Dr Dearbhaile Collins
Clinical director of Cancer Services and consultant medical Oncologist
The future of endometrial cancer care lies in combining prevention with personalised medicine.
Obesity contributes to endometrial cancer by raising oestrogen levels, causing chronic inflammation and affecting hormones. Other factors include diabetes, polycystic ovary syndrome (PCOS), certain hormone therapies, tamoxifen, high blood pressure and genetic conditions like Lynch syndrome.
Preventing endometrial cancer focuses on lifestyle choices. While research on how exercise affects recurrence in endometrial cancer is limited, studies in other hormone-related cancers show that staying active and maintaining a healthy weight can improve survival. This makes national efforts to promote exercise and weight management very important.
Advancements in molecular testing that contributed to treatments
Large-scale molecular studies, including The Cancer Genome Atlas (TCGA) and ProMisE have identified four predominant subtypes: POLE-mutated, mismatch repair (MMR) deficient, p53 mutated (serous-like) and p53 wildtype (no specific molecular profile). These subtypes help predict outcomes and guide treatment.
For example, POLE-mutated cancers often have excellent survival rates, so patients may need less intensive treatment. On the other hand, cancers with abnormal p53 tend to have worse outcomes and benefit more from combined chemotherapy and radiation. In-depth pathology assessment allows doctors to determine a cancer’s subtype quickly and plan personalised treatments.
National programs encouraging healthy weight and exercise can lower the number of cases, while molecular testing provides tailored treatments for each patient
Immunotherapy and drug-based treatments
Some subtypes, such as MMR-deficient and POLE-mutated, have an excellent outcome with immunotherapy. It encourages the body’s immune system to fight cancer and is now in the recommended international guidelines for specific subtypes of endometrial cancers.
Drugs such as pembrolizumab and dostarlimab have shown good results for patients, either used alone or with other targeted drugs like lenvatinib. They often have different side effects than chemotherapy, mainly involving the immune system, and need careful monitoring.
As of February 2026, immunotherapy isn’t yet available for HSE patients with endometrial cancer. Ireland is one of the few European countries in this situation, although it’s expected to change soon.
National programs encouraging healthy weight and exercise can lower the number of cases, while molecular testing provides tailored treatments for each patient. With immunotherapy becoming more widely available, these approaches promise to improve survival and quality of life for women with endometrial cancer.
