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Reproductive System > Clinical Pathology of Uterus > Flashcards

Clinical Pathology of Uterus Flashcards

1
Q

What are the investigations of post-menopausal bleeding?

A

Pelvic examination
Speculum examination
Transvaginal ultrasound
Endometrial biopsy if > 4mm or irregular, blind biopsy e.g. pipelle
Hysteroscopy - outpatient with local anaesthetic or inpatient with GA

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2
Q

What are the advantages and disadvantages of hysteroscopy?

A

Allows visualisation of biopsy site
Risk of uterine rupture
Carries more risks

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3
Q

In what women does endometrial cancer typically occur in?

A 
Post-menopausal women 
Women with high circulating oestrogen levels;
- obesity 
- unopposed E2 therapy/tamoxifen 
- polycystic ovarian syndrome 
- early menarche/late menopause
Atypical endometrial hyperplasia 
HNPCC/Lynch type II familial cancer syndrome
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4
Q

How many new cases of endometrial cancer were there in the UK in 2014?

A

9324

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5
Q

What is the incidence of endometrial cancer in the UK?

A
  1. 8 per 100,000 women

1. 0 per 100,000 women aged 40

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6
Q

What is the mortality of endometrial cancer in the UK?

A

6.7 deaths per 100,000 women

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7
Q

What is the 5 year survival of stage 1 endometrial cancer?

A

95%

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8
Q

What is the 5 year survival of stage 4 endometrial cancer?

A

14%

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9
Q

What is the overall 5 year survival for all stages of endometrial cancer?

A

78%

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10
Q

What stage of endometrial cancer do most women present with?

A

Stage 1

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11
Q

What are the symptoms of endometrial cancer?

A

Abnormal vaginal bleeding - intermenstrual

Post-menopausal bleeding

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12
Q

What percentage of women with post-menopausal bleeding will have endometrial cancer?

A

8%

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13
Q

What are the causes of post-menopausal bleeding?

A 
Endometrial cancer
HRT 
Peri-menopausal bleeding 
Atrophic vaginitis 
Polyps 
Other cancers e.g. cervix, vulva, bladder, anal
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14
Q

How is endometrial cancer staged?

A

MRI done to help pick appropriate surgery and treatment plan
Surgical/pathological staging

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15
Q

What are the advantages of MRI for endometrial cancer?

A

Identifies;
Depth of myometrial invasion
Cervical involvement
Lymph node involvement

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16
Q

What is invaded in stage 1A of endometrial cancer according to FIGO 2009 staging?

A

Inner half of myometrium

17
Q

What is invaded in stage 1B of endometrial cancer according to FIGO 2009 staging?

A

Outer half of myometrium

18
Q

What is invaded in stage 2 of endometrial cancer according to FIGO 2009 staging?

A

Invades cervix

19
Q

What is invaded in stage 3A of endometrial cancer according to FIGO 2009 staging?

A

Serosa/adnexa

20
Q

What is invaded in stage 3B of endometrial cancer according to FIGO 2009 staging?

A

Vagina/parametrium

21
Q

What is invaded in stage 3C of endometrial cancer according to FIGO 2009 staging?

A

Pelvic or para-aortic nodes

22
Q

What is invaded in stage 4 of endometrial cancer according to FIGO 2009 staging?

A

Bladder/bowel/intra-abdominal/inguinal nodes

23
Q

What are the features of type 1 endometrial cancer?

A

Endometrioid adenocarcinoma
By far the commonest
Unopposed oestrogen
Hyperplasia with atypia is a precursor

24
Q

What are the features of type 2 endometrial cancer?

A

Uterine serous and clear cell carcinoma
High grade, more aggressive, worse prognosis
Generally older women
Serous intraepithelial carcinoma is a precursor

25
Q

What is the treatment of early stage endometrial cancer?

A

Surgery

TAH/BSO/washings

26
Q

What is the treatment of high risk histology endometrial cancer?

A

Chemotherapy and surgical management

27
Q

What is the treatment of advanced stage endometrial cancer?

A

Radiotherapy - spread within pelvis, not suitable for surgery

28
Q

What is the palliative treatment of endometrial cancer?

A

Progesterone

29
Q

What are the features of radiotherapy for treatment of endometrial cancer?

A

External beam radiotherapy
Treat the whole of the pelvis, tumour and lymph nodes
Followed by brachytherapy to target actual tumour

30
Q

What are the features of caesium insertion for treatment of endometrial cancer?

A

Intra-cavity
Vault
Applicator put directly into vagina to deliver radiotherapy locally

31
Q

What is the cure rate of stage 1B endometrial cancer?

A

85%

32
Q

What is the cure rate of stage 2A endometrial cancer?

A

75%

33
Q

What is the cure rate of stage 2B endometrial cancer?

A

60%

34
Q

What is the cure rate of stage 3B endometrial cancer?

A

30%

35
Q

What is the cure rate of stage 4 endometrial cancer?

A

21%

Reproductive System (33 decks)

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