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Sera's MBBS > O&G > Flashcards

O&G Flashcards

1
Q

What type of cancers are most endometrial cancer?

A

Majority are endometrial CARCINOMAS (adenocarcinoma, serous papillary carcinoma) but sarcomas can occur from the stoma or myometrium

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2
Q

What are the two types of common endometrial cancers and 1 RARE aggressive type

A

Type 1 (adenocarcinoma) - 90%, oestrogen dependent, younger women, good prognosis, endometrial hyperplasia

Type 2 (serous papillary carcinoma) - non-oestrogen dependent, older women, particularly aggressive, arise from atrophic endsmetrium

RARE - clear cell carcinoma

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3
Q

Principles of type 1 endometrial cancer (adenocarcinoma of the endometrial glands) pathogenesis - what hormone is it related to, mechanism

A

Lifetime oestrogen exposure

  • Post menopause, there is peripheral conversion of androgens to oestrogen in peripheral tissues which do not have opposing progesterone
  • Progesterone PROTECTS
  • Age - old women
  • Tamoxifen - SERM that is oestrogenic in uterus
  • Genetics - Lynch syndrome (AD condition), HNPCC
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4
Q

What is lynch syndrome and what cancer are they at risk of

A

AD condition

40-60% risk of endometrial Ca (type 1, adenocarcinoma)

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5
Q

What cancers are HNPCC associated with?

A

colorectal Ca
Ovarian Ca
Endometrial and urothelial tumours

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6
Q

What are some of the aetiology/risk factors for Type 2 endometrial cancer

A

Not understood.

Type 2 = serous papillary carcinoma

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7
Q

List see common risk factors for Type 1 endometrial Ca/adenocarcinoma

A

Obesity
Diabetes
Nulliparous
Late menopause >52 years, early menarche
Unopposd oestrogen therapy
Tamoxifen therapy
HRT
FHx of colorectal or ovarian Ca (Lynch type 2 syndrome)
NB: cigarette smoking and OCP/progestogens are associated with REDUCED risk

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8
Q

Cigarette smoking protects against this Ca

A

Endometrial Ca

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9
Q

OCP protects against this Ca

A

Endometrial Ca

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10
Q

briefly describe the FIGO staging of endometrial Ca and what Tx is appropriate for which stage

A

Stage 1 - confined within the uterine body → TAH+BSO
Stage 2 - cervical stoma invasion but not beyond the uterus → radical hysterectomy with pelvic node dissection and possible para-aortic node dissection
Stage 3 - Outside of the uterus but not beyond the true pelvis → stage 2 tx+ post-op radio
Stage 4 - distal sites e.g. bladder, abdo, inguinal → chemo for mets

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11
Q

What are uterine sarcomas

A

Cancer of the smooth muscle (myometrium) of the uterus -

Rare 5% of all uterine cancer

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12
Q

Types of uterine sarcomas

A

leimyosarcomas - cancer of the myometrium

carrionsarcomas - mix of epithelial and smooth muscle

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13
Q

How do leiomyosarcoma present

A

perimenopausal women with irregular bleeding and soft enlarged uterus that is growing rapidly + pain (hence DDx from fibrosis)

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14
Q

Treatment for leiomyosarcoma

A

TAH+BSO with adjuvant radiotherapy if mitotic count is high

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15
Q

Treatment for obstetric cholestasis

A

Antenatal care
1st TRIMESTER NA
2nd/3rd TRIMESTER If OC is diagnosed
• Weekly LFTs and PT until delivery.
• Foetal monitoring twice weekly (but does not predict, not prognostic)
• Vit K 10mg OD – from 32/40
• Topical emollients offered but efficacy unknown
• Mainstay treatment is with ursodeoxycholic acid (UDCA) which improves
pruritis and liver function but not proven to improve fetal and neonatal outcomes

Peripartum
Under consultant led care in labour ward with continuous CTG Routine induction IOL after 37+0 weeks
Likely to have meconium passage in pregnancy
Beware of increased risk of PPH

Postpartum
Resolution of pruritis and abnormal LFT should be confirmed after at least 10 days
• LFT increased in normal pregnancy for the first 10 post-partum. Hence delay remeasurement of LFT until at least 10 days after
• Typically recheck at 6 weeks post-delivery Neonatal Vit K essential
Counselling – risk of recurrence in future pregnancies 90%

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16
Q

DDx of Itching - pruritis gravidarum

A
  • Epidemiology: 1/5 of pregnancies
  • Progression usually start in 2-3T
  • Associated with increased ALP b
  • Symptoms expected to subside after child birth
  • Causes
    • usually benign
    • Eczema
    • Urticaria
    • Prurigo of pregnancy
    • Polymorphic eruptions of pregnancy
17
Q

Presentation, Ix and Mx of Polymorphic eruptions of pregnancy

A
  • Presents in last 3 months of pregnancy
    • Urticated papules and plaques in stretch marks and around umbilicus
    • Umbilicus is spared
  • Rash can spread to involve buttocks and thighs
  • Tx: emollients and steroids
  • NB: Tends to look a lot worse than it is
18
Q

Prurigo of pregnancy

A

Prurigo of pregnancy

  • Scattered, itchy, excoriated papules
  • Late 2T
  • Present on limbs and abdo most commonly
  • Tx: emollients and optical steroids
19
Q

Who gets GDM/OGTT screening?

A 
BMI>30 
Previous macrocosmic baby 
previous GD 
FHx in 1st degree relative 
Ethic minorities with increase prevalence
20
Q

Mx of * Severe - hyperemesis gravidarum

A
  • Multiple pregnancy
  • multiple placenta
  • Molar pregnancy
  • NEER GIVE DEXTROSE TO THESE PATIENTS, NEVERE GIVE METACLOPRAMIDE (can induce extra-pyramidal syndrome
    1. IV hydration - normal saline/Hartmann
    2. Anti-emetic
    1. Cyclizine
    2. Ondansetron
    3. Steroids
      1. Thiamine supplement (IV Pabrinex)
21
Q

Name the 3 TYPES of ovarian Ca

A

Epithelial tumours (45-65y.o)
Germ cells tumours (Bimodal, 15-21y.o and 65-69y.o)
Sex cord tumours (post menopausal)

22
Q

The most common type of ovarian tumours is epithelial tumours. Describe the 2 types of epithelial tumours

A

Type 1

  • low grade, indolent
  • less common (20%)
  • present as large tumours without mets
  • arise from well characterised precursors (borderline tumours) and endometriosis
  • histologically: low grade serous, low grade endometriod, low grade mucinous)

Type 2

  • aggressive
  • more common
  • no known precursors
  • > 75% have p53 mutation
  • histologically most are serous subtypes
23
Q

The most common histological subtype of epithelial ovarian tumour is?

A

Serous subtype

  • most common type of epithelial ovarian tumours
  • can be benign, borderline or malignant
  • benign = serous cyst adenomas
  • borderline = borderline ovarian tumour (BOT)
  • malignant = serous ovarian carcinoma (as they are from epithelium)
  • Histological is usually cystic and UNILOCULAR
  • benign = cyst lined by bland epithelium
  • boderline = cyst lined with complex atypical epithelium but no invasion
  • malignant = cyst lined with complex atypical epithelium and invasion beyond basement membrane
24
Q

Name the 2 most common mutations associated with LOW GRADE serous carcinoma

A

Kras and BRAF

v HIGH GRADE SEROUS is p53, K-ras, BRAF and PIK3CA

Sera's MBBS (12 decks)

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