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Endometrial cancer is the most common gynecologic malignancy in the United States. The majority of women are diagnosed with early-stage, low-grade endometrioid tumors that are highly curable with primary surgery. Patients with more advanced and/or higher grade disease require multimodality therapy and have a higher risk for recurrence. Although uterine papillary serous carcinoma and clear cell carcinoma are diagnosed infrequently, they account for almost half of all relapses. As women with recurrent endometrial cancer constitute a heterogeneous group, an individualized approach is required. We review the treatment options of surgery, radiation, hormonal therapy, cytotoxic chemotherapy, and biological agents.