OBS & GYNAE WK 3 Flashcards
what structure is in:
anterior compartment, middle, posterior, lateral
anterior - bladder
middle - uterus
posterior - bowel
lateral - adenexae
pelvic mass - symptoms
- uterine
- ovarian
- long/short term
- acute
uterine - pain
ovarian - bleeding
long term symptoms - benign
short term - malignant
acute - nausea w doubling pain
most common uterine tumour ?? and ix
fibroids
uss
mri
adnexal mass - what is it and ix??
pain or pressure in affected side
growth that develops around the uterus, usually in your ovaries, fallopian tubes and neighboring connective tissues
Ca125
USS
MRI
ix for pelvic mass
fibroids, pre-menopausal ovarian cysts, post-menopausal ovarian masses
USS
fibroids = MRI
pre-menopausal ovarian cysts = MRI, Ca125, AFP, HCG, LDH
postmenopausal ovarian masses = CT, Ca125
benign features on USS
unilocular
presence of solid components less than 7mm
no blood flow
malignant features
irregular solid tumour
at least 4 papillary structures
RMI
what does lower/higher RMI indicate??
riskof malignancy index
Ca125 test on its own is not that great but with MRI, v good
RMI <30
3 in 100 - ovarian cancer
RMI 30-200
20 in 100
RMI >200
75 in 100
FUNCTIONAL CYSTS
fine if less than 6 cm
benign
ENDOMETRIOTIC CYSTS
severe dysmenorrhea
dyspareunia
acute abdomen if ruptures
kissing ovaries
DERMOID CYST
may contain: teeth
sebaceous material
hair
aka teratoma
slow growing
BENIGN OVARIAN TUMOURS TX
conservative
medical - GnRH analogues, OCP
surgical - laparoscopic / laparotomy
3 TYPES OF FIBROIDS AND TX
subserosal - serosa (Outer layer)
intramural - myometrium
submucosal - endometrium (inner layer)
hormonal mx for bleeding
surgery - myomectomy, hysterectomy
malignant bowel obstruction
causes, symptoms, tx
Causes - adhesions, post radiotherapy, constipation
Nausea, vomiting, pain, anorexia, tinkling bowel sounds
gradual onset - over weeks
watch and wait
NG tube, mouth care
surgery
common causes of nausea and vomiting, medication??
- Chemical
- Metabolic
- Raised ICP
- Tumour
- Movement related nausea
- Oesophageal irritation
anti-emetics
endometrial carcinoma
50-60 yrs = peak group
under 40 = rare
2 types
staging is most important prognostic factor
2 types of E.C and what are their precursors ??
type 1
type 2
serous
known risk factor for endometrial cancer?? and whyyyy
OBESITY
Adipocytes express aromatase which converts androgens to oestrogens, inducing endometrial proliferation
what syndrome is related to high risk of colorectal cancer and endometrial cancer
WHAT IS ITS GENETIC MUTATION??
LYNCH SYNDROME
aka HNPCC
AUTOSOMAL DOM
in DNA mismatch repair gene
endometrial carcinoma staging
1-4
1 - confined to UTERUS
1a -
1b -
2
3a -
3b -
3c -
4 - distant metastasis
carcinosarcoma - presence of what = worst prognosis??
rhabdomyosarcoma
abnormalities of the myometrium - smooth muscle tumours ?? (2)
leiomyoma - fibroids (v common, associated w menorrhagia and infertility)
leiomyosarcoma (rare)
endometrial stromal sarcoma
low vs high grade
abnormal uterine bleeding
most common uterine sarcoma?? - most common symptoms ??
leiomyosarcoma
malignant tumour, spindle cell morphology, poor prognosis, >50 yrs old
abnormal vaginal bleeding
palpable pelvic mass and pain
endometriod carcinoma - 3 grades, percentage of solid growth??
1 = <5%
2 = 6-50%
3 = >50%
what supplies the ovary
ovarian artery branching off the abdominal aorta
laparscopy vs robot-assisted
robot - costlier, same advantages as laparoscopy
best tx for uterine cancer??
surgery !!!
hysterectomy
bso
plnd
tx for cervical cancer??
dependant on stage and if completed family
up to stage 1B - surgery
chemoradiotherapy - for after stage 1
tx for ovarian cancer??
chemotherapy and surgery combo
esp for after stages 3
tx for vulval cancer??
wide local excision, groin nodes removal
adjuvant vs neoadjuvant vs radical
adjuvant - following surgery
neoadjuvant - before surgery
radical - primary treatment
what cancers use radiotherapy??
endometrial - adjuvant
cervical - radical
vulval - adjuvant, depends on histology results
what cancers use chemotherapy??
ovarian - neoadjuvant / adjuvant (carboplatin)
cervical - concomitant (cisplatin)
