PMB Flashcards
Define PMB
Bleeding at least 6 months after menopause
What is the main worry about PMB
endometrial carcinoma
Uterine causes of PMB?
HRT therapy, endometrial polyps/fibroids/hyperplasia/carcinoma
Cervical causes of PMB?
carcinoma/polyps/trauma
Vaginal causes of PMB?
Atrophy, carcinoma, trauma
Vulval causes of PMB?
Trauma, carcinoma
Ovarian cause of PMB?
estrogen secreting tumour of the theca cells
Associated symptoms to ask about with PMB?
cramps, sickness, pain
Most common type of endometrial cancer?
Endometrial adenocarcinoma
Types of endometrial cancer?
endometrial adenocarcinoma, papillary serous adenocarcinoma, clear cell adenocarcinoma, mixed adenocarcinoma
3 management options of suspected endometrial cancer?
transvaginal USS, endometrial biopsy, hysteroscopy
At what endometrial thickness would you send for endometrial sampling?
5mm or more
What do you use to take a sample in an endometrial biopsy?
Pipelle sampler
When can a women not be investigated via TVS and need a hysteroscopy first line?
If they are on Tamoxifen
What is the staging system is used for endometrial cancer?
FIGO staging
Stage 1a,1b,1c?
1a - confined to endometrium, 1b - invades less than half the myometrium, 1c - invades more than half
What is the 5 year survival of stage 1 endometrial cancer?
85%
What is the 5 year survival of stage2,3,4?
2 - 75%, 3 - 45%, 4 - 25%
What is stage 2 endometrial cancer?
Spread to the cervix
What is stage 3 endometrial cancer?
Spread outside the uterus but within the pelvis but not the bladder or rectum
What is stage 4 endometrial cancer?
Spread to the bladder and rectum or distant metastases
What investigations do you need to undertake with a confirmed endometrial cancer?
MRI for staging, CXR, blood - LFTs, U/E, FBP
Difference in surgery for stage 1 vs stage 2 endometrial cancer?
Stage 1 - TAH+BSO+lymph nodes whereas stage 2 - modified radical hysterectomy + BSO + lymph nodes
2 types of radiotherapy?
External beam radiotherapy and brachytherapy
When is progesterone hormonal therapy used as treatment for endometrial cancer?
When contraindicated for surgery, radiotherapy, chemo
What is the lymphatic drainage of the upper uterus?
paraaortic nodes
What is the lymphatic drainage of the fundus of the uterus?
inguinal nodes
What is the lymphatic drainage of the lower uterus?
paracervical, obturator, iliac nodes
What is the follow up like after a endometrium carincoma removal?
6 week post op check, 3 months for 1 year then 6 monthly for second year to 5 years
What investigations are performed at endometrial cancer follow up?
Speculum exam, PV, PR
What infections can cause vulval itch?
BV, candidiasis, BV, lice, scabies, threadworm ,HSV
Dermatological conditions that can cause vulval itch?
Contact dermatitis, psoriasis, eczema, lichen sclerosis, lichen planus, squamous cell hyperplasia
Neoplastic conditions that can cause vulval itch?
VIN, SCC
Why is it important to ask about time of day when questioning about vulval itch?
Lichen sclerosis is worse at night
How do you confirm lichen sclerosis diagnosis?
Vulval biopsy under LA with Keyes biopsy knife
Why is it important to ask about acute/chronicity of vulval itch?
Acute suggestive of contact dermatitis
Topical treatments for lichen sclerosis?
topical steroids, clobestasol propionate, soap substitutes, barrier creams
Systemic illnesses that can cause vulval itch?
Hepatic failure, renal failure, anaemia
What type of infection is lichen sclerosis?
lymphocyte mediated dermatosis
