Diseases of the female genital system 2 Flashcards
What is endometriosis?
ectopic endometrium
What is the epidiemiology of endometriosis?
6-10% of women, 30 – 40yo
What are the clinical features of endometriosis?
- 25% asymptomatic
- dysmenorrhoea
- dyspareunia
- pelvic pain
- subfertility
- pain on passing stool
- dysuria
What is the treatment for endometriosis?
Medical (COCP - GnRH agonists/antagonists, progesterone antagonists)
surgical (ablation/ TAH-BSO)
What other diseases is endometriosis linked to?
- Ectopic pregnancy
- ovarian cancer
- IBD
What is endometritis?
Inflammation of the endometrium
What are the acute causes of endometritis?
- Retained POC/placenta
- prolonged ROM
- complicated labour
What are the chronic causes of endometritis?
- PID
- retained gestational tissue
- endometrial TB
- IUCD infection
What is the difference in histology between acute and chronic endometritis?
Acute - neutrophils
Chronic - lymphocytes/plasma cells
What are the clinical features of endometritis?
- Abdominal/pelvic pain
- pyrexia
- discharge
- dysuria
- abnormal vaginal bleeding
What is the treatment of endometritis?
- Analgesia
- abx
- remove cause
What are endometrial polyps?
Sessile/polypoid E2-dependent uterine overgrowths
What are the clinical features of endometrial polyps?
- Often asymptomatic
- intermenstrual bleeding
- post menopausal bleeding
- menorrhagia, dysmenorrhoea
What is the treatment for endometrial polyps?
- medical (P4/GnRH agonists)
- surgical (curettage)
What is leiomyomata?
Uterine fibroids - benign myometrial tumours with E2/P4-dependent growth
What is the epidemiology of leiomyomata?
~20% women 30-50’s
What are the risk factors for leiomyomata?
- Genetics
- nulliparity
- obesity
- PCOS
- HTN
What are the clinical features of leiomyomata?
- Often asymptomatic
- menometrorrhagia (Fe def. anaemia)
- subfertility/ pregnancy problems
- pressure sx
What are the treatments for leiomyomata.
- Medical (IUS/NSAIDs/OCP/P4/Fe2+);
- non-medical (artery embolization, ablation, TAH)
What is the prognosis for leiomyomata?
- menopausal regression
- malignancy risk 0.01%
What is endometrial hyperplasia?
Excessive endometrial proliferation (increased E2, decreased P4)
What are the risk factors for endometrial hyperplasia?
- obesity
- exogenous E2
- PCOS
- E2-producing tumours
- tamoxifen
- HNPCC (PTEN mutations)
How is endometrial hyperplasia classified?
- non-atypical hyperplasia (1-3% progress)
- atypical hyperplasia (23-48% are carcinoma on hysterectomy)
What are the symptoms of endometrial hyperplasia?
Abnormal bleeding - IMB/PCB/PMB
What is the treatment for endometrial hyperplasia?
- medical (IUS, P4),
- surgical (TAH)
What is the prognosis for endometrial hyperplasia?
- endometrial adenocarcinoma
- regression
What is the most common cancer of the female genital tract?
endometrial carcinoma
What are the two types of endometrial carcinoma?
- Type 1 - endometroid
- Type 2- serous
What is the difference in epidemiology between serous and endometroid carcinoma?
Incidence
- endometroid - 75% of cases
- serous - 25% of cases
Age
- endometroid - Pre/perimenopausal
- serous - postmenopausal
What mutations are found in endometroid carcinoma?
PTEN
Kras
What mutations are found in serous carcinoma?
p53
What is the E2 status of endometroid cancer?
E2 +ve
What is the E2 status of serous cancer?
E2 -ve
What are the grades of endometroid cancer?
Grades 1,2,3
What are the grades of serous cancer?
3
How is endometrial carcinoma staged?
FIGO (1 - 4)
What are the treatments for endometrial cancer?
- medical (P4), surgery (TAH-BSO), adjuvant therapy (chemo-/radiotherapy)
What is the prognosis for endometrial cancer?
- Stage 1 = 90% 5yr survival
- Stage 2-3 =
What is polycystic ovary syndrome?
Complex endocrine disorder; hyperandrogenism, menstrual abnormalities and polycystic ovaries
What is the epidemiology of polycystic ovary syndrome?
6-10% women (20-30% have polycystic ovaries)
What investigations are performed for PCOS?
- USS
- fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS )
- OGTT
How is PCOS diagnosed?
Rotterdam criteria 2/3 of:
- polycystic ovaries
- hyperandrogenism (hirsuitism/ biochemical)
- irregular periods (>35 days)
What are the treatments for polycystic ovary syndrome?
- lifestyle (weight loss)
- medical (metformin, OCP, clomiphene)
- surgical (ovarian drilling)
What other conditions are linked to PCOS?
- infertility
- endometrial hyperplasia/ adenocarcinoma
What is hypergonadotrophic hypogonadism?
Primary failure of gonads
What are the congenital causes of hypergonadotrophic hypogonadism?
- Turner syndrome (XO)
- Klinefelter’s syndrome (XXY)
What are the acquired causes of hypergonadotrophic hypogonadism?
- Infection
- surgery
- chemo-radiotherapy
- toxins/drugs
What is hypogonadothrophic hypogonadism?
Hypothalamic/ pituitary failure -> secondary failure of gonads
What are the causes of hypogonadothrophic hypogonadism?
- Sheehan’s syndrome
- pituitary tumours
- brain injury
- empty sella syndrome
- PCOS
What is the presentation of hypogonadothrophic hypogonadism?
- amenorrhoea/absent menarche; delayed puberty
- decreased sex hormone levels +/-
- increased LH and FSH levels
What investigations are used in suspected hypogonadothrophic hypogonadism?
- Hormonal profiling
- karyotyping
What is the treatment for hypogonadothrophic hypogonadism?
- Difficult - address cause
- HRT
What are the origins of ovarian neoplasms?
Sex-cord stromal tumours
- Granulosa cell thecomas
- fibrothecomas
- Sertoli-Leydig cell tumours
Surface epithelial stromal tumours
- Serous
- Mucinous
- Endometroid
- Transitional cell
- Clear cell
Germ cell tumours
- Teratomas
- Yolk sac tumours
- Dysgerminomas
What is the most common group of epithelial neoplasms?
Epithelial tumours
What are the three major histological types of epithelial ovarian tumours?
- Serous (tubal)
- Mucinous (endocervical)
- Endometroid (endometrium)
What are sex cord stromal tumours?
- Rare; arise from ovarian stroma, which was derived from sex cord of embryonic gonad
- Can generate cells from the opposite sex
What are thecoma/ fibrothecoma/ fibromas?
- Benign, thecomas and fibrothecomas produce E2 (also rarely androgens)
- Fibromas hormonally inactive
- Comprised of spindle cells (plump spindle cells with lipid droplets = thecoma appearance)
What are granulosa cell tunours?
Low grade malignant, produces E2
What are Sertoli-Leydig cell tumours?
Produces androgens; 10-25% malignant
What is the 2nd commonest gynae cancer?
Ovarian cancer
What are the risk factors for ovarian cancer?
- Fx
- ↑age
- PMHx
- breast cancer
- smoking
- E2-only HRT
- Lynch II syndrome
- obesity (weak)
- nulliparity (weak)
What are the protective factors for ovarian cancer?
- OCP
- breastfeeding
- hysterectomy
What is the typical history for ovarian cancer?
- non-specific symptoms
- pain
- bloating
- weight loss
- PV bleeding
- urinary frequency
- anorexia
What is the treatment for ovarian cancer?
- Stage
What is the prognosis for ovarian cancer?
Overall 5 years 43% survival
What is the most common type of metastatic ovarian tumour and where do they spread from?
Mullerian
- Uterus
- Fallopian tube
- Pelvic peritoneum
- Contralateral ovary
What are the site of spread for extra-mullerian tumours?
Lymphatic/ haematogenous spread:
- GI tract: Large bowel, stomach
- (Krukenberg tumour), pancreatobiliary
- Breast
- Melanoma
- kidney
- lung
Direct extension
- bladder
- rectal
