# Cancer of the uterus (endometrial cancer)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Endometrial Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK525981/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GD28.04 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Cancer of the uterus (endometrial cancer) - disease-level clinical article (uterine-cancer-full.txt)

## Treatment metadata

- No drug therapy in primary care (Recognition & Referral)

## Complete treatment card

```text
CANCER OF THE UTERUS (ENDOMETRIAL CANCER)
Sources: Endometrial Cancer - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK525981/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class GD28.04 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Cancer of the uterus (endometrial cancer) - disease-level clinical
               article (uterine-cancer-full.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (4)
    - Abnormal uterine bleeding is by far the most common presenting symptom  [abnormal uterine
      bleeding]
    - About 10% of postmenopausal bleeding is ultimately traced to endometrial cancer  [abnormal
      uterine bleeding]
    - Advanced disease can bring pelvic and abdominal pain, ascites, and spread through the
      lymphatics or peritoneum  [abdominal pain · ascites · pelvic pain]
    - Vaginal discharge, pelvic pain, constipation, or diarrhea are less common presenting
      complaints  [abdominal pain · constipation · diarrhoea · pelvic pain · vaginal discharge]
  SIGNS - what you find (1)
    - The exam is often unremarkable, though an enlarged uterus may be felt in advanced disease
  TESTS (5)
    - An endometrial stripe under 4 mm on transvaginal ultrasound has a negative predictive value
      above 99%
    - A postmenopausal endometrial stripe of 4 mm or more calls for biopsy
    - Tissue is obtained by pipelle aspiration or by dilatation and curettage, with or without
      hysteroscopy
    - Chest, abdomen, and pelvis CT is done for high-grade histology to rule out spread before
      surgery
    - Molecular subtyping alongside histology can now shift the assigned stage up or down in early
      disease
  IF NOT THIS - what else fits (4)
    - Abnormal bleeding differentials are organized by the PALM-COEIN framework, spanning structural
      causes like polyps or fibroids to non-structural causes like clotting or ovulation disorders
    - An intrauterine or ectopic pregnancy, and gestational trophoblastic disease, must be ruled out
      in premenopausal bleeding
    - A hormone-secreting ovarian tumor or thyroid and adrenal disease can drive bleeding through
      ovulatory dysfunction
    - A pelvic mass may turn out to be a fibroid, ovarian cyst, hydrosalpinx, or scar tissue rather
      than cancer
  Source  StatPearls "Endometrial Cancer" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line]
   Adult    Malignant uterine (usually endometrial) tumour; postmenopausal bleeding is the cardinal
            warning sign and mandates urgent gynae-oncology referral for biopsy and staging rather
            than primary-care treatment. - Refer
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Malignant uterine (usually endometrial) tumour; postmenopausal bleeding is the cardinal
            warning sign and mandates urgent gynae-oncology referral for biopsy and staging rather
            than primary-care treatment.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Abnormal uterine bleeding in premenopausal women aged 45 or older, or in
            younger premenopausal women with risk factors (obesity, PCOS, Lynch syndrome, tamoxifen
            use), requires endometrial assessment to exclude cancer.
            RED FLAG - Pelvic pain, abnormal vaginal discharge, or uterine enlargement on
            examination may indicate advanced endometrial malignancy requiring evaluation.
            RED FLAG - Postmenopausal bleeding, abnormal or heavy intermenstrual bleeding in an
            older woman, or a pelvic mass.

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