Last reviewed: May 2019
Last updated: November  2017



History and exam

Key diagnostic factors

  • post-menopausal bleeding

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 and weight loss
  • symptoms of metastatic spread
  • signs of metastatic spread

Risk factors

  • obesity
  • inactivity
  • age >50 years
  • endometrial hyperplasia
  • unopposed endogenous oestrogen
  • unopposed exogenous oestrogen
  • tamoxifen use
  • 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
  • endometrial biopsy and histopathology
  • hysteroscopy, D&C and histopathology
  • Pap smear
  • FBC
Full details

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 scan of pelvis, abdomen, and chest
Full details

Treatment algorithm


Authors VIEW ALL

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, and Clovis Oncology. 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 declares that she has no competing interests.

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 monograph. NSH and AHR declare that they have no competing interests.

Peer reviewers VIEW 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.

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