🔑 Key Learning

  • Most common gynaecological malignancy; oestrogen-dependent.
  • Preceded by endometrial hyperplasia.
  • Post-menopausal bleeding is endometrial cancer until proven otherwise.
  • NICE: Refer women aged ≥55 with post-menopausal bleeding on a 2WW suspected cancer pathway.

🧬 Pathophysiology

  • A common, oestrogen-dependent malignancy, which is preceded by endometrial hyperplasia, which subsequently progresses to malignancy.
  • Any post-menopausal bleeding should be considered endometrial ca. until proven otherwise. 

👀 Clinical Features

Red Flags and Referrals

  • Post-menopausal bleeding = unexplained PV bleeding >12 months after menstrual cessation.
  • Women ≥55 years with post-menopausal bleeding → urgent 2WW referral.
  • Women <55 years with post-menopausal bleeding → consider urgent 2WW referral.
  • Women ≥55 years → consider direct access pelvic ultrasound if:
    • Unexplained vaginal discharge plus:
      • first presentation
      • thrombocytosis
      • visible haematuria
    • Visible haematuria plus anaemia or thrombocytosis or hyperglycaemia.

📝 Exam Clues & Clinchers

  • Woman ≥55 with PV bleeding → urgent 2WW suspected cancer pathway referral.

🔗 Useful Links and References

NICE CKS. Gynaecological cancers - recognition & referral. Available at URL: https://cks.nice.org.uk/topics/gynaecological-cancers-recognition-referral/background-information/presentation/