Endometrial cancer

Last reviewed: 7 May 2023
Last updated: 14 Dec 2022



History and exam

Key diagnostic factors

  • postmenopausal vaginal bleeding (PVB)
More key diagnostic factors

Other diagnostic factors

  • uterine mass, fixed uterus, or adnexal mass indicating extrauterine disease
  • abnormal menstruation or vaginal bleeding in a premenopausal woman
  • pain (abdominal or pelvic) and weight loss
  • symptoms of metastatic disease
  • signs of metastatic disease
Other diagnostic factors

Risk factors

  • overweight and obesity
  • age >50 years
  • endometrial hyperplasia
  • unopposed endogenous estrogen
  • unopposed exogenous estrogen
  • tamoxifen use (postmenopausal women)
  • insulin resistance
  • family history of endometrial cancer
  • family history of breast cancer or ovarian cancer
  • family history of Lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • family history of PTEN syndromes
  • polycystic ovary syndrome
  • radiation therapy
  • inactivity
  • diet
  • nulliparity and infertility
More risk factors

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • serum CA-125 level
  • saline infusion sonohysterogram
  • BUN 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


stage IA endometrioid carcinoma not considering fertility preservation

stage IA endometrioid carcinoma considering fertility preservation

stage IB or II endometrioid carcinoma

stages III to IV endometrioid carcinoma; all nonendometrioid carcinomas (high risk)


recurrent or incurable disease



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 is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.

Richard T. Penson, MD, MRCP
Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital




RTP declares that his institution has received research funding from Array BioPharma Inc., AstraZeneca, Genentech, and Vascular Biogenics Ltd on his behalf. RTP has received research funding from Genentech Inc., ImClone Systems Inc., Endocyte Inc., AstraZeneca, Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. He has been paid for participating in scientific advisory boards for AbbVie, AstraZeneca, Baxalta Oncology, Clovis Oncology, Curio Science, Eisai Inc., Endocyte Inc., Genentech, Janssen Oncology (J&J), Merck & Co., Mersana Therapeutics Inc., NewLink Genetics, Nexus Global Group, Pieris Pharma Inc., Roche Inc., Sutro Biopharma, Syndax Pharmaceuticals, Tesaro 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.


Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to 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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