Diagnosis

In patients who are suspected of having endometrial carcinoma, clinicians should obtain:

• a detailed account of the presenting symptoms
• complete drug history e.g. - HRT, oral contraceptive pill, tamoxifen
• a gynaecological history to find out about early menarche/late menopause, known endometrial hyperplasia, parity
• medical and surgical history - obesity, treatment for breast cancer, diabetes mellitus, hypothyroidism, hypertension, and Lynch-type syndrome (1)

General practitioners in the UK should refer women with postmenopausal bleeding to a rapid access gynaecology clinic to be seen within two weeks.

The following patients should be referred to a gynaecologist to rule out other possible sources of vaginal bleeding

• premenopausal patient older than 40 years who presents with a recent onset abnormal bleeding pattern
• a premenopausal patient of any age with an abnormal bleeding pattern and risk factors for endometrial cancer

A definitive diagnosis is made histologically through a tissue sample obtained either by a Pipelle curette (as an outpatient procedure) or by hysteroscopy and dilatation and curettage under general anaesthesia.

Patients who are confirmed of having endometrial cancer should be referred to a specialised gynaecology oncological centre for further evaluation (1).

Reference:

• (1) Saso S et al. Endometrial cancer. BMJ. 2011;343:d3954