What the diagnosis means
Endometrial cancer arises in the lining of the uterus. Most are endometrioid adenocarcinomas linked to oestrogen exposure (obesity, diabetes, late menopause, no pregnancies); a smaller group of high-grade types (serous, clear cell, carcinosarcoma) behave more aggressively. Diagnosis is by ultrasound and endometrial biopsy; staging is surgical, supported by MRI or CT.
Modern pathology adds a molecular classification — POLE-mutated, mismatch-repair deficient (dMMR), p53-abnormal, or "no specific molecular profile" — which predicts risk of recurrence and response to treatment. Ask whether this has been done on your specimen.
Where medical oncology fits
- Surgery (removal of uterus, ovaries and tubes, with lymph-node assessment) by a gynaecological oncologist is the main treatment and is curative for most early-stage disease.
- After surgery, depending on stage, grade and molecular type: no further treatment, radiation (external or vaginal brachytherapy) by the radiation oncologist, chemotherapy, or a combination. Medical oncology provides chemotherapy for high-risk and stage III–IV disease.
- Advanced or recurrent disease: chemotherapy with immunotherapy (particularly effective for dMMR cancers), immunotherapy combinations, or hormone therapy for low-grade, hormone-receptor-positive cancers — a gentle, tablet-based option for suitable patients.
What to expect
Adjuvant chemotherapy is typically four to six three-weekly cycles; side effects include hair loss, tiredness, nausea, nerve tingling and low blood counts. Immunotherapy adds immune-related effects that are monitored with blood tests. Follow-up examinations continue for several years; vaginal bleeding after treatment always needs review.
Questions to ask
- What is my stage, grade and molecular type, and what risk group does that put me in?
- After surgery, do I need radiation, chemotherapy, both, or neither?
- If the cancer is advanced: is immunotherapy or hormone therapy an option for my type?
- Should I be tested for Lynch syndrome (if dMMR)?
- How will treatment affect my weight, diabetes and heart health?
Preparing for your consultation
Bring the biopsy and surgical pathology reports (including molecular results), MRI/CT reports, and a medicine list including hormone treatments. Note diabetes, blood pressure and weight history — they influence treatment choices.