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Uterine cancer is cancer that starts in the uterus (the womb). Most of the time it begins in the lining of the uterus, the endometrium, which is why you will often hear it called endometrial cancer. It is one of the most common cancers of the female reproductive organs – and the most common in higher-income countries – and one of the few cancers becoming more common rather than less.1
The good news is that it usually announces itself early, most often with unexpected bleeding, and when it is caught early it is very treatable.1
If you take one thing from this page, let it be this: any bleeding after menopause, or any new, persistent, unusual bleeding before it, deserves prompt assessment. It is very often nothing sinister, but it is the single most important early clue, and getting it checked quickly is what gives the best outcomes.1
This is general information and not a substitute for personalised medical advice. If something here rings true for you, please see your doctor.
What is uterine cancer?
The uterus is a hollow, muscular, pear-shaped organ. It has an inner lining (the endometrium) that thickens and sheds each menstrual cycle, and a thick muscular wall (the myometrium). Uterine cancer is any cancer that develops in this organ, and where it starts shapes how it behaves.1
The overwhelming majority of cases – roughly nine in ten – are endometrial carcinomas, which grow from the gland cells of the lining.1 A much smaller group, fewer than one in ten, are uterine sarcomas, which grow from the muscle or supporting tissue of the uterine wall and tend to behave more aggressively.5 The two are quite different diseases that happen to share an address, so we will cover them separately below.
A quick note on language: this page is for women and for anyone with a uterus, including trans men and non-binary people, who can all develop these cancers.
How common is uterine cancer?
Uterine cancer is the second most common gynaecological cancer in the world, after cervical cancer, with more than 420,000 new cases of endometrial cancer diagnosed globally in 2022.2 Unlike many cancers, its numbers are climbing, particularly in higher-income regions and in places going through rapid changes in diet and lifestyle, a trend closely tied to rising rates of obesity.2
It is largely, though not only, a cancer of later life. Across most of the world the peak occurs between about 70 and 74 years of age, with most cases appearing after menopause.2 That said, it is not exclusively a postmenopausal disease, and certain risk factors can bring it forward into the reproductive years.1
What are the symptoms of uterine cancer?
The hallmark symptom is abnormal bleeding. After menopause, that means any bleeding at all. Before menopause, it means bleeding that is unusual for you – heavier periods, bleeding between periods, or bleeding after sex.1
Postmenopausal bleeding is the symptom that matters most, because it is the one that brings the great majority of cases to attention while they are still early and curable.1 Most people who have postmenopausal bleeding do not turn out to have cancer, but because a meaningful minority do, it should always be investigated.1
Other possible signs include unusual or watery vaginal discharge, pelvic pain or pressure, pain during sex, and, in more advanced disease, unexplained weight loss. These are far less specific than bleeding, but worth mentioning to your doctor if they persist.1
In our clinic, the first thing we do for anyone with unexplained bleeding is send them to their doctor to have it assessed. That’s not a cause for panic – it’s simply the sensible, routine step, and most of the time the check brings reassuring news.
What causes it, and who is at higher risk?
Most endometrial cancers are driven by oestrogen that is not balanced by progesterone over a long period. Anything that raises lifetime exposure to unopposed oestrogen tends to raise risk, which is why so many of the risk factors are linked.1
Excess body weight is the single biggest modifiable factor. Fat tissue converts other hormones into oestrogen, so carrying more of it means more oestrogen reaching the uterine lining – it is estimated that around 40 per cent of endometrial cancers are linked to excess weight.1 This is also where conditions like insulin resistance and type 2 diabetes feed in.
Other recognised risk factors include:
- starting periods early or reaching menopause late, both of which lengthen oestrogen exposure
- never having been pregnant, or difficulty ovulating
- polycystic ovary syndrome, recently renamed PMOS, which involves irregular ovulation and often insulin resistance
- oestrogen-only hormone therapy taken without progesterone
- tamoxifen, a breast cancer medicine that acts like oestrogen on the uterus
- increasing age, high blood pressure and diabetes
There is also an important inherited cause. Lynch syndrome (hereditary non-polyposis colorectal cancer) is a genetic condition that markedly raises the risk of both bowel and endometrial cancer – those affected have an estimated 20 to 60 per cent lifetime risk of endometrial cancer, and often develop it younger.1 If endometrial or bowel cancer runs in your family, this is worth raising with your doctor, as it changes how closely you should be watched.
A useful clinical reframe: conditions such as PCOS, endometrial hyperplasia, relative oestrogen excess and ongoing insulin resistance are often the slow-burn background to endometrial cancer, not separate unrelated issues. Addressing them early, as whole-body problems rather than isolated symptoms, is part of lowering long-term risk.
The two main types, explained
Endometrial carcinoma
This is the common one, arising from the lining. Historically it was split into two broad groups: type 1 tumours, which are oestrogen-driven, usually low grade and generally have a favourable outlook; and type 2 tumours, which are less common, not especially oestrogen-driven, and tend to be more aggressive.1
That older picture is now being replaced by a more precise molecular classification, which sorts tumours into four groups based on their genetics: POLE-mutated, mismatch repair deficient (dMMR), p53-abnormal, and a no-specific-molecular-profile group.3 This matters because the groups behave very differently – POLE-mutated tumours have the best outlook, p53-abnormal the worst, and the other two sit in between – and this information increasingly guides how each cancer is staged and treated.3
Uterine sarcoma
Sarcomas are rarer and come from the muscle or connective tissue of the uterus rather than the lining. The main subtypes are leiomyosarcoma (from the muscle wall), endometrial stromal sarcoma, adenosarcoma, and undifferentiated uterine sarcoma.5
As a group they behave more aggressively than the typical endometrial carcinoma and carry a poorer prognosis, though this varies a lot by subtype – low-grade endometrial stromal sarcoma, for instance, is generally slow-growing, while high-grade and undifferentiated types are far more serious.5
How is uterine cancer diagnosed?
Diagnosis usually starts the moment abnormal bleeding is investigated. The two main first-line tools are a transvaginal ultrasound, which measures the thickness of the endometrial lining, and an endometrial biopsy, which takes a small tissue sample to examine under the microscope.1
In those with postmenopausal bleeding, a thin lining on ultrasound is reassuring, while a thickened lining or continued bleeding prompts a biopsy.1 If results are unclear, a hysteroscopy – where a thin camera is passed into the uterus, often with a dilation and curettage to sample the lining more thoroughly – gives a definitive answer.1
One point worth being clear about: there is no routine screening test for uterine cancer in people at average risk, the way a Pap test screens for cervical cancer. No test has been shown to work for the general population.1
Early detection relies almost entirely on people noticing abnormal bleeding and acting on it, which is exactly why that symptom deserves so much respect. People at high risk, such as those with Lynch syndrome, are an exception and may be offered regular surveillance.1
An interesting area to watch is the vaginal and uterine microbiome. Researchers are developing non-invasive swab tests that look for cancer-related signals in vaginal samples, which could one day make detection easier and earlier. It is early days, but it sits squarely in the territory we care about.
How is it staged?
Staging describes how far a cancer has spread, and it guides treatment. Uterine cancer uses the FIGO system, which runs broadly from stage I (confined to the uterus) through to stage IV (spread to distant organs).3
The system was substantially updated in 2023 to fold in tumour grade, the specific cell type, and – for the first time – molecular classification, so that two cancers that look similar under the microscope but behave differently are no longer treated as the same.3
In practice this means staging is becoming more personalised, which helps spare lower-risk patients from over-treatment while making sure higher-risk ones get enough.3
How is uterine cancer treated?
Treatment depends on the type, stage and molecular profile of the cancer, as well as your general health and whether preserving fertility is a consideration. It is always planned by a specialist gynaecological oncology team, and what follows is a general map, not a personal plan.
Surgery is the mainstay for most uterine cancers, typically removing the uterus and cervix (hysterectomy), usually along with the fallopian tubes and ovaries, and sometimes nearby lymph nodes.1 Depending on the findings, this may be followed by radiotherapy or chemotherapy to lower the chance of the cancer returning.1
For oestrogen-driven cancers, and in carefully selected younger people who wish to preserve fertility, hormonal (progestin) treatment can sometimes be used.1 And in a significant recent shift, immunotherapy has changed the outlook for advanced and recurrent disease.
Drugs that release the brakes on the immune system, given alongside chemotherapy, have produced practice-changing results, especially in mismatch-repair-deficient tumours, and are now an established part of care for advanced endometrial cancer.4
What is the outlook?
For endometrial cancer, the outlook is generally good, largely because so many cases are found early. Overall, around four in five people are alive five years after diagnosis, and for cancer caught while it is still confined to the uterus that figure rises to roughly 90 to 95 per cent.1 Outlook falls as the stage rises, which is the whole reason early bleeding should never be ignored.1
Uterine sarcomas are more variable and, on average, more serious, with prognosis depending heavily on the subtype and how completely the tumour can be removed.5 This is one reason an accurate diagnosis of exactly which uterine cancer is present matters so much.
Can uterine cancer be prevented?
You cannot change your age or your genes, but several of the biggest risk factors are modifiable. Maintaining a healthy weight is the most powerful lever, because it directly affects how much oestrogen reaches the uterine lining.1 Managing insulin resistance, diabetes and conditions like PCOS all feed into the same picture.
Some hormonal approaches also lower risk. Combined oral contraceptives and progestin-containing treatments reduce endometrial cancer risk, and where oestrogen hormone therapy is used after menopause in someone with a uterus, it should always be paired with progesterone to protect the lining.1
If you carry a known genetic risk such as Lynch syndrome, your specialist can discuss surveillance and risk-reducing options with you.1
Frequently asked questions
Is uterine cancer the same as cervical cancer?
No. Cervical cancer starts in the cervix, the neck of the uterus, and is usually caused by HPV. Uterine cancer starts higher up, in the body of the uterus, and is mostly linked to hormones. The Pap test screens for cervical cancer, not uterine cancer.
Does a Pap smear detect uterine cancer?
Not reliably. A Pap test is designed to find cervical cell changes. It occasionally picks up uterine abnormalities by chance, but it is not a test for uterine cancer, which is why abnormal bleeding still needs separate investigation.
Can you get uterine cancer after a hysterectomy?
If the entire uterus has been removed, you cannot develop uterine cancer, because the organ is gone. Other gynaecological cancers remain possible, so routine care still matters.
Can younger people get uterine cancer?
Yes, though it is much less common before menopause. Risk before menopause rises with conditions such as PCOS, obesity, insulin resistance and Lynch syndrome.1 Persistent abnormal bleeding at any age deserves assessment.
Is uterine cancer curable?
Often, yes, especially when it is found early and confined to the uterus.1 Outcomes are strongly tied to stage at diagnosis, and to the specific type of cancer.
Is bleeding after menopause always cancer?
No – most postmenopausal bleeding has a non-cancerous cause, such as thinning of the tissues. But because a real minority of cases are cancer, all postmenopausal bleeding should be checked promptly.1
What to do next
If you have had any bleeding after menopause, or new and persistent abnormal bleeding before it, book an appointment with your doctor to have it assessed – this is the single most useful step on this page. It is usually nothing serious, but it is always worth knowing.
If you would like to understand your own risk picture, it can help to look at the conditions that sit upstream of endometrial cancer, such as oestrogen balance and insulin resistance, and address them as part of your wider health rather than in isolation.
If you would like to talk something through, you can use Aunt Vadge’s Assistant, the chat in the bottom-left of your screen, or book in with one of our practitioners for a personalised consultation. For anything involving suspected cancer, our role is to support you alongside, not instead of, your gynaecological and oncology team.
- Mahdy H, Vadakekut ES, Crotzer D. Endometrial Cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated 2024.
- Zhu B, et al. Global burden of gynaecological cancers in 2022 and projections to 2050. J Glob Health. 2024;14:04155.
- Berek JS, Matias-Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet. 2023;162(2):383–394.
- National Cancer Institute. Expanded role for immunotherapy to treat endometrial cancer. Cancer Currents Blog. 2023.
- Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynaecol Obstet. 2018;143(Suppl 2):51–58.
