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Gynae > Disorders of the uterus > Flashcards

Disorders of the uterus Flashcards

1
Q

What is the other term for adenomyosis?

A

Endometriosis interna, presence of the endometrium and its underlying stroma within the myometrium.

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2
Q

When is adenomyosis most common?

A

In women at 40 years

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3
Q

What is adenomyosis associated with?

A

Endometriosis and fibroids

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4
Q

Is adenomyosis oestrogen dependent?

A

yes

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5
Q

What are the clinical features of adenomyosis?

A

painful, regular, heavy menstruation is common. uterus may be mildly enlarged and tender

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6
Q

What is the investigation for adenomyosis?

A

MRI (NOT USS)

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7
Q

What is the treatment for adenomyosis?

A

non-steroidals or progestogens to control menorrhagia and dysmenorrhoea but hysterectomy often required.

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8
Q

What are the causes of endometritis?

A

Often secondary to STIs, as a complication of surgery (eg c-section/termination), or caused by IUD or products of conception.

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9
Q

What are the clinical features of endometritis?

A

Persistent, often heavy vaginal bleeding, pain, tender uterus, open os, fever may be absent but septicaemia may ensue.

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10
Q

What investigations are needed to confirm endometritis?

A

Vaginal and cervial swabs, FBC (pelvic USS may not be very reliable)

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11
Q

How to you treat endometritis?

A

Broad-spec ABs and/if needed evacuation of retained products of conception (ERPC)

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12
Q

At what age are the presence of intrauterine polyps most common?

A

Between 40 and 50 ( when oestrogen levels are high)

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13
Q

When are polyps commonly found in post-menopausal women?

A

Women who are on tamoxifen for breast ca.

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14
Q

What are the symptoms of polyps?

A

IMB and menorrhagia, can occasionally prolapse through the vagina

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15
Q

Which investigations are needed to diagnose polyps?

A

USS or hysteroscopy because of abnormal bleeding

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16
Q

What is the most common genital tract cancer?

A

Endometrial carcinoma

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17
Q

When is endometrial cancer most prevalent?

A

60 years

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18
Q

What percentage of endometrial cancer occurs pre-menopausely?

A

15%

19
Q

Is it more benign than ovarian cancer?

A

no, it is stage for stage the same prognosis as ovarian cancer

20
Q

What is the common pathology of endometrial cancer?

A

Commonly adenocarcinoma or columnar endometrial gland cells (90%)

21
Q

Another common type of endometrial cancer is adenosquamos carcinoma, what is its prognosis in comparison?

A

Poorer

22
Q

What is the aetiology behind endometrial cancers?

A

A high ratio of oestrogen to progesterone, when there is a state of ‘unopposed oestrogen’.

23
Q

What are the risk factors for endometrial cancer?

A

Obesity (androgens -oestrogens), exogenous oestrogens without a progestogence increase risk x6, PCOS, late menopause, ovarian granulosa and theca (osetrogen secreting tumour), tamoxifen.

24
Q

What is protective for endometrial cancer?

A

COCP and pregnancy

25
Q

What are endogenous causes of excess oestrogen?

A

PCOS & obesity, oestrogen secreting tumours, nulliparity and late menopause.

26
Q

What are the exogenous causes of excess oestrogen?

A

Unopposed oestrogen therapy and tamoxifen

27
Q

What are the miscellaneous causes of endometrial cancer?

A

Diabetes, hypertension (not independent), history of breast or ovarian cancer and lynch type II syndrome

28
Q

What is Lynch type II syndrome?

A

HNPCC associated with cancers of the GI or reproductive system.

29
Q

Is there premalignant disease for endometrial cancer?

A

Yes, unopposed or erractic oestrogen can cause ‘cystic hyperplasia’. If there is further stimulation this can lead to atypical hyperplasia.

30
Q

What are the symptoms of premalignant endometrial cancer?

A

Menstrual abnormalities, such as PMB.

31
Q

If pre-malignant disease is recognised what is indicated?

A

This is seldom recognised but a hysterectomy is indicated.

32
Q

In women with PMB, what percentage are at risk of carcinoma?

A

10%

33
Q

In premenopausal women, how does endometrial carcinoma present?

A

IMB, or occasionally recent onset menorrhagia

34
Q

What is the commonest cause of PMB?

A

Atrophic vaginitis

35
Q

Which lymph nodes may be affected in endometrial cancer?

A

Pelvic and para-aortic

36
Q

What is seen in stage 1 endometrial ca?

A

Lesions confined to the uterus. 1a-endometrium only, 1b- deepest invasion<0.5 myometrial thickness, 1c- deepest invasion is >0.5 myometrial thickness

37
Q

What is seen in stage 2 endometrial ca?

A

Lesions confined to uterus and cervix.
2a- in endocervical glands only
2b- in cervical stroma

38
Q

What is seen in stage 3 endometrial ca?

A

Tumour invades through uterus
3a- invades serosa and/or adnexae and/or positive cytology
3b- vaginal masses
3c- metastases to pelvic/para-aortic lymph nodes

39
Q

What is seen in stage 4 endometrial ca?

A

Further spread to
4a- bowel or bladder
4b- distant mets

40
Q

What percentage present at stage 1 and what is the treatment?

A

75% and laparotomy with TAH and bilateral salpingo-oophorectomy. Also lymph node biopsy to determine stage. If lymph node involvement then external beam radiotherapy used. This reduces recurrence but does not prolong survival- used for palliation of symptoms.

41
Q

Where is recurrence of endometrial cancer most commonly seen?

A

In the vaginal vault in the first 3 years

42
Q

What factors would lead to a poorer prognosis with endometrial cancer?

A

Older age, advanced stage, deep myometrial invasion, high tumour grade and adenosquamos histology.

43
Q

What is the 5-year survival rate of endometrial ca?

A

75%

44
Q

What operation should a jehovahs witness who wants a surgical management of mennorhagia have?

A

sub-total abdominal hysterectomy (where cervix is left in situ)

Gynae (15 decks)

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