• Glycaemic index and glycaemic load: How fast a food raises blood sugar (index) and how much, given the portion (load).
• Metabolic syndrome and insulin resistance: Metabolic syndrome is a cluster of central obesity, high blood pressure, high blood sugar and abnormal blood fats.
• Microsatellite-stable (MSS) / mismatch-repair proficient (pMMR): The 'normal' result on the mismatch-repair test: the tumour has intact DNA spell-checking and few mutations.
• Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP): Four groups defined by a few tests that predict outcome better than the microscope: POLE-mutated (excellent), mismatch-repair deficient, p53-abnormal (worst), and 'no specific profile'.
• Bowel cancer after abdominal and pelvic radiotherapy: Radiotherapy to the abdomen or pelvis raises the risk of cancer in the bowel that sat in the field, and the risk is confined to the irradiated segment.
• Choices made at the time of treatment that change the second cancer risk: Some of this risk is a decision rather than a fate.
• TP53-mutated (p53-abnormal): Loss of the p53 'guardian of the genome', the most commonly mutated gene in cancer.
• Hysterectomy: Removing the uterus (womb), often with the cervix, tubes and ovaries.
• Obesity-related cancers (IARC list of 13): Excess body fat is an established cause of thirteen cancers on the IARC list, including womb, oesophagus, kidney, liver, bowel, pancreas and postmenopausal breast cancer.
• Lynch syndrome: Lynch syndrome is the most common inherited cancer syndrome: a faulty mismatch-repair gene raises lifetime bowel cancer risk to 40-80% and also endometrial and other cancers.

Diagnosis and staging: Endometrial biopsy for postmenopausal bleeding; MRI for myometrial and cervical invasion; molecular classification (p53, MMR IHC, POLE sequencing) on the diagnostic specimen.

Biomarker results to ask for: MMR/MSI, POLE, p53, HER2 (serous), ER/PR, TROP2, MMR IHC / MSI (dMMR ~25-30%; Lynch syndrome in ~3% of all cases), POLE exonuclease-domain mutation, p53 IHC, HER2 IHC/ISH (serous, p53abn), L1CAM (NSMP risk), CTNNB1 (NSMP low-grade recurrence risk), PD-L1 (limited utility), FRα and TROP2 (ADC trials), ARID1A, PIK3CA, PTEN (targetable in trials).

Scans and tests linked to this cancer: Companion diagnostics, Germline (hereditary) testing, Histopathology & immunohistochemistry, MRI, MSI and mismatch-repair testing, MRD / molecular residual disease testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Prevention and hereditary risk: 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. (Germline (hereditary) testing, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR), Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD))
• Early: Hysterectomy; adjuvant therapy by molecular class.
• Early stage surgery: Minimally invasive total hysterectomy and bilateral salpingo-oophorectomy with sentinel lymph node mapping (FIRES, SENTOR); omentectomy for serous histology. (Robotic & minimally invasive surgery, Sentinel lymph node biopsy, FIRES & SENTOR (sentinel node mapping))
• Adjuvant, low and intermediate risk: Observation (low risk, POLEmut) or vaginal brachytherapy (intermediate risk; PORTEC-2); molecular class may de-escalate (PORTEC-4a). (Brachytherapy, Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP))
• Adjuvant, high risk (stage III, serous, p53abn, deep invasion grade 3): Chemoradiation plus carboplatin-paclitaxel (PORTEC-3) or chemotherapy alone (GOG-258); pembrolizumab or dostarlimab added for stage III-IV per RUBY/GY018 eligibility. (PORTEC-3, Carboplatin, Paclitaxel / nab-paclitaxel, IMRT / IGRT (modern external beam), Pembrolizumab, Dostarlimab)
• Advanced/recurrent: Chemotherapy + dostarlimab or pembrolizumab; lenvatinib-pembrolizumab; T-DXd if HER2+. (Dostarlimab, Pembrolizumab, Trastuzumab deruxtecan)
• Fertility-sparing (grade 1, stage IA, no invasion): Progestin (oral or IUD) with re-biopsy every 3-6 months; hysterectomy after childbearing. (Fertility-sparing hormonal treatment of early endometrial cancer, Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD))
• Advanced or recurrent, first line (any MMR status): 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. (RUBY / ENGOT-EN6 / GOG-3031, NRG-GY018 / KEYNOTE-868, DUO-E / GOG-3041 / ENGOT-EN10, Dostarlimab, Pembrolizumab, Durvalumab, Chemotherapy + PD-1/PD-L1 blockade, first-line advanced endometrial cancer)
• Recurrent, dMMR, after chemotherapy: Single-agent PD-1 blockade (dostarlimab GARNET, pembrolizumab) if immunotherapy-naive; otherwise chemotherapy or trials. (Dostarlimab, Pembrolizumab, Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR))
• HER2-positive serous: Trastuzumab with carboplatin-paclitaxel (randomised phase 2) or T-DXd for IHC 3+ after prior therapy. (Trastuzumab, Trastuzumab deruxtecan, HER2, DESTINY-PanTumor02)
• Recurrent, pMMR, after platinum: 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. (Lenvatinib, Pembrolizumab, KEYNOTE-775 / Study 309, Trastuzumab deruxtecan, DESTINY-PanTumor02, Letrozole (and other aromatase inhibitors), Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD))

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.