58 Endometrial cancer (EC), the most common gynaecological cancer in high-income countries, is seeing rising incidence and mortality rates, with challenges in disease management increasing as new insights into its underlying biology emerge. While advances in understanding EC’s heterogeneity have led to new treatment options, disparities in outcomes persist, particularly among Black women, who continue to face higher mortality rates even when adjusting for disease stage and histology. The findings were published in the journal Nature Reviews Clinical Oncology. The disease’s complexity has led to new classifications and staging systems, with the latest updates from the International Federation of Gynecologists and Obstetricians (FIGO) reflecting a shift towards incorporating molecular and histopathological features for more nuanced staging. Molecular profiling, particularly through the use of circulating tumour DNA and immunohistochemical markers, is becoming an essential tool for refining treatment strategies and ensuring more personalised care. Historically, EC has been classified into two types: type I (endometrioid) and type II (non-endometrioid), each characterised by distinct clinicopathological features. Type I cancers are often hormone-driven, developing against a background of excess oestrogen, whereas type II cancers, such as serous and clear-cell subtypes, are more aggressive and not typically influenced by hormonal factors. Obesity is a prominent risk factor for EC, especially for type I tumours, and may be linked to over half of all cases in high-incidence countries. Therapeutic advances are showing promise, particularly for advanced-stage and recurrent EC. Molecular classification of EC into subgroups based on tumour genetics has paved the way for targeted therapies. Immune-checkpoint inhibitors (ICIs), for instance, have emerged as a powerful tool for treating patients with mismatch repair (MMR)-deficient tumours. These inhibitors are now being combined with chemotherapy as the first-line treatment for advanced or recurrent disease. Recent research highlights the potential of antibody-drug conjugates like trastuzumab deruxtecan in treating previously treated advanced-stage EC. These therapies represent a shift from traditional chemotherapy and could significantly alter the standard of care for patients whose disease has progressed despite initial treatment. Addressing disparities in EC incidence and outcomes remains a significant challenge. Delayed access to care and lower socioeconomic status have been identified as contributing factors to the poorer outcomes observed among Black women, but these do not fully explain the disparities. Increased funding for EC research, particularly into molecular characteristics and targeted therapies, is crucial for improving outcomes for all patients. The 2023 FIGO staging system aims to refine risk stratification by incorporating molecular and histopathological features. This approach allows for more precise prognostication, potentially improving treatment personalisation. However, implementation challenges exist, particularly regarding the complexity of molecular profiling, which remains cost-prohibitive in many settings. The treatment landscape for EC is evolving rapidly. The integration of molecular data, use of circulating tumour DNA, and adoption of novel therapeutics all represent positive steps towards improving survival outcomes. But disparities in access and the need for more personalised treatment strategies are ongoing challenges that must be addressed to ensure equitable improvements in care for all women affected by this disease.