This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Post menopausal bleeding, Subject name: Gynaecology & Obstetrics
An obese woman of 49 years of age, affluent woman with diabetes and hypeension, complains of heavy menstrual bleeding with delayed and irregular cycles. Which of these is the most impoant cause that should be ruled out in this patient? 
Select and explain. 
A. Cancer cervix, B. Ca endometrium, C. Fibroid uterus, D. Polycystic ovaries
B: Ca endometrium
Answer: B: Ca endometrium 
Explanation: Risk factors for ca endometrium are Nulliparity Late menopause Obesity Diabetes mellitus Unopposed estrogen therapy Tamoxifen therapy Atypical endometrial hyperplasia Lynch II syndrome 20 Since the patient here is 49 yrs, obese, and diabetic, endometrial cancer must be ruled out here.