Pelvic tumors

Question 1

What are symptoms of myoma uteri?

Answer 1

Bleeding disorders (menorrhagia)
Sense of heaviness
Pollakissuria (pressure on the bladder)
Pain, dysmenhorrea
Reduced fertility

Question 2

What are characteristic of benign lesion in the ovaries?

Answer 2

Unilocular
Fluid-filled
< 4 cm for pre-menopausal
women
< 2 cm for post-menopausal
women

Question 3

What is the most common gynecological cancer in Norway? What gynecological cancer has the best prognosis?

Answer 3

Endometrial cancer (most common and best prognosis.)

Question 4

What gynecological cancer has the worst prognosis?

Answer 4

Ovarian cancer.

Question 5

What is meant by the “ovulationtheory” in the etiology of ovarian cancer?

Answer 5

Fewer ovulations, due to e.g. contraceptive pills, multiparity, breastfeeding, are associated with reduced risk of cancer.

Question 6

What is a STIC?

Answer 6

Serous tubal intraepithelial carcinoma. (80 % of ovary cancers are believed to originate from a STIC.)

Question 7

What factors increase the risk of ovarian cancer?

Answer 7

Genetics: BRCA1 and 2 mutations (and Lynch).

More ovulations: No children/pregnancies. Infertility. Early menarche. Late menopause.

Question 8

What is the most common type of cancer in the ovaries?

Answer 8

Epithelial serous tumors.

Question 9

What are symptoms of ovarian cancer?

Answer 9

Most patient experience symptoms, but they are often vague.
Abdominal discomfort:
– bloating
– fullness
– increased stomach size
– pain
– bowel movement changes
– change in urination pattern
Reduced general condition
Poor appetite, weight loss

Question 10

How is can ovary cancer be diagnosed/evaluated?

Answer 10

Gynecological examination with ultrasound.
CT thorax/abdomen/pelvis.
CA 125 - tumor marker.

Question 11

What is the primary treatment of ovarian cancer?

Answer 11

Surgery: Hysterectomy, bilateral salpingo-oophorectomy, omental resection, gland sampling, debulking.
Chemotherapy: If spread beyond 1 ovary. Adjuvant chemotherapy (after radical surgery) and neoadjuvant (to enable radical surgery).

Question 12

What is the most common cause of postmenopausal vaginal bleeding?

Answer 12

Atrophy of the vaginal mucus membrane.

Question 13

Is endometrial hyperplasia a malignant condition?

Answer 13

No, it is a pre-malignant condition and may develop into cancer if left untreated.

Question 14

How is endometrial hyperplasia treated?

Answer 14

Low-risk: Local or systemic hormone treatment with progesterone.
High-risk: Surgical treatment. Hysterectomy.

Question 15

What is the most common type of uterine cancer?

Answer 15

Adenocarcinomas (80%).

Question 16

What are symptoms of endometrial cancer?

Answer 16

Irregular menstrual bleeding
Post-menopausal bleeding
Vaginal discharge

Question 17

What is the treatment against uterine cancer?

Answer 17

Surgery alone:
– Hysterectomy
– Ooforectomy
– Glandelstaging
(Dependent on tumor size, histologic grade and deep growth. Sentinel node.)
(Eventuelt cytostatika og hormonbehandling.)

Question 18

What are risk factors for cervical cancer?

Answer 18

Primary risk factors:
– High-risk (oncogenic) HPV types
– Persistent infection (>2 years)
– Not screened

Secondary risk factors:
– Smoking
– Immunosupression (medication, HIV, hereditary syndromes).

Question 19

What are symptoms of cervical cancer?

Answer 19

Postcoital bleeding
Intermenstrual bleeding
Post-menopausal bleeding
Bloody discharge
Pain/pressure in the pelvis
Unilateral lower extremity edema