Diagnosis

The following investigations should be considered:

• transvaginal pelvic ultrasound (if not already done)
• outpatient endometrial biopsy
• endometrial biopsy (if diagnosis of malignancy not already obtained)
• abdomino-pelvic-chest CT scan
• MRI scans
• routine blood tests.

Staging

Staging is based on pathological and surgical findings. Where surgery is not performed, a clinical stage may be determined based on physical examination and imaging-related information.

Treatment planning

All newly diagnosed patients should be discussed in a gynaecology oncology multidisciplinary team meeting (MDM) before definitive treatment.

Special considerations that need to be addressed at this stage may include issues around medical comorbidities, obesity, diabetes, early menopause and hormonal changes.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.

Communication

The lead clinician’s (1) responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.

Checklist

Timeframe

Diagnostic investigations and relevant staging should be completed within 2 weeks of the initial specialist appointment.