Disease overview
Endometrial Cancer
Disease Overview
The NHS England Endometrial Cancer Audit Pilot (ECAP) audit referenced on this page has been funded by GSK by the provision of a grant, GSK has had no editorial input or control over the audit or its outputs
Uterine cancer, of which endometrial cancer is the most common type, is the fourth most common cancer in women in the UK, with approximately 10,200 new cases and 2,700 deaths per year1
The most common symptom of endometrial cancer is unusual vaginal bleeding, including postmenopausal bleeding or spotting, significant changes in the menstrual cycle or spotting between periods. These and other symptoms of endometrial cancer may resemble those of many other conditions2
The lifetime risk of endometrial cancer in women is approximately 1 in 39 (~3%). Risk factors include increased exposure to unopposed oestrogen (for example longer menstrual lifespan, or use of oestrogen-only hormone-replacement therapy [HRT]), obesity, and certain medical conditions such as polycystic ovary syndrome and diabetes. Up to 34% of endometrial cancer cases in the UK are preventable3
A reduction in the risk of endometrial cancer is seen in women who have had a higher number of pregnancies, were of an older age at their last birth, experienced earlier menopause, or have a history of using oral contraceptives or intrauterine devices3
In women presenting with symptoms or history suspicious for endometrial cancer, the diagnostic approach usually consists of transvaginal ultrasound (TVS), hysteroscopy and endometrial biopsy 4
More than 71% of women diagnosed with endometrial cancer in the UK survive their disease by ≥10 years.1 The 5-year survival rates decrease with increasing stage at diagnosis, from 90% for Stage 1 to 15% for Stage 45
Approximately 10–15% of women diagnosed with endometrial cancer will experience recurrence following remission6,7
Uterine cancer is the fourth most common cancer in women in the UK, with approximately 10,200 new cases (5% of all new female cancer cases) and 2,700 deaths per year.1 Endometrial cancer is the most common type of uterine cancer, accounting for ≥90% of cases.8
Age
Incidence rates of endometrial cancer in the UK are highest in patients aged 70-74 years, with 28% of cases diagnosed in those aged ≥75 years. However, rates in younger patients are increasing; since the 1990s, diagnosis rates have increased by 61% in the 25−49 years age group and by 37% in the 50–59 years age group.9
Ethnicity and social deprivation
Relative to their representation in the general population in the UK, the prevalence of endometrial cancer is disproportionately high among younger Asian and Black women.10
In the UK, social deprivation is more common in younger age groups of women diagnosed with endometrial cancer compared with older age groups of women.10
Future projection
Since the early 1990s, uterine cancer incidence rates have increased by 58% in women in the UK. Over the past 10 years, incidence rates of uterine cancer in the UK have increased by 3%.9
Endometrial cancer incidence rates in the UK are projected to decrease by 2% from 2024–2026 to 2038–2040, from 29.3 to 28.7 cases per 100,000 women per year.9
Symptoms of endometrial cancer
Endometrial cancer symptoms can vary, and some women may not experience symptoms until the cancer has reached an advanced stage.4
The most common symptom of endometrial cancer is unusual vaginal bleeding:2,11
Figure 1. Symptoms of endometrial cancer.
Risk factors of endometrial cancer
Approximately 30–40% of endometrial cancers can be attributable to modifiable risk factors, with obesity as the largest contributor (26–34%) of attributable risk.12
Common risk factors include:13
- Increasing age
- Obesity/high body mass index
- Diabetes
- Prolonged unopposed oestrogen exposure (e.g., use of HRT, nulliparity, longer menstrual lifecycle)
- Family history/genetic syndromes (e.g. Lynch syndrome)
Diagnostic investigations of endometrial cancer
Patients with suspected or confirmed endometrial cancer should be assessed by a gynaecological oncology team.4 The assessment of a woman presenting with suspicion of possible endometrial cancer usually involves:4
- A detailed medical and gynaecological history
- Blood tests, as appropriate, including a full blood count
- Abdominal, speculum and pelvic examination
- Imaging with TVS, including assessment of endometrial thickness
- Outpatient endometrial biopsy and/or hysteroscopy with biopsy, depending on feasibility of outpatient biopsy, presenting symptoms, and additional risk factors.
- Hysteroscopy should be considered for women with persistent symptoms despite negative outpatient biopsy, pre-menopausal women with heavy menstrual bleeding, or recurrent post-menopausal bleeding. Depending on local pathways, hysteroscopy may be offered to any woman with endometrial thickness >4mm.
Endometrial cancer is classified based on histology, molecular features, grade and stage.12,14–17 In recent years, molecular classification has been integrated into the traditional histopathological classification of endometrial cancer.14,17
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Molecular classification of endometrial cancer
Molecular classification of endometrial cancer
In 2013, The Cancer Genome Atlas (TCGA) established the heterogeneity of endometrial tumours, identifying four distinct molecular subtypes:14,18
- POLE-ultramutated
- Microsatellite instability hypermutated
- Copy-number low (endometrioid)
- Copy-number high (serous-like)
Figure 2. Mutation spectra across endometrial carcinoma molecular classifications.14
Image adapted from Cancer Genome Atlas Research Network, 2013. -
Histological subtypes of endometrial cancer
Histological subtypes of endometrial cancer
Endometrial cancer can be classified into two major histological subtypes:12,19
1. Endometrioid carcinomas
- The most common subtype, accounting for 75–80% of cases
- Well differentiated (usually low grade)
- Usually associated with a better prognosis than non-endometrioid carcinomas
2. Non-endometrioid carcinomas
- Account for approximately 20–25% of endometrial cancer cases
- Include serous carcinoma, clear cell tumours, carcinosarcomas and other more rare subtypes
- Typically, these are more aggressive and carry a worse prognosis than endometrioid carcinomas
Figure 3. Distribution of morphology groups among women diagnosed with endometrial cancer in the UK, from 2017–2019, by age at diagnosis.10
Adapted from NHS England, 2025. -
Staging of endometrial cancer
Staging of endometrial cancer
The International Federation of Gynaecology and Obstetrics (FIGO) developed a standardised staging system for endometrial cancer used to describe the extent of tumour spread to guide prognosis and treatment.16,17
FIGO Stage I: Confined to uterus and ovary
FIGO Stage II: Cervical stroma invasion or substantial LVSI or aggressive histology with myometrial invasion
FIGO Stage III: Local/regional spread
FIGO Stage IV: Spread to bladder mucosa, intestinal mucosa, and/or distant metastasis beyond the pelvis
The previous FIGO staging system from 2009 was updated in 2023; key updates to FIGO staging include:17
- Incorporation of non-anatomic parameters including tumour type, grade and LVSI
- Risk stratification by molecular classification
- Further subdivision of Stages 1, 2, 3 and 4
FIGO 200918 FIGO 202317 Stage* Description Stage Description 1 Tumour confined to the corpus uteri 1 Confined to the uterine corpus and ovary§ 1A Tumour invading <50% of the myometrium 1A Disease limited to the endometrium OR non-aggressive histological type¶ 1AmPOLEmut POLEmut endometrial carcinoma, confined to the uterine corpus or with cervical extension, regardless of the degree of LVSI or histological type 1A1 Non-aggressive histological type limited to an endometrial polyp OR confined to the endometrium 1A2 Non-aggressive histological types involving less than half of the myometrium with no or focal LVSI 1A3 Low-grade endometrioid carcinomas limited to the uterus and ovary§ 1B Tumour invading ≥50% of the myometrium 1B Non-aggressive histological types with invasion of half or more of the myometrium, and with no or focal LVSI** 1C Aggressive histological types†† limited to a polyp or confined to the endometrium 2 Tumour invades cervical stroma, but does not extend beyond the uterus† 2 Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological types with myometrial invasion 2A Invasion of the cervical stroma of non-aggressive histological types 2B Substantial LVSI** of non-aggressive histological types 2C Aggressive histological types†† with any myometrial involvement 2Cmp53abn p53abn endometrial carcinoma confined to the uterine corpus with any myometrial invasion, with or without cervical invasion, and regardless of the degree of LVSI or histological type 3 Local and/or regional spread of the tumour 3 Local and/or regional spread of the tumour of any histological subtype 3A Tumour invades the serosa of the corpus uteri and/or adnexae‡ 3A Invasion of uterine serosa, adnexa, or both by direct extension or metastasis 3A1 Spread to ovary or fallopian tube (except when meeting Stage 1A3 criteria)§ 3A2 Involvement of uterine subserosa or spread through the uterine serosa 3B Vaginal and/or parametrial involvement‡ 3B Metastasis or direct spread to the vagina and/or to the parametria or pelvic peritoneum 3B1 Metastasis or direct spread to the vagina and/or the parametria 3B2 Metastasis to the pelvic peritoneum 3C Metastases to pelvic and/or para-aortic lymph nodes‡ 3C Metastasis to the pelvic or para-aortic lymph nodes or both 3C1 Positive pelvic nodes 3C1 Metastasis to the pelvic lymph nodes 3C1i Micrometastasis 3C1ii Macrometastasis 3C2 Positive para-aortic lymph nodes with or without positive pelvic lymph nodes 3C2 Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes 3C2i Micrometastasis 3C2ii Macrometastasis 4 Tumour invades bladder and/or bowel mucosa, and/or distant metastases 4 Spread to the bladder mucosa and/or intestinal mucosa and/or distance metastasis 4A Tumour invasion of bladder and/or bowel mucosa 4A Invasion of the bladder mucosa and/or the intestinal/bowel mucosa 4B Distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes 4B Abdominal peritoneal metastasis beyond the pelvis 4C Distant metastasis, including metastasis to any extra- or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain or bone Table 2. FIGO 2009 and 2023 classification by surgical and histological characteristics.
*Grade 1, 2 or 3; †Endocervical glandular involvement only should be considered as Stage 1 and no longer as Stage 2; ‡Positive cytology has to be reported separately without changing the stage; §Disease limited to low-grade endometrioid carcinomas involving the endometrium and ovaries (Stage 1A3) must be distinguished from extensive spread of the endometrial carcinoma to the ovary (Stage 3A1), by the following criteria: (1) no more than superficial myometrial invasion is present (<50%); (2) absence of extensive/substantial LVSI; (3) absence of additional metastases; and (4) the ovarian tumor is unilateral, limited to the ovary, without capsule invasion/rupture (equivalent to pT1a); ¶i.e. low-grade endometroid, with <50% myometrium invasion with no or focal LVSI OR good prognosis disease; **LVSI as defined in WHO 2021: extensive/substantial, ≥5 vessels involved; ††Grade and histological type.
FIGO, International Federation of Gynaecology and Obstetrics; LVSI, lymphovascular space invasion; WHO, World Health Organisation.
The British Association of Gynaecological Pathologists (BAGP) and British Gynaecological Cancer Society (BGCS) recommend continued use of the 2009 FIGO endometrial cancer staging system in the UK and do not currently recommend use of the 2023 FIGO system.22,23 Only 35% of their UK core MDT (tumour board) members want the FIGO 2023 system to be implemented, compared with 41% who do not. They feel that deferring implementation should have no impact on patient management as the parameters included in the new FIGO 2023 system are already incorporated into current risk stratification and treatment algorithms.23
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Stage at diagnosis
Stage at diagnosis
The majority of cases of endometrial cancer in the UK (79%) are diagnosed at Stage 1 or 2, with 21% diagnosed at Stage 3 or 4.24 This trend is also corroborated by similar findings from the UK Endometrial Cancer Audit Pilot study (Figure 4).10
Figure 4. Distribution of endometrial cancer stage at diagnosis in the UK, 2017–2019.24
Adapted from NHS England, 2025.
Patients with advanced or recurrent endometrial cancer have less favourable prognosis compared with localised disease.5
Endometrial cancer 5-year survival rates for England are as follows:5,25,26
Figure 5. 5-year survival rates of endometrial cancer by age group and stage at diagnosis in England (year of diagnosis: 2013–2017)
Graph adapted from Cancer Research UK using data from the Office of National Statistics.
Recurrence of endometrial cancer
Approximately 10–15% of patients with endometrial cancer (all stages) who reach remission following treatment experience disease recurrence, with 80– 90% of these recurring within 3 years.6,7
Recurrence rates increase with more advanced stage at diagnosis.27–29
Survival at this stage is largely dependent on the site of recurrence; 3-year overall survival rates are 73% in patients with isolated vaginal vault recurrence compared with 14% for those with distant recurrence.4
Ethnicity and social deprivation
Among women with endometrial cancer, racial disparities in survival are significant. Recently, the Office for National Statistics (ONS) and National Disease Registration Service (NDRS) published data showing Black ethnic groups having substantially higher mortality rates than other ethnic groups in the UK.10,30 Additionally, Black women in the UK have an age-standardised mortality rate for endometrial cancer of approximately 16–18 per 100,000, compared with approximately 7.5 per 100,000 in White women.30 Higher rates of late-stage diagnosis of endometrial cancer are observed among Black Caribbean and Black African women compared with women from other ethnic groups.30
In the UK, endometrial cancer survival outcomes are associated with socio-economic deprivation. Women from the middle and most deprived socio-economic groups are more likely to die from endometrial cancer, with a two-fold and a 53% increased risk respectively, compared with the least deprived women.31 Similarly, data published by the NDRS showed that 5-year age-standardised, endometrial cancer-specific survival in women from middle-deprived (79.9%) and most-deprived (76.7%) socio-economic groups was worse compared with women from the least-deprived groups (81.9%).10 It is estimated that 630 deaths from endometrial cancer each year in the UK are linked with deprivation.1
References (all URLs accessed July 2026)
- Cancer Research UK. Uterine cancer statistics. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer;
- NHS England. Symptoms – Womb (uterus) cancer. https://www.nhs.uk/conditions/womb-cancer/symptoms/;
- Cancer Research UK. Uterine cancer risk. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/risk-factors;
- Morrison J et al. Eur J Obstet Gynecol Reprod Biol 2022;270:50–89;
- Cancer Research UK. Survival for womb cancer. https://www.cancerresearchuk.org/about-cancer/womb-cancer/survival;
- Fung-Kee-Fung M et al. Gynecol Oncol 2006;101:520–529;
- Sorbe B et al. Oncol Lett 2014;8:1800–1806;
- Cancer Research UK. Uterine cancer by anatomical site. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/uterine-cancer/incidence;
- Cancer Research UK. Uterine cancer incidence. https://crukcancerintelligence.shinyapps.io/CancerStatsDataHub/_w_400066ededfd4ddc82fb4e58a003f8b9/_w_e542c571ef9b42f2ba8a498bc59cdb90/?_inputs_&nav=%22Incidence%20Breakdowns%20and%20Trends%22&app_select_CancerSite=%22Uterus%22&app_select_Country=%22United%20Kingdom%22;
- NHS England. Endometrial Cancer Audit Pilot (ECAP) baseline report. https://digital.nhs.uk/ndrs/data/data-outputs/cancer-publications-and-tools/ecap-baseline-report;
- Peng Y et al. Gynecol Oncol Rep 2020;33:100604;
- Webb PM et al. Endometrial cancer. In: Wild CP et al., eds. World Cancer Report: Cancer research for cancer prevention. Lyon, France: International Agency for Research on Cancer; 2020;
- Cancer Research UK. Risks and causes of womb cancer. https://www.cancerresearchuk.org/about-cancer/womb-cancer/risks-causes;
- Cancer Genome Atlas Research Network et al. Nature 2013;497:67–73;
- Soslow RA et al. Int J Gynecol Pathol 2019;38:S64–S74;
- Pecorelli S. Int J Gynaecol Obstet 2009;105:103–104;
- Berek JS et al. Int J Gynaecol Obstet 2023;162:383–394;
- Concin N et al. Lancet Oncol 2025;26:e425–e435;
- National Cancer Institute. Advances in Endometrial Cancer Research. https://www.cancer.gov/types/uterine/research;
- Pandita P et al. Cancers (Basel) 2019;11:1665;
- Peters EEM et al. Histopathology 2025;86:173–182;
- McCluggage WG et al. Int J Gynecol Cancer 2024;34:138–143;
- The British Association of Gynaecological Pathologists. FIGO 2023 endometrial carcinoma staging update: A critical appraisal. https://www.thebagp.org/wp-content/uploads/download-manager-files/FIGO-2023-Endometrial-carcinoma-staging-update-A-UK-perspective-Prof-Glenn-McCluggage.pdf;
- NHS England. Cancer Registration Statistics, England, 2022. https://digital.nhs.uk/data-and-information/publications/statistical/cancer-registration-statistics/england-2022/incidence-by-stage-at-diagnosis;
- Cancer Research UK. Survival for common cancers. https://crukcancerintelligence.shinyapps.io/CancerStatsDataHub/_w_c0fb56066c284f5da2ee494325c20266/_w_9014a54dc2fe44c49eb4d64a6758ae61/?_inputs_&nav=%22Survival%20By%20UK%20Country%20and%20Cancer%20Site%22&Survival-select_CountrySurvCommon=%22England%22&Survival-select_CountrySurvGender=%22England%22&Survival-select_CountrySurvAge=%22England%22&Survival-select_CountrySurvDep=%22England%22&Survival-select_CancerSiteSurvGender=%22Uterus%22&Survival-select_CancerSiteSurvAge=%22Uterus%22&Survival-select_CancerSiteSurvDep=%22Uterus%22;
- Office for National Statistics. Cancer survival in England - adults diagnosed, 2013–2017. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancersurvivalratescancersurvivalinenglandadultsdiagnosed;
- Åkesson A et al. Gynecol Oncol 2023;168:127–134;
- Huijgens ANJ et al. Facts Views Vis Obgyn 2013;5:179–186;
- Siegenthaler F et al. Gyne Oncol 2022;165:230–238;
- Moss EL et al. Lancet Oncol 2023;24:586–588;
- Njoku K et al. BJOG 2021;128:1215–1224.
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