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The gynaecological cancer where immunotherapy has had the biggest impact, guided by molecular classification.
Endometrial cancer is the most common gynaecologic cancer in high-income countries (~420,000 cases a year worldwide) and one of the few cancers whose incidence and mortality are rising, driven by obesity, diabetes, and an ageing population. Most cases are low-grade endometrioid tumours found at stage I because of postmenopausal bleeding, and are cured by hysterectomy; a minority (serous, clear-cell, carcinosarcoma, and other p53-abnormal tumours) behave like high-grade ovarian cancer and account for most deaths. Since 2013, four molecular classes (POLE-mutated, mismatch-repair deficient, p53-abnormal, no specific molecular profile) have replaced histology as the primary prognostic and predictive framework.
The standard of care for early disease is minimally invasive hysterectomy with sentinel lymph node mapping, and adjuvant therapy scaled to risk: observation or vaginal brachytherapy for low and intermediate risk, pelvic radiotherapy or chemoradiation plus chemotherapy for high risk (PORTEC-3), with molecular class increasingly steering choices and fertility-sparing progestin therapy available for young women with the earliest tumours. Advanced and recurrent disease changed in 2023: three phase 3 trials (RUBY, NRG-GY018, DUO-E) established chemotherapy plus a PD-1/PD-L1 antibody as first-line standard, with dramatic benefit in dMMR tumours and a survival gain in the whole population (RUBY, OS 44.6 vs 28.2 months). Lenvatinib plus pembrolizumab (KEYNOTE-775) remains the second-line option for mismatch-repair-proficient disease, and trastuzumab deruxtecan is approved for HER2 IHC 3+ tumours.
Next: molecular-class-directed adjuvant therapy (RAINBO, PORTEC-4a), folate-receptor and TROP2 ADCs (rinatabart sesutecan with Breakthrough designation, sacituzumab tirumotecan), CDK4/6 plus endocrine therapy for low-grade ER-positive disease, and HER2 ADCs moved earlier in serous cancer. The 2026 failure of selinexor maintenance (XPORT-EC-042) is a caution about subgroup-derived hypotheses. Prevention through weight management and progestin-releasing IUDs, and equitable outcomes for Black women, whose mortality is nearly double, are the population-level problems.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Endometrial cancer accounts for ~420,000 cases per year worldwide and is the most common gynaecologic cancer in the US and Europe; most are found at stage I because of postmenopausal bleeding and cured by hysterectomy.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsChemotherapy with dostarlimab or pembrolizumab first line, lenvatinib-pembrolizumab second line, T-DXd for HER2-positive serous tumours.
Nothing recorded yet.
Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Serous and carcinosarcoma histologies behave like ovarian cancer.
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Chemotherapy + dostarlimab or pembrolizumab; lenvatinib-pembrolizumab; T-DXd if HER2+.
Universal MMR testing of tumours to identify Lynch syndrome; risk-reducing hysterectomy and salpingo-oophorectomy for Lynch carriers after childbearing; levonorgestrel IUD and weight management reduce risk; no screening for average-risk women.
Endometrial biopsy for postmenopausal bleeding; MRI for myometrial and cervical invasion; molecular classification (p53, MMR IHC, POLE sequencing) on the diagnostic specimen.
Minimally invasive total hysterectomy and bilateral salpingo-oophorectomy with sentinel lymph node mapping (FIRES, SENTOR); omentectomy for serous histology.
Progestin (oral or IUD) with re-biopsy every 3-6 months; hysterectomy after childbearing.
Observation (low risk, POLEmut) or vaginal brachytherapy (intermediate risk; PORTEC-2); molecular class may de-escalate (PORTEC-4a).
Chemoradiation plus carboplatin-paclitaxel (PORTEC-3) or chemotherapy alone (GOG-258); pembrolizumab or dostarlimab added for stage III-IV per RUBY/GY018 eligibility.
Carboplatin-paclitaxel plus dostarlimab (RUBY), pembrolizumab (NRG-GY018/KEYNOTE-868), or durvalumab (DUO-E; dMMR in the US), continued as maintenance up to 2-3 years.
Lenvatinib + pembrolizumab (KEYNOTE-775) if not previously given immunotherapy; T-DXd if HER2 IHC 3+; chemotherapy (doxorubicin, weekly paclitaxel); hormonal therapy for low-grade ER-positive disease.
Single-agent PD-1 blockade (dostarlimab GARNET, pembrolizumab) if immunotherapy-naive; otherwise chemotherapy or trials.
Trastuzumab with carboplatin-paclitaxel (randomised phase 2) or T-DXd for IHC 3+ after prior therapy.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
See all on the product pages:CarboplatinDostarlimabDurvalumabLenvatinibLetrozole (and other aromatase inhibitors)Paclitaxel / nab-paclitaxelPembrolizumabProgestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD)Trastuzumab deruxtecan·Printable cards in the navigator
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.