Endometrial Cancer: A Daily Clinical Practice Guide for Radiologists

Abstract

Endometrial cancer (EC) is projected to become the third most common cancer and the fourth leading cause of cancer-related deaths among women by 2040, with the most substantial increases observed in non-Hispanic Black, Hispanic, and Asian populations. The International Federation of Gynecology and Obstetrics (FIGO) 2023 classification introduces key updates, including a refined staging system incorporating molecular markers for improved risk stratification. MRI plays a critical role in treatment planning by evaluating the extent of the disease, determining eligibility for fertility-preserving options, guiding radiotherapy planning, and supporting follow-up care. It is also essential for distinguishing EC from cervical cancer. Notable revisions in the FIGO 2023 staging guidelines focus on assessing myometrial invasion, identifying synchronous or metastatic ovarian tumors, and evaluating peritoneal involvement. Recurrence typically occurs within the first 2 years, with common sites including the vaginal vault and lymph nodes, where MRI remains the preferred imaging modality. While CT is routinely employed to assess metastatic disease, ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT is valuable for detecting nodal and distant metastases. Additionally, some institutions have begun using ¹⁸F-FDG PET/MRI to evaluate both local recurrence and distant metastases, offering a more integrated approach for EC follow-up.