Endometrial cancer risk — DRCOG MCQ

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HardGynaecological OncologyEndometrial cancer riskDRCOG

A 62-year-old with obesity and type 2 diabetes has postmenopausal bleeding. Examination is normal. Which initial test is usually coordinated by the urgent bleeding pathway?

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Correct answer: C — Transvaginal ultrasound to assess the endometrium

The best answer is “Transvaginal ultrasound to assess the endometrium”. Transvaginal ultrasound is the usual initial investigation used to assess endometrial thickness in postmenopausal bleeding, with biopsy or hysteroscopy determined by findings and persistence. Her obesity and diabetes increase endometrial-cancer risk, so a normal external examination does not justify reassurance or delayed assessment. The UK pathway uses a 75 g two-hour OGTT, not the US 50 g screen followed by a 100 g three-hour test. Women with risk factors are tested at 24–28 weeks, while previous gestational diabetes prompts early self-monitoring or an early OGTT with repeat testing if normal. Diagnostic thresholds are fasting glucose at least 5.6 mmol/L or two-hour glucose at least 7.8 mmol/L.

Reference: NICE NG12: Suspected cancer recognition and referral: https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer