Background:
Endometrial cancer is one of the most common gynaecological cancers globally, with its incidence rising in both high-income and low-income regions. Treatment outcomes are closely linked to the stage at diagnosis. Despite the growing burden, studies on endometrial cancer in Nigerian settings remain scarce.

Objectives:
To assess the prevalence, identify associated risk factors, evaluate clinical presentation patterns, characterise histological subtypes, and analyse treatment outcomes of endometrial cancer.

Methods:
A retrospective descriptive cross-sectional study was conducted using medical records of women with histologically confirmed endometrial cancer at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria, between January 1, 2017, and December 31, 2021. Patients without a histological confirmation of endometrial cancer or those whose case notes were missing or could not be retrieved were excluded from the study. Patient data were extracted from the histopathology register and corresponding case files. Descriptive statistics were performed using SPSS version 25.

Results:
Among 209 gynaecological malignancies recorded during the study period, endometrial cancer accounted for 18.7%, ranking third after cervical (45.5%) and ovarian (24.4%) cancers. Major risk factors included postmenopausal status (74.2%), hypertension (58.1%), diabetes mellitus (25.8%), obesity (9.7%), and a history of endometrial hyperplasia or malignancy (6.5%).

The most frequently reported presenting symptom was vaginal bleeding, occurring in 90.3% of cases. The predominant histological subtype was endometrioid carcinoma (35.5%), followed by serous carcinoma (22.6%) and carcinosarcoma (16.1%). Early-stage presentation occurred in 58.1% of patients. Multimodal treatment (surgery, chemotherapy, and/or radiotherapy) was received by 64.5% of patients. A total of 22.6% died, 38.8% survived at the time of the study, 6.5% achieved disease-free survival, and 38.7% were lost to follow-up.

Conclusion:
Endometrial cancer represents a significant disease burden at NAUTH, with late presentation in over 40% of cases and a substantial loss to follow-up. Strengthening early detection strategies and retention in care may improve outcomes.