Diagnosis of Endometrial Carcinoma

Endometrial carcinoma (EC) is the most common invasive malignancy of the female genital tract and a major global health concern, with increasing incidence and mortality driven by obesity, metabolic syndrome, and aging populations. This chapter provides a comprehensive overview of the diagnostic and molecular landscape of EC, highlighting the transition from conventional histopathological evaluation to integrated molecular classification. It discusses the clinical presentation, diagnostic pathways, histologic and immunohistochemical markers, and recent updates from The Cancer Genome Atlas (TCGA) defining four major molecular subtypes—POLE-ultramutated, MMR-deficient, p53-abnormal, and NSMP. The integration of molecular testing (POLE, MMR, and p53) into routine practice refines prognostication and guides precision therapy, including immunotherapy and targeted agents. Emphasis is placed on risk-adapted management, fertility-sparing options, and addressing global disparities in access to diagnostics and novel treatments. Future directions include AI-driven diagnostics, cost-effective molecular testing, and equitable implementation of personalized care in low-resource settings.