Decoding the 2023 FIGO Staging System in Endometrial Cancer: A Practical, Visually Guided Framework for Molecular Risk-Adapted Care Incorporating the 2025 Risk Group Update

PURPOSE OF REVIEW: The FIGO staging system for endometrial cancer has evolved substantially over the past five decades, progressing from the original clinical classification in 1971, through the surgical refinements of 1988 and 2009, to the most recent 2023 revision that integrates both pathological and molecular determinants of disease behaviour, with the overarching aim of optimising adjuvant treatment selection to maximise therapeutic benefit while minimising unnecessary harm. This review aims to contextualise the rationale underlying these revisions and to clarify their clinical implications for contemporary staging and risk-adapted management. RECENT FINDINGS: The 2023 FIGO update introduces refined anatomic criteria, including depth of myometrial invasion, cervical stromal involvement, lymphovascular space invasion, and improved discrimination between nodal micrometastases and macrometastases, while formally incorporating biologically defined molecular subgroups (POLEmut, p53abn, MMRd, and NSMP). Importantly, the 2025 ESGO-ESTRO-ESP recommendations further advance this framework by mandating estrogen receptor (ER) assessment within the NSMP category, demonstrating that ER negativity identifies early-stage disease with a significantly increased risk of recurrence and mortality and directly influences adjuvant treatment selection. Together, FIGO-2023 and ER-refined molecular stratification represent a clinically actionable precision-staging model. To support implementation, this review provides a uniquely integrated visual educational framework that combines a comprehensive schematic representation of FIGO-2023 staging pathways with corresponding high-resolution histopathological images and detailed interpretive guidance, facilitating accurate recognition of key pathological features and consistent application of the revised staging criteria in practice. The integration of refined anatomic staging with molecular and ER-informed risk stratification enhances prognostic precision, supports multidisciplinary communication, and enables more individualised therapeutic decision-making. Familiarity with this evolving framework is essential for improving consistency of staging across institutions and for optimising clinical outcomes through earlier and more accurate identification of dissemination and metastatic potential in endometrial cancer.