3.1 Specialist diagnostic work-up
The treatment team, after taking a thorough medical history and making a thorough medical examination of the patient, should undertake the following investigations under the guidance of a specialist:
- transvaginal pelvic ultrasound, if not already done
- outpatient endometrial biopsy
- endometrial biopsy, which may be obtained via a hysteroscopy and/or dilation and curettage to confirm the diagnosis, if a diagnosis of malignancy is not already obtained
- abdomino-pelvic-chest CT scan, which may be appropriate to help define the extent of disease
- MRI scans, which may be warranted in cases where surgery cannot be performed due to a patient’s wishes to retain fertility or where the primary site of advanced pelvic malignancy is unknown
- routine blood tests to assess general health.
Pre-treatment diagnostic investigations and relevant staging (see section 3.2) should be completed within two weeks of the initial specialist appointment.
Pharmacogenetics describes how individual genetic differences can lead to differences in the way certain medicines interact with the body. These interactions can affect the effectiveness of medications and any side effects. Applying pharmacogenetics to treatment planning may help patients to be prescribed the most appropriate treatment at the optimal dose from the beginning of treatment (NHMRC 2013).
