Modern Management of Endometrial Cancer: Molecular Classification, Surgery, Immunotherapy, and Regional Challenges.

Abstract

Background

The approach to the diagnosis and treatment of endometrial cancer has gradually changed in recent years. The addition of molecular classification to traditional histopathological and anatomical assessment has helped stratify patients into risk groups more accurately. At the same time, minimally invasive surgery, sentinel lymph node mapping, and the use of immune checkpoint inhibitors have expanded treatment options in both early-stage and advanced disease.

Methods

This article was prepared as a narrative review that also includes a regional implementation perspective. Clinical guidelines, randomized clinical trials, systematic reviews, and major prospective studies published between 2013 and 2026 were reviewed in PubMed/MEDLINE, Scopus, and Web of Science. Particular attention was given to molecular classification, surgical staging, sentinel lymph node assessment, immunotherapy, and the implementation of these approaches across different healthcare systems.

Main Findings

Molecular classification complements conventional risk assessment by dividing endometrial cancer into POLE-mutated, mismatch repair-deficient, p53-abnormal, and no specific molecular profile groups. In early-stage disease, minimally invasive surgery and sentinel lymph node mapping provide opportunities for less morbid surgical staging. In advanced and recurrent disease, phase III trials such as RUBY, NRG-GY018, DUO-E, and AtTEnd have shown that combining immune checkpoint inhibitors with chemotherapy may improve clinical outcomes, particularly in patients with dMMR/MSI-H tumors.

Conclusion

The management of endometrial cancer is increasingly being complemented by molecular and biomarker-based personalized approaches. Data describing the extent to which these strategies are implemented in routine clinical practice in Azerbaijan and the Caucasus remain limited. Regional registries, mapping of molecular testing capacity, and multicenter clinical data collection may therefore represent useful directions for future development.