Who is at risk
- Excess oestrogen without progesterone is the common thread through almost every risk factor below.
- Obesity — fat tissue makes oestrogen, so risk rises substantially with weight. This is the biggest modifiable factor and largely explains why rates are climbing.
- Never having been pregnant, early first period, or late menopause — all mean more lifetime oestrogen exposure.
- Polycystic ovary syndrome and chronic anovulation.
- Tamoxifen for breast cancer, and oestrogen-only hormone therapy without progesterone in a woman who still has her uterus.
- Type 2 diabetes and high blood pressure.
- Lynch syndrome — a genetic condition carrying a high lifetime risk. Endometrial cancer is often the first cancer a woman with Lynch develops, which makes its diagnosis a signal for the whole family.
- Prior pelvic radiation. Note that combined oral contraceptives and pregnancy both lower risk.
Finding it early
There is no screening test for uterine or endometrial cancer — no Pap test equivalent, and pelvic ultrasound is not recommended for screening women at average risk. What this cancer has instead is an early warning sign that works.
Any bleeding after menopause is abnormal until proven otherwise. Not spotting that is "probably nothing." Not "just once." Around 90% of women with endometrial cancer have abnormal bleeding, and it usually appears while the cancer is still confined to the uterus — which is why two thirds are caught at that stage. This is the single most important sentence on this page.
Before menopause, watch for bleeding between periods, periods that become much heavier or longer, or bleeding after sex. Persistent watery or blood-tinged discharge, pelvic pain and pain during sex also warrant assessment.
If you have Lynch syndrome, the risk is high enough that surveillance and risk-reducing surgery after childbearing are discussed — this is the one group where active screening is offered.
How it’s diagnosed
The usual sequence is transvaginal ultrasound to measure the endometrial lining, then an endometrial biopsy — a sample taken in the clinic, usually in a few minutes. It is crampy rather than painful for most women, though it can hurt; ask about pain relief beforehand rather than enduring it silently.
If the biopsy is inconclusive or bleeding continues despite a normal result, hysteroscopy with dilation and curettage under anaesthetic gives a fuller sample. Continued bleeding after a normal biopsy still needs investigating — a normal result does not close the question.
Every endometrial cancer should be tested for mismatch repair (MMR/MSI) status. It identifies women who may have Lynch syndrome — with implications for their children and siblings — and predicts response to immunotherapy. Molecular classification (POLE, p53, MMR) is increasingly used to decide who needs additional treatment.
Staging explained simply
Uterine cancer is staged surgically — the true stage is known after the operation, when the uterus and sampled lymph nodes are examined. Many centres now use sentinel lymph node mapping, sampling only the first draining node rather than removing many, which sharply reduces the risk of permanent leg swelling (lymphoedema). It is worth asking whether your surgeon does this.
| Stage | What it means in plain words |
|---|---|
| Stage I | Confined to the body of the uterus. Most cases are found here. |
| Stage II | Has grown into the cervix but not outside the uterus. |
| Stage III | Spread beyond the uterus — to ovaries, tubes, vagina, or pelvic lymph nodes. |
| Stage IV | Invades bladder or bowel, or has spread to distant organs. |
Grading and biology
Grade matters more here than in most cancers, and it is worth knowing yours. Grade 1 and 2 endometrioid cancers are usually slow-growing and oestrogen-driven, often cured by surgery alone. Grade 3 and the non-endometrioid types — serous, clear cell and carcinosarcoma — behave aggressively even when they look early, and are treated much more intensively.
These are sometimes described as Type 1 (oestrogen-driven, better outlook) and Type 2 (not oestrogen-driven, worse outlook). Type 2 cancers are disproportionately common in Black women, which is part of why uterine cancer mortality is substantially higher in Black women — a disparity that is real, under-discussed and not explained by biology alone.
Molecular classification (POLE-mutated, MMR-deficient, p53-abnormal, no specific profile) is now guiding treatment: POLE-mutated cancers do unusually well and may need less treatment, while p53-abnormal ones need more.
How it’s treated
Surgery is the primary treatment — removal of the uterus, cervix, tubes and ovaries, with lymph node assessment. Minimally invasive (laparoscopic or robotic) surgery is standard for most and means faster recovery.
Radiation is a major part of care here. After surgery, vaginal brachytherapy — a short course delivering radiation from inside the vagina, usually three to five brief outpatient sessions — substantially lowers the risk of the cancer returning at the vaginal cuff, with far fewer side effects than treating the whole pelvis. For higher-risk disease, external pelvic radiation is added, sometimes with chemotherapy. For women who cannot have surgery, radiation alone can be curative.
Chemotherapy is used for higher-risk and advanced disease. Immunotherapy has changed the outlook for MMR-deficient advanced cancers dramatically, and immunotherapy combinations are now standard in advanced disease.
Fertility-sparing treatment with progestin therapy is possible for carefully selected young women with early, low-grade disease who want to conceive — it requires close monitoring and definitive surgery afterwards, but it exists. Ask if it applies to you.
Where CureRays fits: vaginal brachytherapy and pelvic radiation are core radiation oncology work, and the difference between a well-planned and an adequate course shows up years later in bowel, bladder and sexual function.
What the guidelines say
In broad strokes: stage surgically with sentinel node mapping where possible; test every tumour for mismatch repair status; use molecular classification to guide how much treatment is needed; give vaginal brachytherapy for intermediate-risk disease and pelvic radiation with or without chemotherapy for higher risk; and treat advanced disease with chemotherapy plus immunotherapy, guided by MMR status.
Your team will follow national guidelines such as those from the National Comprehensive Cancer Network (NCCN). The above is a plain-language overview of the general approach, not the guideline itself. NCCN publishes free NCCN Guidelines for Patients®.
Outcomes and odds of cure
Source: NCI SEER Cancer Stat Facts: Uterine Cancer, SEER 21 (excluding IL), 2015–2021. SEER reports uterine and endometrial cancer together; endometrial cancer makes up the large majority of cases.
| When it is found | Share of cases | 5-year relative survival |
|---|---|---|
| Localized — confined to the uterus | 67% | 95.1% |
| Regional — spread to nearby lymph nodes | 18% | 70.0% |
| Distant — spread to other organs | 11% | 19.4% |
| Unstaged | 4% | 58.8% |
These are population statistics from the National Cancer Institute's SEER program. They describe large groups of people, not any one person, and lag current treatment by several years. They cannot predict what will happen to you.
One trend deserves saying plainly: uterine cancer is one of the few cancers where both new cases and deaths are rising — incidence up about 0.7% a year and death rates up about 1.6% a year (SEER, through 2023). Rising obesity accounts for much of the incidence; the mortality rise is driven partly by more aggressive subtypes, and it falls hardest on Black women. This is not a reason for alarm about your own case — it is a reason to take postmenopausal bleeding seriously and to insist on prompt evaluation.
Side effects and how we watch for them
Surgery brings immediate menopause if the ovaries are removed before natural menopause — hot flushes, sleep disruption, bone and cardiovascular effects. This deserves a proper conversation, not a leaflet. Lymphoedema of the legs is the other main long-term risk, and sentinel node mapping reduces it.
Vaginal brachytherapy is generally well tolerated: some urinary irritation and vaginal dryness or narrowing. Using a vaginal dilator or remaining sexually active after treatment genuinely prevents narrowing — this is under-discussed because it is awkward, and it matters.
Pelvic radiation adds bowel urgency and diarrhoea during treatment, usually settling afterwards; a minority have lasting bowel changes.
How it is assessed: graded on a standard scale at each visit. Report new leg swelling, persistent diarrhoea, or bleeding.
Follow-up, remission and survivorship
Remission means no detectable cancer. Most recurrences appear within the first three years, and the vaginal cuff is the most common site — which is treatable, and often curable, when caught early.
Follow-up is mostly clinical: examination every 3–6 months for two to three years, then less often. Routine imaging is not needed for everyone. Any new vaginal bleeding after treatment should be reported straight away.
Survivorship covers menopausal symptoms, bone density, sexual health and vaginal function, lymphoedema care, and weight and diabetes management — which affects both recurrence risk and everything else. If your tumour was MMR-deficient, ask about genetic counselling: Lynch syndrome has real consequences for your relatives.
Questions people actually ask
I spotted once after menopause and it stopped. Do I still need checking?
Yes. Any bleeding after menopause needs evaluation, even a single episode that settles. It is most often something benign — but it is also the main way this cancer announces itself early, and the stakes of ignoring it are high.
Is a hysterectomy always necessary?
For most, yes — surgery is the primary treatment. Selected young women with early, low-grade disease who want to conceive may be offered progestin therapy with close monitoring instead, followed by surgery later. Ask whether you qualify.
What is brachytherapy like?
A short applicator is placed in the vagina and radiation is delivered for a few minutes, usually three to five times as an outpatient. There is no anaesthetic for most protocols and you go home the same day. Side effects are far milder than whole-pelvis radiation.
Will I need chemotherapy too?
It depends on grade, subtype, stage and molecular features. Many women with early low-grade disease need surgery alone or surgery plus brachytherapy. Higher-grade or advanced disease usually involves chemotherapy.
Why does my doctor want genetic testing?
Because endometrial cancer is often the first cancer a woman with Lynch syndrome develops. Finding it changes screening for you — and for your children and siblings, who may not know they are at risk.
Related pages
Keep Endometrial Cancer Away® — endometrial cancer is the most common type of uterine cancer, covered in more detail there. See also Keep Cervical Cancer Away® and Keep Ovarian Cancer Away®.
Informational only, not medical advice — confirm with your care team.
Go deeper on uterine cancer
Read the full plain-language guide, or ask our team about vaginal brachytherapy.