When should I refer a patient for specialist assessment if endometrial cancer is suspected based on my initial evaluation?

Refer a patient for specialist assessment using a suspected cancer pathway referral if endometrial cancer is suspected in the following situations:

• Women aged 55 years and over with unexplained postmenopausal bleeding (vaginal bleeding more than 12 months after menstruation has stopped) should be referred urgently for specialist assessment within 2 weeks.
• Consider referral for women under 55 years with postmenopausal bleeding.
• For women aged 55 and over presenting with unexplained vaginal discharge, especially if it is a new symptom, or if they have thrombocytosis, haematuria (visible or reported), low haemoglobin, or high blood glucose levels, consider a direct access ultrasound scan to assess for endometrial cancer and refer if indicated.

These referrals should be made promptly without delay, as early specialist assessment is critical for diagnosis and management.

Summary: Urgent referral for women ≥55 years with postmenopausal bleeding; consider referral for women <55 years with postmenopausal bleeding; consider ultrasound and referral for women ≥55 years with unexplained vaginal discharge and associated risk factors.

References: NICE CKS, NICE NG12