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Reproductive Exam 2 > Endometrial Hyperplasia > Flashcards

Endometrial Hyperplasia Flashcards

1
Q

endometrial hyperplastic changes are usually assocated with what hormonal problem

A

unopposed estrogen stimulation

- means not stabilized by progesterone so it keeps growing

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2
Q

how does endometrial hyperplasia present as microscopically

A
  • prolifertaion of glands and stromal
  • crowding of glands
  • increase mitosis
  • prominent nucleoli
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3
Q

what is endomet hyperplasia aka

A

pre-cancer of the endometrium

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4
Q

another word for cystic

A

simple

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5
Q

another word for complex

A

adenomatous

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6
Q

name the 4 different classifications of endomet hyperplasia

A
  • Simple Endometrial Hyperplasia
  • Complex Endometrial Hyperplasia
  • Simple Endometrial Hyperplasia with atypia
  • Complex Endometrial Hyperplasia with atypia
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7
Q

what are the characteristics of Simple Endometrial Hyperplasia

A

regular glandular pattern
NO CYTOLOGIC ATYPIA
1% will progress to cancer

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8
Q

what are the characteristics of Complex Endometrial Hyperplasia

A

Irregular glands crowded back to back
NO ATYPIA
3% will progress to cancer

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9
Q

what are the characteristics of Simple Endometrial Hyperplasia with atypia

A

regular glandular patterns
CYTOLOGIC ATYPIA
8% will progress to cancer

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10
Q

what are the characteristics of Complex Endometrial Hyperplasia with atypia

A

irregular crowded glands
CYTOLOGIC ATYPIA
29% will progress to cancer

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11
Q

how does a pt with endomet hyperplasia present s/s

A

irregular uterine bleeding

-infrequent is missed periods is common

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12
Q

what is the etiology of a missed menses

A

endometrial lining during the menstrual cycle changes from proliferative to secretory endometrium

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13
Q

what do women who are prone to hyperplasia do or dont have

A

DONT have progesterone to ensure that there is a synchronized menstrual cycle

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14
Q

Which hormone can a girl lack and still have a period

A

progesterone

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15
Q

endometroisis patients have hormone imbalance, causing what

A

lining in one area of the uterus to become thicker faster than antoher area
-eventually outgrows blood supply

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16
Q

so what happens d/t the ischemia of the lining

A

its going to break off and eventually bleed abnormally

  • thus different sections of the uterus will have inconsistent endometrial lining thickening
  • lack of concerted shedding of lining
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17
Q

what is is called when the wall gets so think with blood it “hangs” off the uterine wall

A

endometrial polyp

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18
Q

is it healthy shedding of lining if a pt has 1 concerted period every 3 month

A

Yes

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19
Q

girls on BCP will have lighter, shorter, less crampy periods because

A

the pills are designed to not allow to have the tissue grow in the first place

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20
Q

if you’re on BCP are you at risk of developing hyperplasia

A

NOPE

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21
Q

what is the risk factor for endometrial hyperplasia

A

over 35 years old

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22
Q

how do you diagnose endometrial hyperplasia

A

endometrial sampling
office visit - endometrial biopsy w/o dilation
outpts surgery - D&C

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23
Q

can a pap smear show hyperplasia

A

not really

BUT it can show AGUS results

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24
Q

pap smear is usually used for what

A

cervical problems

  • AGUS (abnl glandular cells of undetermined signfi)
  • with AGUS need to do endometrial biopsy and endo cervical canal biopsy to see where the cells are coming from
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25
Q

how do you treat endometrial hyperplasia

A

hormonal
D&C follow by hormonal
hysterectomy

26
Q

hormonal tx for endometrial hyperplasia

A

becoming a carcinoma is low, so giving more progestin can REVERSE this

27
Q

when do you use D&C followed by hormonal for endometrial hyperplasia

A

if you have lots of or severe form

28
Q

when do you do a hysterectomy for endometrial hyperplasia

A

in most severe form (complex with atypia will be treated aggressively) or no longer at birthing age

29
Q

treatment can be affected by what three things

A

pts age
maintaining fertility
histiologic type of hyperplasia

30
Q

what is the 4th most common cancer for woman

A

endometrial cancer

31
Q

which age group is does endometrial cancer occur

A

50-59 year old
75% occur in post-menopausal
-not ovulating anymore

32
Q

how are women able to make estrogen even after menopause

A

via the adrenal glands

33
Q

what mostly occurs in chunkers women and how does it happen

A

endometrial hyperplasia

-converting androsteindione to estrone (or E3 estriol, i dk) in all that adipose tissues

34
Q

what happens to post meno skinny bitches

A

suffer more symptoms of menopause BUT they dont develop endometrial hyperplasia

35
Q

if a woman is still making estrogen but lack progesterone, what can you do

A

give them progestrone

-giving cyclic progestin will ensure they have at least one good period every 1-3 months

36
Q

what does giving depo or low dose bcp allow

A

continuous progesterone administration

-which will stop the normal hormonal production of pulsatile motion

37
Q

what are the risk factors of endometrial cancer

A 
Early menarche
Late menopause
Unopposed estrogen
Nulliparity
Obesity
Diabetes
Tamoxifen use
Other pelvic cancer
38
Q

what is the MOST at risk factor

A

unopposed estrogen

  • chronic anovulation
  • extra-genital estrogen production
39
Q

how is Tamoxifen a risk factor

A

its used for blocking the estrogen receptors in the breast but has OPPOSITE effect on the ovaries/uterus

40
Q

when is the peak time for women to develop endometrial hyperplsia and carcinoma

A

40-50’s (perimenopausal)

41
Q

what are the s/s of endometrial cancer

A
  • abnl uterine bleeding
  • pre-menopausal: menorrhagia or metrorrhagia
  • post-meno: bleeding of any amt is always anbl and needs to be investigated
42
Q

how do you diagnose endometrial cancer

A

> 35 years old with irregular bleeding

  • endometrial biopsy
  • D&C
43
Q

how do you stage endometrial cancer

A

FIGO surgical staging

44
Q

what is the FIGO staging

A

Stage 1: limited to UTERUS
Stage 2: extension to CERVIX
Stage 3: PELVIC extension
Stage 4: mucosa of BLADDER/BOWEL or distant metastases

45
Q

what is menorrhagia

A

excessive uterine bleeding

46
Q

what is metrorrhagia

A

irregular uterine bleeding

47
Q

what needs to be done for a lymphatic spread to lymph nodes

A

post-operative radiology

48
Q

which stage has the best 5 year survival rate of endometrial cancer

A

stage one 75-90%

49
Q

the other stage survival rates

A

Stage two 15% - 60%
Stage three 7% - 35%
Stage four 3% - 10%

50
Q

what is the most COMMON spread patteren

A

direct extension to adjacent tissues

51
Q

in cases with deep myometrial invasion, where is teh lymphatic spread usually

A

pelvic and para-aortic nodes

52
Q

which spread is less likely

A

hematogenous spread

53
Q

what is the most common histologic type

A

adenocarcinoma - 60%

54
Q

other histological types

A 
Adenocanthoma- 22%
Clear cell- 6%
Papillary serous- 5%
Secretory- 1.5%
Adenosquamous carcinoma- 7%
55
Q

why is staging needed

A

to tell us where it is, where it started, where it spread

56
Q

prognosis : staging of tumor

A

Myometrium invasion
Peritoneal cytology
Lymph nodes
Adnexal involvement

57
Q

what does grading of tumor mean

A

nuclear atypia of the tissue involved in the cancer

  • Grade 1 – well differentiated carcinoma
  • Grade 2 – moderately well differentiated
  • Grade 3 – undifferentiated, or poorly differentiated

histiologic differentiation

58
Q

how do you treat endometrial cancer

A

surgery
radiation
chemotherapy

59
Q

what 2 types of radiation can be done

A
  1. external beam
  2. intra-cavitary*
    - done before hysterectomy
    - treating and closing down any lymph spread before hysterectomy
60
Q

is chemo used regularly

A

no

-usually reserved for recurrence (rescue therapy)

61
Q

which down there cancer is much more aggressive than endometrial carcinoma

A

uterine sarcoma (muscle –> myometrium)

62
Q

uterine sarcoma prognosis

A

POOR! stage 1 has 50% 5 yr survival rate

Reproductive Exam 2 (5 decks)

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