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repro > benign gynae > Flashcards

benign gynae Flashcards

1
Q

10yr survivals of repro cancers

A

endometrial 72%
cervical 51%
vulval 67%
ovarian 35%

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2
Q

side effects of radiotherapy in repro cancers

A
  • Vaginal discharge/dryness
  • Vaginal stenosis
  • Rectal stenosis
  • Radiation cystitis

fatigue N+V+D

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3
Q

indications for radical radiotherapy as primary curative treatment

A

cervical cancer
- stage I is medically unfit for surgery
- stage II, III, IV

endometrial cancer if medically inoperable
some vulval cancers

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4
Q

adjuvant radiotherapy, indications?

A

following surgery to treat microscopic disease + reduce the risk of disease recurrence

indications
- cervical - large tumour diameter, positive margins on resection, positive lymph nodes
- endometrial - grade III, IV, grade II depending on histology
- vulval - depending on histology

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5
Q

palliative radiotherapy indications

A

pain
bleeding
spinal cord compression from metastases
skin mets

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6
Q

most commonly used chemo in ovarian cancer

A

carboplatin +/- paclitaxel

usually 6 cycles - may have debulking after 3
treatment depends on stage/grade of cancer

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7
Q

what origin is the symptom of bleeding usually from? what would bimanual examination show?

A

uterine

midline, lobulated mass
moves with cervical motion
NONtender

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8
Q

what origin is the symptom of pain usually from? what would bimanual examination show?

A

ovarian

lateral, occupying fornices
NO movement with cervical motion
can be TENDER

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9
Q

what origin pressure symptoms usually from?

A

uterine or ovarian

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10
Q

how do benign vs malignant present differently?

A

benign
- long term symptoms
- smooth mass, MOBILE

malignant
- short term
- cachexia (wasting of body)
- ascities
- craggy mass
- NOT mobile

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11
Q

investigating premenopausal vs postmenopausal ovarian masses

A

pre - MRI, tumour markers (AFP, HCG, LDH)

post - CT + CA125

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12
Q

nonmalignant causes of a raised Ca125

A

endometriosis
fibroids
adenomyosis
pelvic infection
liver disease
pregnancy

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13
Q

tumour markers

A

alphafetoprotein (AFP) - embryonal carcinoma
human chorionic gonadotrophin (HCG) - choriocarcinoma

LDH - dysgerminoma

women under 40 with a complex ovarian mass require tumour markers for a possible germ cell tumour

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14
Q

risk of malignancy index

A

estimates risk of an ovarian mass being malignany
takes into account 3 things -
- menopausal status
- ultrasound findings
- CA125 level

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15
Q

how to calculate risk of malignancy index

A

A = menopausal status
- pre = 1
- post = 3

B =ultrasound features (no =0, one feature = 1, >1=3)
- multioculated
- solid areas
- bilaterality
- ascities
- metastasis

C=serum Ca125

RMI = A x B x C

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16
Q

RMI value meanings

A

RMI <30 -> 3% risk of ovarian cancer

RMI 30-200 -> 10%

RMMI >200 -> 75%

17
Q

functional ovarian cysts

A
  • Related to ovulation
  • Common in premenopausal – postmenopausal may need further Ix
  • Rarely >5cm
  • Usually resolve spontaneously after a few cycles
  • May cause menstrual disturbance
  • Consider as differential in acute abdomen as may bleed or rupture
  • Often asymptomatic/incidental finding

follicular or corpus luteum cyst

18
Q

endometriotic cysts

A

presents with
o Severe dysmenorrhea/premenstrual pain
o Dyspareunia
o Assoc with sub fertility
o Occasionally asymptomatic
o Acute abdomen if ruptures

Examination
o Tender mass with modularity
o Tenderness behind uterus

19
Q

dermoid cysts

A

Totipotential
o Teeth
o Sebaceous material
o Hair
o Thyroid tissue

Assoc with ovarian torsion
Commonest benign tumour in women under30

20
Q

ovarian mass investigation

A
  • ultrasound
  • Premenopausal simple ovarian cyst <5cm on US don’t need further investigation
  • Ca125
  • Women under 40 with complex ovarian mass require tumour markers for a possible germ cell tumour
    o Lactate dehydrogenase (LDH)
    o AFP
    o HCG
21
Q

management of benign ovarian tumours

A

monitoring, if >7cm MRI

medical - GNRH analogues, OCP
surgical - laparoscopic/laparotomy
- ovarian cystectomy
- uni/bilateral oophrectomy
- pelvic clearance

22
Q

borderline ovarian tumours

A
  • Growth much more controlled than cancer
  • Unlikely to spread
  • Even if spread – as implant rather than deeply invasive
  • Usually a better prognosis compared to ovarian cancer
  • Young women – unilateral cystectomy/oophorectomy with close follow up
  • Postmenopausal women – pelvic clearance
23
Q

fibroids

A

smooth muscle cell tumour - usually benign
v common 40-60% of women in later reproductive years

**oestrogen sensitive - grows in response

24
Q

types of fibroids

A

subserosal - just below outer layers of uterus, grow outwards + can become v large filling abdominal cavity, PAIN

intramural - within myometrium, can distort uterus, BLEEDING

submucosal - just below lining of uterus, PAIN + BLEEDING

pedunculated - on stalk

25
Q

fibroids presentation

A

heavy menstrual bleeding + prolonged
reduced fertility
post coital bleeding
lower abdo pain - worse during period

deep dyspareunia
urinary/bowel symptoms - due to pelvic pressure

26
Q

fibroids investigations

A

abdo + bimanual exam
- palpable pelvic mass
- enlarged firm non-tender uterus

diagnosis = transvaginal US

27
Q

management of fibroids

A

asymptomatc = nothing, monitor

medical
- wants kids -> tranexamic acid
- for fibroids <3cm, Mx same as HMB
–> mirena coil = 1st line
- GnRH agonists (goserline) - reduce size
–> induce menopause like state, reduce oestrogen but SE = hot flushes, dry vaj, loss of bone min density

surgical
- endometrial ablation(<3cm), myomectomy, hysterectomy
- uterine artery embolisation (starves fibroid of O2)

28
Q

endometriosis

A

presence of endometrial glands + stroma outside of uterine cavity
- endometrioma
- adenomyosis = endometrial tissue within myometrium of uterus

20-30% of infertile women

29
Q

causes of endometriosis

A

retrograde menstruation = blood flows backwards into fallopain tubes and implants in pelvis

abnormal development as fetus
spread through lymphatics - altered immune function
metaplasia
altered cellular adhesion

IDK

30
Q

presentation of endometriosis

A

dysmenorrhoea - pain before menstruation
dysparenunia
menorrhagia
painful defaecation
chronic pelvis pain
infertility
bleeding from other sites - haematuria

chocolate cysts
gunpowder appearance on laparoscopy
endometrial tissue in poterior fornix
tenderness in vagina, cervix + adnexa

31
Q

endometriosis investigation

A

lapaoscopy = gold standard
–> definitive diagnosis - biopsy lesion

pelvic US may reveal large endoetriomas + chocolate cysts

32
Q

endometriosis management

A

initial mx - NSAIDs / paracetamol
hormonal mx - COCP or POP
– still want kids -> GnRH analogues (pseudomenopause to reduce oestrogens)

surgical Mx
- laparoscopic surgery to excise or ablate endometrial tissue + adhesions
- hysterectomy - stop response to menstrual cycle

surgery may improve fertility, hormonal therapies may improve symptoms not fertility

33
Q

endometriosis complications

A

infertility
adhesions
ectopic pregnancy
malignancy - endometriod carcinoma

repro (33 decks)

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