Uterine papillary serous cancer (UPSC) is commonly more aggressive than the endometrioid subtype and accounts for more than 50% of endometrial cancer deaths annually. Despite the known increased aggressiveness and risk of relapse in USPC, a standardized treatment paradigm for early-stage disease confined to the endometrium remains lacking. Literature is currently limited to small series and retrospective reviews. Various studies have demonstrated no difference in recurrence rates in patients with stage IA UPSC without myometrial invasion who received adjuvant therapy versus those observed. These studies also found that observation alone renders a favorable prognosis in patients with stage IA USPC without myometrial invasion and therefore, these patients may not routinely need to receive adjuvant therapy. Additional answers likely lie within an improved molecular understanding of this disease which can shed light on future directions and individualized treatment strategies.