Last reviewed: June 2020
Last updated: July  2019



History and exam

Key diagnostic factors

  • post-menopausal vaginal bleeding (PVB)

Other diagnostic factors

  • uterine mass, fixed uterus, or adnexal mass indicating extra-uterine disease
  • abnormal menstruation or vaginal bleeding in a pre-menopausal woman
  • pain (abdominal or pelvic) and weight loss
  • symptoms of metastatic disease
  • signs of metastatic disease

Risk factors

  • overweight and obesity
  • inactivity
  • age >50 years
  • endometrial hyperplasia
  • unopposed endogenous oestrogen
  • unopposed exogenous oestrogen
  • tamoxifen use (post-menopausal women)
  • insulin resistance
  • family history of endometrial cancer
  • family history of breast cancer or ovarian cancer
  • family history of hereditary non-polyposis colon cancer (Lynch syndrome)
  • family history of PTEN syndromes
  • nulliparity and infertility
  • polycystic ovary syndrome
  • radiotherapy
  • white ethnicity

Diagnostic investigations

1st investigations to order

  • pelvic (transvaginal) ultrasound
  • outpatient endometrial biopsy (with or without outpatient hysteroscopy) and histopathology
  • hysteroscopy, dilation and curettage (D&C), and histopathology
  • Pap smear
  • FBC
More 1st investigations to order

Investigations to consider

  • serum CA-125 level
  • saline infusion sonohysterogram
  • urea and creatinine (renal function testing)
  • LFTs
  • chest x-ray
  • CT scan of chest, abdomen, and pelvis
  • MRI of uterus, pelvis, and abdomen
  • PET/CT scan
More investigations to consider

Treatment algorithm


Alexander B. Olawaiye

Associate Professor

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology, and Reproductive Sciences

Magee-Womens Hospital of UPMC

University of Pittsburgh School of Medicine




ABO declares that he has no competing interests.

Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital




RTP declares that he is on the scientific advisory boards of: Genentech, Inc., AstraZeneca, Endocyte, Inc., Eisai Inc., Vascular Biogenics Ltd, Baxalta Oncology, AbbVie, Clovis Oncology, Roche, and Merck. RTP receives research funding from: Genentech, Inc., ImClone Systems, Inc., Endocyte, Inc., AstraZeneca., Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. Vs. Apotex Inc in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion. 

Larissa J. Lee

Assistant Professor

Department of Radiation Oncology

Brigham and Women’s Hospital/Dana-Farber Cancer Institute




LJL receives research funding from the Koch Institute at the Massachusetts Institute of Technology and Dana-Farber Cancer Institute. LJL is also the Principal Investigator of an immunotherapy and radiation trial sponsored by AstraZeneca.

Dr Alexander B. Olawaiye, Dr Richard T. Penson, and Dr Larissa J. Lee would like to gratefully acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.

Peer reviewersVIEW ALL

Associate Professor/Chief

Gynecologic Oncology

S/M Obstetrics & Gynecology (UCD)

University of Colorado Health Sciences Center




SAD declares that she has no competing interests.

Attending Radiologist

Assistant Professor of Radiology

Memorial Sloan-Kettering Cancer Center

New York



SM declares that she has no competing interests.

Use of this content is subject to our disclaimer