muscle support. The team may need to check for infection or a blockage.

Severe pain, blood, inability to pass urine or stool, or a swollen abdomen with vomiting.

Bleeding

Radiotherapy, cancer medicines, a procedure to block bleeding blood vessels (embolisation), surgery or other local treatment, depending on the cause and severity.

Pain or pressure

Pain medicines, radiotherapy, cancer medicines, procedures to reduce nerve pain, and treatment of constipation or a blockage.

Bowel or urinary obstruction

A tube to hold a passage open (stent), an operation to create another route for urine or stool, or symptom medicines. Discuss the goal and how long the benefit may last.

Ascites or fluid

Draining the fluid, medicines for symptoms, nutrition support and cancer treatment when suitable.

Surgical menopause

Removal of both ovaries before natural menopause causes menopause straight away. Discuss hot flushes, sleep, mood, bone and heart health, and sexual wellbeing. Hormone therapy needs an individual review of your cancer risk.

Vaginal dryness

Regular vaginal moisturiser, lubricant for sexual activity and review for local oestrogen or non-hormonal prescription options when appropriate.

Vaginal narrowing after radiotherapy

Dilator programme when advised, moisturiser, pelvic-floor therapy and gradual return to comfortable sexual activity.

Pelvic-floor symptoms

Specialist physiotherapy for urinary urgency or leakage, bowel control, pelvic pain and sexual function.

Lymphoedema

Early assessment for persistent leg, groin or genital swelling; skin care, compression, exercise and specialist therapy.

Fertility loss and grief

Fertility counselling, psychological support and space to discuss identity, relationships and family-building options.