Recurrent Endometrial Cancer: What to Look for and How to Treat It

Written by Stephanie Watson
Medically Reviewed by Traci C. Johnson, MD on March 14, 2025
8 min read

Endometrial cancer is a type of cancer that starts in the lining of the uterus, called the endometrium. It's the most common form of gynecologic cancer in the United States. 

Although survival rates for endometrial cancer are high, this cancer can come back months or years after treatment. Recurrent means the cancer has returned. 

Hearing that your cancer came back can stir up a lot of anxiety and worry. Know that recurrent endometrial cancer is treatable. Your doctor can help you understand the next steps in your cancer journey.

Types of recurrence

Endometrial cancer can recur in two ways:

Local: A local recurrence is when the cancer comes back in or near the place where it started. The most common locations are the pelvis or vagina. 

Distant: A distant recurrence is when the cancer comes back in a different part of the body, like the lungs or bone.

After treatment, 15% to 20% of people with early-stage (stage I or II) endometrial cancer will have a recurrence. Around 50% of them have a local recurrence, 25% have a distant recurrence, and 25% have both local and distant recurrences. 

Most recurrences happen within three years after treatment.

Recurrent endometrial cancer after hysterectomy

Hysterectomy is surgery to remove the uterus and cervix – the bottom of the uterus that connects to the vagina. It's the main treatment for endometrial cancer.

The cancer can come back, even after you have your uterus removed. About 15% to 20% of people with endometrial cancer have a recurrence after a hysterectomy. "Though the cancer can recur anywhere, it is most common at the vaginal cuff (or top of the vagina)," says Ritu Salani, MD, director of gynecologic oncology at UCLA Health in Los Angeles.

Certain things increase the risk of an endometrial cancer recurrence. It's more likely to return if:

  • You have a late-stage cancer.
  • Your cancer has spread to lymph nodes.
  • You have a large tumor.
  • You waited six months or more after the biopsy to have a hysterectomy.
  • The cancer has spread into the middle layer of your uterus.
  • You had a hysterectomy but the surgeon didn't remove your fallopian tubes, cervix, and ovaries (bilateral salpingo-oophorectomy).
  • The cancer has a gene mutation like TP53 that makes it more aggressive.

Not everyone with these risk factors will have a recurrence. Other things are involved in determining the risk. And even if you don't have any of these risks, your cancer might come back.

Your oncologist will check you every three to six months for the first three years after treatment. These visits are to make sure that if your cancer does return, it's caught early. 

Between visits, call your doctor if you have any of these symptoms of recurrent endometrial cancer:

  • Bleeding from your vagina
  • Changes in your bladder or bowel habits
  • Belly or back pain
  • Tiredness
  • Bloating
  • Shortness of breath
  • Nausea or vomiting 

The treatment for recurrent endometrial cancer depends on where the cancer is, how much cancer there is, the cancer subtype, and what treatment you had before. "Options include radiation, chemotherapy, immunotherapy, or combinations of these approaches," Salani says. Surgery may be an option in certain situations.

Because you may need more than one treatment, it's a good idea to work with a team of doctors, including a radiation oncologist, medical oncologist, and surgeon.

Surgery

Surgery may be an option for a local recurrence. Depending on where the cancer is and how big it is, the surgeon might remove just the cancer, or entire organs like the bladder or ovaries. Sometimes, radiation therapy or chemotherapy is given after surgery to lower the chance of the cancer coming back.

Risks of surgery include:

  • Bleeding
  • Infection
  • Blood clots
  • Damage to healthy tissues
  • Infertility
  • Menopause symptoms like hot flashes, night sweats, and vaginal dryness

Radiation therapy

This treatment aims high-energy X-ray beams at the cancer. The radiation is delivered from inside or outside your body.

Brachytherapy is a treatment for cancer that's in the same area as the original tumor. A radioactive material is put into an applicator, which goes inside your pelvis near the cancer. The applicator stays inside your body for a few minutes or up to four days.

External beam radiation therapy aims the radiation at your body from a machine. You get this treatment five days a week for four to six weeks. 

Possible side effects from radiation therapy are:

  • Skin redness, blistering, and peeling
  • Diarrhea
  • Upset stomach
  • Problems peeing
  • Tiredness
  • Pain in the vagina
  • Low blood cell counts

These problems should go away within a few weeks after you stop treatment.

Chemotherapy 

Chemotherapy kills cancer cells all over your body. It's a treatment for distant recurrences that surgery can't fully remove. You get the medicine through a vein or take it as a pill. 

Some of the most commonly used chemotherapy drugs for endometrial cancer are:

  • Carboplatin
  • Cisplatin
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Paclitaxel (Taxol)

You may need more than one chemotherapy drug. Common combinations for endometrial cancer are carboplatin and paclitaxel or cisplatin with doxorubicin. Taking these medicines together helps them work better. You'll get chemotherapy in cycles, with periods of rest in between.

Possible side effects of chemotherapy include:

  • Nausea and vomiting
  • Hair loss
  • Mouth sores
  • Appetite loss
  • Low blood cell counts

Most of these side effects should improve once you stop treatment. In the meantime, your doctor has ways to help you manage them.

Hormone therapy

Some endometrial cancers have receptors for the hormones estrogen and progesterone. Those cancers respond well to hormone therapy. The most common hormone used to treat endometrial cancer is progestin (Megace, Provera).

Hormone therapy comes in an injection, pill, or liquid.

Possible side effects of this treatment are:

  • Menopause symptoms like hot flashes and night sweats
  • Weight gain
  • Higher blood sugar levels in people with diabetes
  • Worse depression
  • Serious blood clots (rarely)

Immunotherapy

This treatment boosts your own immune response against cancer. Checkpoint inhibitors like dostarlimab (Jemperli) pembrolizumab (Keytruda) and block a protein called PD-1 on immune cells. Blocking this protein wakes up your immune system so it can kill endometrial cancer cells. 

Possible side effects from immunotherapy are:

  • Tiredness
  • Fever
  • Cough
  • Nausea
  • Itching
  • Rash
  • Appetite loss
  • Muscle or joint pain

Targeted therapy

This treatment blocks substances the cancer needs to grow. Medicines like bevacizumab (Avastin) and lenvatinib (Lenvima) stop the growth of new blood vessels that feed endometrial cancer. 

Side effects of targeted therapy include:

  • Tiredness
  • Diarrhea
  • Nausea and vomiting
  • Weight loss
  • High blood pressure

Thanks to improved treatments and early detection, endometrial cancer survival rates have improved. Today, 95% of people who are diagnosed at an early stage will still be alive five years later.

When endometrial cancer comes back, the survival rate depends on its location. The five-year survival rate for recurrent endometrial cancer in the vagina is 77%. If the cancer is more distant, the survival rate is 36%.

The cancer's genes also affect survival time. For people whose cancer has a mismatch repair deficient (MMRd) gene trait, the average survival time is 43 months. But for those with the more aggressive p53abn type, the average survival is 10 months. 

Keep in mind that these numbers represent large numbers of people. They're just averages, and they may be very different from your experience. Your doctor can give you a better idea of your outlook.

After treatment you might worry that your cancer will come back. It's not always possible to prevent a recurrence, but there are things you can do to lower your risk. One of the most important is to follow a healthy lifestyle. Exercise regularly, eat a well-balanced diet, don't smoke, and try to stay at a healthy weight.

Also be vigilant for new symptoms. "Report symptoms, particularly vaginal bleeding, to your doctor," says Salani.

A cancer diagnosis is a lot to process. Learning that your cancer has come back can bring up all the old worries and anxiety from your first diagnosis. Having people to support you through the next phase of your treatment will help you cope better with what's ahead.

These organizations offer support for people with endometrial cancer:

  • CancerCare has oncology social workers, financial assistance, and support groups to help you navigate the challenges that come with your diagnosis. Contact them at 800-813-HOPE (800-813-4673) or [email protected].
  • The American Cancer Society's helpline will connect you to a trained specialist who can answer your questions and listen to your concerns. Their support line is available 24 hours a day, seven days a week at 800-227-2345.
  • Share Cancer Support offers a wide variety of services for people with endometrial cancer. Their National Support Line is 844-ASK-SHARE (844-275-7427).

Up to 20% of people who are diagnosed with early-stage endometrial cancer will have a recurrence. The cancer can come back in the area where it started, or in other parts of the body. Watch for signs like bleeding from the vagina, belly or back pain, and tiredness, and report them to your doctor. Treatment for a recurrence depends on where the cancer is. Options include radiation, chemotherapy, surgery, hormone therapy, and immunotherapy.

What is the chance of endometrial cancer recurrence after five years?

Endometrial cancer usually returns within three years after treatment. Most of the studies that looked at recurrence rates lasted less than five years, so it's hard to know exactly how many recurrences happened after five years. In one study, 10% of people with endometrial cancer had a recurrence more than five years after their treatment.

Is recurrent endometrial cancer curable?

Recurrent endometrial cancer is curable if it's caught early, before it spreads. Even if your cancer isn't curable, treatments can help you live longer and improve your quality of life.

What is the recurrence rate of stage III endometrial cancer?

The recurrence rate depends on how aggressive the cancer is. In one study, the recurrence rate was 37%.