Ultrasound pelvis
CT pelvis and
abdomen
Saline hysterography
Spinal and Chest X-ray
Full blood count
Pap smear ectocervix
Pap smear endocervix
Coagulation profile
Serum CA125
Renal function tests
Liver function tests
Blind endometrial
biopsy
Office hysteroscopy
TSH
Serum FSH
D&C uterus
None of the above
Ultrasound pelvis Rarely of much value because 75% of patients on Tamoxifen for >12m have abnormal endometrial echo
This is due to microcysticchange in the endometrium and proximal myometrium
However, 98% negative predictive value for Ca endometrium if the echo is < 5 mm
Ultrasound pelvis Rarely of much value because 75% of patients on Tamoxifen for >12m have abnormal endometrial echo
This is due to microcysticchange in the endometrium and proximal myometrium
However, 98% negative predictive value for Ca endometrium if the echo is < 5 mm
CT pelvis and
abdomen
Not unless you (or the patient or the radiologist)
are prepared to pay for it!
Rarely of much value because 75% of patients on Tamoxifen for >12m have abnormal endometrial echo
This is due to microcysticchange in the endometrium and proximal myometrium
However, 98% negative predictive value for Ca endometrium if the echo is < 5 mm
Saline hysterography Of some use in the evaluation of Tamoxifen-
affected endometrium
Of most use in the
delineation of polyps
Doppler flow in the stalk of
polyps also useful
Full blood count Only if there has been substantial PV bleeding or
there is clinical evidence of
anaemia or blood
dyscrasia
Pap smear
ectocervix
Pap smear
endocervix
Should be done if not previously done or overdue
Because the
sqaumocolumnar junction
retreats into the cervical
canal postmenopause an
endocervical sample is
desirable
But this has poor diagnostic
value for endometrial
cancer
Blind endometrial
biopsy e.g. Pipelle
Tamoxifen is oestrogenic to the endometrium
And has a 0.2 – 4.0% risk of
causing endometrial
cancer
This is usually a diffuse
endometrial disease
And can be excluded with
>98% certainty by a blind
endometrial sampling
Uterine D&C A 21st century gynaecologist would
favour ultrasound + Pipelle
sampling or office
hysteroscopy
No tests 5 – 10 % of patients with postmenopausal bleeding
have an endometrial
cancer
And this patient on
Tamoxifen is at increased
risk
She will not be happy if you
miss this, her second, brush
with cancer
Do nothing It is rare for the cervix to be “closed” when an
endometrial cancer is
present
If the endometrial echo
was <5 mm on ultrasound
this would be a reasonable
option
Uterine D&C with
general anaesthesia
A reasonable option to exclude endometrial
cancer
It is not 100% diagnostic
And re evaluation of the
patient is desirable if the
symptoms persist or
There are other grounds for
suspicion