Watch: the CureRays® explainer series
Prefer to read? The full guide below is complete on its own, with tables you can revisit any time.
What is uterine (endometrial) cancer?
The uterus (womb) is the organ where a baby grows, and its inner lining is called the endometrium. Most uterine cancers begin in this lining. The most common early warning sign is abnormal vaginal bleeding — especially any bleeding after menopause — which leads many women to see a doctor while the cancer is still confined to the uterus and highly curable. It is the most common gynecologic cancer in the United States, and risk is linked to factors that raise estrogen exposure, including obesity.
The main types
Doctors group uterine (endometrial) cancer by where it starts and how it behaves:
| Type | What it means, simply |
|---|---|
| Endometrioid adenocarcinoma | By far the most common type; usually slower-growing and often found early through abnormal bleeding. |
| Serous & clear cell carcinoma | Less common, more aggressive types that need closer attention and often more treatment. |
| Uterine sarcoma | A rarer cancer that starts in the muscle wall of the uterus rather than the lining, and behaves differently. |
Staging, in plain terms
Gynecologic cancers use the FIGO system, which (like TNM) describes how deeply the cancer has grown into the uterus and how far it has spread. The tumor's grade and molecular features now also guide treatment.
| FIGO / TNM | What it generally means |
|---|---|
| Stage I | Cancer is confined to the uterus. The large majority of cases — and very often cured with surgery alone. |
| Stage II | Spread to the cervix (the neck of the uterus) but no further. |
| Stage III | Spread beyond the uterus to nearby structures such as the ovaries, vagina, or pelvic lymph nodes. |
| Stage IV | Spread to the bladder or bowel lining, or to distant organs. Treated with combinations of surgery, medicine, and radiation. |
The standard of care
Uterine (Endometrial) Cancer is almost always treated by a team that may include a surgeon, a medical oncologist, and a radiation oncologist, combining therapies for the best result. The usual building blocks are:
Surgery
The main treatment — removing the uterus, cervix, and usually the tubes and ovaries (hysterectomy), often with lymph-node sampling to check for spread.
Radiation therapy
After surgery, radiation lowers the chance the cancer returns in the pelvis. It may be internal (brachytherapy), external, or both, depending on risk.
Systemic medicine
Chemotherapy for higher-risk or advanced disease, plus newer immunotherapy and targeted drugs guided by the tumor's molecular profile.
How radiation treatment works
Radiation uses focused high-energy x-rays to damage cancer-cell DNA so the cells can no longer divide. Healthy cells repair this damage better than cancer cells, so treatment clears cancer while sparing normal tissue. Brachytherapy places the radiation source right where the risk is, delivering a strong local dose while limiting exposure elsewhere. Treatments are painless and brief; side effects can include temporary bladder or bowel changes and vaginal dryness, which the care team helps manage.
The main ways radiation is delivered for uterine (endometrial) cancer:
Vaginal brachytherapy
Places a radiation source briefly inside the vagina to treat the area where cancer is most likely to recur, with few side effects and a short schedule.
External-beam radiation (IMRT/IGRT)
Treats the whole pelvis when lymph nodes are involved or risk is higher, shaping the dose to protect the bladder and bowel.
Definitive radiation
For women who cannot have surgery, radiation — often combining external and internal techniques — can treat the cancer directly.
Latest studies shaping care
Care keeps improving — often toward getting the same excellent results with less burden on patients. A few developments:
Molecular classification guides treatment: Sorting endometrial cancer into molecular groups (such as POLE-mutated or p53-abnormal) helps spare some women extra treatment while intensifying it for others who need it.[1]
PORTEC-4a and TCGA-based studies
Immunotherapy added to chemotherapy: Adding immunotherapy to chemotherapy improved outcomes for advanced or recurrent endometrial cancer, especially tumors with mismatch-repair deficiency.[2]
NRG-GY018 / RUBY trials
Vaginal brachytherapy alone for many: For most high-intermediate-risk cancers, internal radiation alone controls the disease as well as whole-pelvic radiation, with fewer side effects.[3]
PORTEC-2 long-term results
Common questions
I have bleeding after menopause — should I worry? Any bleeding after menopause should be checked promptly. It is often something benign, but it is also the most common early sign of uterine cancer, and catching it early makes it very curable.
Will radiation make me feel sick? Most women tolerate it well. Vaginal brachytherapy in particular has few side effects; external radiation may cause temporary bowel or bladder changes and fatigue that settle after treatment.
Do I always need chemo and radiation after surgery? No. Many early uterine cancers are cured by surgery alone. Added treatment is tailored to your stage, grade, and increasingly the tumor's molecular features.
References
Numbered sources for the studies cited above. Links open the primary publication on PubMed or the publisher’s site.