endometriosis

Question 1

where can it develop?

Answer 1

peritoneum 
pouch of douglas 
sacrotuberous ligmament 
(ovary - cholocate cyst) 
myometrium - adenomyosis

Question 2

on examination ?

Answer 2

fixed retroverted uterus

Question 3

what is cause thought to be ?

Answer 3

rerograde flow of menstrual blood

Question 4

symptom relief?

Answer 4

NSAIDS and pain team

Question 5

hormonal therapy ?

Answer 5

mirena
COCP
danazol (synthetic testosterone)
GnRH agonist (goserelin)

Question 6

surgical?

Answer 6

o on curative removal of foci.
o Curative hysterectomy with bilateral oophorectomy.
♣ This should only be carried out in women who do not wish to get pregnant.

Question 7

3 types of endometrial hyperplasia?

Answer 7

o Simple 0% risk of progessing to endometrial cancer.
o Complex 1 – 2% risk of progessing to endometrial cancer.
Atypical 10 – 20% risk of progessing to endometrial cancer

Question 8

management of atypical

Answer 8

total hysterectomy + bilateral salpino-oophrectomy.

Question 9

Without atypia

Answer 9

♣ 1st line: mirena coil.

♣ 2nd line: oral progesterone.

Question 10

why do you treat with mirena and progesterone ?

Answer 10

hyperplasia thought to be due to unopposed oestrogen

Question 11

endometroid cancer?

Answer 11

Type 1: 80% of tumours, arise from hyperplasia

Question 12

serous and clear cell

Answer 12

Type 2: 20%, don’t arise from hyperplasia

Question 13

Lynch syndrome increased risk of which cancer?

Answer 13

endometrial, ovarian, and NPCC

Question 14

on transvaginal US thickness of over what is suspicious?

Answer 14

5mm

Question 15

how do you do an endometrial biopsy?

Answer 15

o Pipelle carried out during trans vaginal ultrasound.

Dilation and curettage requires GA and hysteroscopy

Question 16

/how do yo uget biopsy if patient unable to tolerate pipelle

Answer 16

hysteroscopy

Question 17

staging endometrial cancer?

Answer 17

MRI for staging

CTCAP - for distant mets

Question 18

staging endometrial cancer?

Answer 18

1-4
1 - confined to body uterus
2 invasion of stoma bt confined to uterus
3 local spread
4 invasion of bladder, bowel or distant mets

Question 19

surg management of end canc?

Answer 19

• Surgical: total hysterectomy + bilateral salpingo-oophrectomy.

Question 20

med management of end canc

Answer 20

o	External beam radiotherapy. 
o	Vaginal brachytherapy. 
o	External beam radiotherapy. 
o	Oral progesterone. 	
o	Chemotherapy.

Question 21

management by stage?

Answer 21

o Stage 1: surgical +/- radiotherapy.
o Stage 2: surgical +/- radiotherapy.
o Stage 3: maximal debulking surgery + lymph node dissection + radiotherapy.
o Stage 4: maximal debulking surgery + palliative radiotherapy or chemotherapy.