Last reviewed: 8 Nov 2021
Last updated: 31 Mar 2021



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
  • smoking
  • 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 colorectal 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

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

Treatment algorithm



Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
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, MD, MRCP
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, MD
Larissa J. Lee

Assistant Professor

Department of Radiation Oncology

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




LJL receives institutional funding for investigator-initiated immunotherapy trial from AstraZeneca; Grant funding from the Koch Institute at MIT and DFCI; sponsored travel from AstraZeneca for immunotherapy symposium; and has an international patent filing for quantitative tumour oxygen measurements in cervical cancer.


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.


NSH and AHR declare that they have no competing interests.

Peer reviewers

Susan A. Davidson, MD

Associate Professor/Chief

Gynecologic Oncology

S/M Obstetrics & Gynecology (UCD)

University of Colorado Health Sciences Center




SAD declares that she has no competing interests.

Svetlana Mironov, MD

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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