endometrial ca + fibroids Flashcards
endometrial cancer prognosis
good prognosis due to early detection
most in post-menopausal, but around 25% occur before menopause
endometrial cancer risk factors
excess oestrogen
- nulliparity
- early menarche, late menopause
- unopposed oestrogen (in HRT without progestogen)
metabolic
- obesity
- diabetes
- PCOS
tamoxifen
hereditary non-polyposis colorectal carcinoma
protective factors for endometrial cancer
multiparity
COCP
smoking - unclear why
unopposed oestrogen in HRT
the addition of a progestogen to oestrogen reduces this risk
risk is eliminated is a progestogen is given continously
endometrial cancer presentation
postmenopausal bleeding
premenopausal - develop menorrhagia or intermenstrual bleeding
- pain is not common - signifies extensive disease
- vaginal discharge is unusual
endometrial cancer investigations
all women >= 55yrs who present with postmenopausal bleeding hsould be referred to suspected cancer pathway
1st line = trans-vaginal US
- hysteroscopy with endometrial biopsy
what is a normal endometrial thickness
<4mm
management of endometrial cancer
localised = total abdominal hysterectomy with bilateral salpingo-oophorectomy
high risk = postoperative radiotherapy
management of endometrial cancer in frail elderly women not suitable for surgery
progestogen therapy
uterine fibroids
benign smooth muscle tumours of the uterus
- occur in 20% of white women
- 50% of black women
(in later reproductive years)
rare before puberty, develop in response to oestrogen, regress after menopause
which ethnic group is fibroids more assoc with
afro-caribbean women
fibroids presentation
menorrhagia - iron def anaemia
bulk related sx
- abdo pain - cramping, often during menstruation
- bloating
- urinary sx - frequency (occurs in big fibroids)
subfertility
polycythaemia - rare
why might polycythaemia (rarely) occur with fibroids
secondary to autonomous production of erythropoietin
- heavy bleeding -> aneamia -> reactive increase in erythropoietin production -> bone marrow makes more RBCs (secondary polycythaemia)
- rare - produces erythropoietin themselves - paraneoplastic
diagnosis of fibroids
transvaginal fibroids
management of menorrhagia secondary to fibroids
Levonorgestrel IUS
- cannot be used if distortion of uterine cavity
mefenamic acid
tranexamic acid
COCP
oral progestogen
injectable progestogen
management of asymptomatic fibroids
no treatment
periodic reveiw to monitor size + growth
medical management to shrink/remove fibroids
GnRH agonist
- may reduce size
- used short term due to side effects -> menopausal sx (hot flushes, vag dryness)
+ loss of bone mineral density
surgical management of fibroids
myomectomy
- hysteroscopic endometrial ablation
- hysterectomy
- uterine artery embolisation - can’t be used in large (>10cm) or pedunculated (stalk may become necrotic -> cx) or if want babys
red degeneration of fibroids
acute infarction within fibroid leading to haemorrhage + necrosis
seen in pregnancy due to rapid fibroid growth (in response to increase oestrogen/progesterone) + increased vascular demand
sx = severe pain, fever, nausea, 2nd trim preg
mx - self limiting
