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Gynaecology > 1: Menstruation: Endometrial Hyperplasia and Endometrial Cancer > Flashcards

1: Menstruation: Endometrial Hyperplasia and Endometrial Cancer Flashcards

1
Q

Define endometrial hyperplasia

A

Abnormal proliferation of the endometrium, more than would expect during menstrual cycle

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2
Q

What is the major risk with endometrial proliferation

A

Risk of endometrial cancer

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3
Q

How have WHO classified endometrial hyperplasia

A
  • Hyperplasia without atypia

- Atypical hyperplasia

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4
Q

What causes endometrial hyperplasia

A

Unopposed oestrogen

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5
Q

How may endometrial hyperplasia present

A

Menorrhagia
Intermenstrual bleeding
Post-menopausal bleeding

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6
Q

Explain pathophysiology of endometrial hyperplasia

A

Unopposed oestrogen stimulates proliferation of the glands causing endometrial hyperplasia

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7
Q

What is first line for investigating endometrial hyperplasia

A

Trans-vaginal US

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8
Q

What on trans-vaginal US indicates endometrial hyperplasia

A

> 4mm

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9
Q

What is performed if endometrial thickness on US is >4mm

A

Endometrial sampling

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10
Q

What is third-line for endometrial hyperplasia

A

Hysteroscopy and biopsy

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11
Q

What is the risk of endometrial hyperplasia without atypia progressing to cancer

A

<5% in 20-years

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12
Q

How should endometrial cancer without atypia be managed

A

Lifestyle: Weight Loss, Stop HRT

Medical:

  • LNG-IUS or POP
  • Repeat endometrial biopsy at 6-months

Lifestyle factors: weight loss, stop HRT

  • 6m endometrial biopsy
  • Levornegestrel releasing system
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13
Q

What is an alternative to levonorgestrel intra-uterine system

A

Continuous oral progesterone

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14
Q

How long should individuals with endometrial hyperplasia without atypia be treated

A

5-years

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15
Q

What is the risk that patients with atypical hyperplasia have endometrial cancer

A

40%

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16
Q

What is the risk of patients with atypical hyperplasia developing endometrial cancer

A

70%

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17
Q

how is atypical hyperplasia managed

A

hysterectomy

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18
Q

why are those with atypical hyperplasia managed with hysterectomy

A

due to risk of progression to endometrial cancer

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19
Q

in post-menopausal women with atypical hyperplasia what is offered

A

hysterectomy with bilateral salpingoopherectomy

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20
Q

what is main complication of endometrial hyperplasia

A

endometrial cancer

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21
Q

what is endometrial cancer

A

adenocarcinoma

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22
Q

what is the prevalence of endometrial cancer in the UK

A

4th most common cancer

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23
Q

what is happening to incidence of endometrial cancer and why

A

increasing - thought due to obesity

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24
Q

when is peak incidence of endometrial cancer

A

65-75y

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25
in which population does endometrial cancer occur
post-menopausal women
26
in which ethnicity is endometrial cancer more common
North American
27
what causes endometrial cancer
Unopposed oestrogen exposure
28
what are 3 groups of risk factors that lead to increase oestrogen
1. Anovulation 2. Unopposed oestrogen 3. Other
29
why does anovulation increase risk oestrogen
Due to no production of corpus luteum which is meant to release progesterone
30
what anovulatory factors increase risk of endometrial cancer
- PCOS - Early menarche - Late menopause - Nulliparous
31
what are two protective factors against endometrial cancer
- Multiparous | - COCP
32
what are 3 causes of oestrogen exposure
- HRT - Tamoxifen - Obesity
33
why does obesity increase oestrogen
Increases peripheral conversion androgens to oestrogen
34
what 'other' factors increase risk of endometrial cancer
Age, Lynch Syndrome
35
what syndrome is endometrial cancer associated with
Lynch Syndrome
36
what are two protective factors for endometrial cancer
COCP | Multiparous
37
what is the main symptom of endometrial cancer
post-menopausal bleeding
38
what % of women with endometrial cancer will have PMB
90
39
what % women with PMB will have endometrial cancer
10 - very non-specific sign
40
what are 2 other symptoms of endometrial cancer
Clear vaginal discharge Weight loss Abdominal pain
41
What are the vulval causes of post-menopausal bleeding
Atrophic vaginitis | Vulval carcinoma
42
What are the cervical causes of postmenopausal bleeding
Cervical polyps | Cervical cancer
43
What are the endometrial causes of PMB
Endometrial cancer | Endometrial polyps
44
what is first-line for endometrial cancer
Transvaginal-US
45
what endometrial thickness is abnormal
>4
46
if endometrial thickness is more than 4 what should be done
Pipelle biopsy
47
what type of biopsy is used for endometrial cancer
Pipelle biopsy
48
if patient is high-risk, what type of biopsy will they recieve
Hysteroscopy and biopsy
49
what is used to stage endometrial cancer
FIGO (Federation international obstetrics and gynaecology)
50
what staging system is used for endometrial cancer
FIGO
51
what is FIGO stage 1
Uterus only
52
what is FIGO stage 2
Uterus and cervix
53
what is FIGO stage 3
Pelvis
54
what is FIGO stage 4
Outside pelvis
55
How is FIGO stage 1 cancer managed
- Hysterectomy and bilateral salping-oopherectomy
56
What should be taken during hysterectomy and bilateral salpinoopherectomy
- Peritoneal washings
57
What is 5-year survival rate of type 1 endometrial cancer
90
58
What is management for FIGO stage 2 cancer
Radical hysterectomy and lymphadenectomy
59
How is stage 3 FIGO managed
De-bulking surgery | Chemoradiotherapy
60
How is stage 4 FIGO managed
De-bulking surgery Palliative radiotherapy High-dose oral progesterone Frail old ladies who cannot undergo surgery are given oral progesterone
61
What is 5-year survival in FIGO stage-4 cancers
25%

Gynaecology (22 decks)

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