Endometrial carcinoma was long considered the “benign” type among gynecological malignancies: it presents with symptoms early, is usually diagnosed at Stage I, and is curable by surgery. This characterization remains true for the majority of patients. For the minority with advanced or recurrent disease, however, almost everything has changed within just a few years. Molecular classification has evolved from a research tool to the standard for treatment planning; the FIGO classification has incorporated molecular parameters into its staging system, and the combination of chemotherapy and checkpoint inhibition has produced survival curves in the mismatch repair-deficient subgroup that were previously unknown for this entity. Version 4 of the S3 guideline, published in May 2026 and updated in July 2026, reflects this paradigm shift [1].
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