Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

m4 obgyn > Postmenstrual bleed, endometrial cancer > Flashcards

Postmenstrual bleed, endometrial cancer Flashcards

1
Q

Most common gynaecological cancer in SG

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common benign cause of postmenopausal bleeding

A

Atrophic vaginitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Note: ALL postmenopausal bleeding is endometrial cancer until proven otherwise

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of endometrial cancer

A

Type 1 (more common):
- Estrogen-related (exogenous)
- Favourable prognosis

Type 2:
- Unrelated to estrogen stimulation
- Non-endometroid tumours: Serous/ Clear Cell/ Mucinous/ Squamous
- Poorer prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors of Type 1 endometrial ca

A
  1. Unopposed estrogen
    - Chronic anovulation
    - Estrogen-only HRT
    - Estrogen-secreting tumour
    - Tamoxifen
    - Early menarche/ late menopause
    - Nulliparity (relative exposure to estrogen is higher)
    - Metabolic syndrome: obesity, DM
  2. Strong family history: breast, colon, ovary, endometrial ca
    - Lynch II syndrome
    - BRCE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Protective factors of endometrial cancer

A

Pregnancy  
Mirena  
Estrogen-Progestin combined hormonal therapy
Breastfeeding
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of endometrial cancer

A

Postmenopausal women: PMB

Premenopausal women: intermenstrual bleeding
- Get an endometrial sampling, NOT ultrasound as there is no normal endometrial thickness as standard (women undergoing menses can still have thick ET)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of endometrial cancer

A

Anemia: SOBOE/ Fatigue/ Dizziness/ Palpitations

Regional invasion (Urinary and Bowel)
- Dysuria/ Hematuria/ LUTS Symptoms
- Flank discomfort/ mass (hydronephrosis)
- PV leakage of urine/ stools (fistula formation)
- Constipation/ Tenesmus/ hematochezia
- Compressive Symptoms/ peritoneal involvement: Early satiety/ LOA

Metastatic Invasion
- Lung (Dyspnea, Hemoptysis, Persistent Cough)
- Liver (Abdominal discomfort, mass)
- Brain (Headache, Nausea, Focal Neuro Deficit)
- Bone (Bone pain/ pathological fractures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Physical examination for endometrial cancer

A
  • Cachexia/ Pallor
  • Lymph Nodes: Cervical/ Inguinal, Supraclavicular
  • Breast Examination
  • Abdomen Examination: Scars/ Masses

Pelvic Examination (Size/ Mobility/ Axis/ Uterus)
- Speculum examination:
TRO other sources of bleed
> Atrophic Vaginitis: Diagnosis of exclusion; very common; look for petechiae bleeding
> Vulva CA (More common after 70 years old)
> Cervical CA (Last PAP smear)
- Bimanual palpation
Adnexal masses and uterus
- DRE
POD to look for nodularity
Feeling for parametrium and side walls of pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations for endometrial cancer

A

TVUS
Endometrial sampling with pipelle
KIV D&C +/- hysteroscopy

MRI pelvis
PET-CT
CXR
Pre-op bloods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Endometrial evaluation in postmenopausal bleeding

A
  1. Assess endometrial thickness on TV ULTRASOUND

2a. Less than 5mm -> unlikely malignancy -> observe -> if persistent bleeding -> D&C +/- hysteroscopy

2b. 5mm or more -> endometrial sampling with pipelle (done in clinic) -> proves malignancy or not

3a. If insufficient or inadequate -> D&C +/- hysteroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Before treatment of endometrial cancer, must have

A

HISTOLOGICAL diagnosis
- no meat, no treat
- endometroid (adenocarcinoma) most common histo substype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FIGO staging for endometrial cancer

A

I: confined to uterus
II: cervix
III: pelvic
IV: local and distant systemic spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prognosis of endometrial cancer according to Figo staging

A

I: 90%
II: 70%
III: 50%
IV: 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

High risk features of endometrial cancer

A
  • Primary tumour 2cm or more
  • 50% or more myoinvasion
  • Histology results:
    > grade 3 endometroid
    > clear cell
    > serous
  • Cervix involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of endometrial cancer

A
  1. Standard of care: Total hysterectomy + bilateral salpingo-oophorectomy
    KIV pelvic and para-aortic lymphadenectomy
    (LN assessment only done when there are high risk features present)
  • also for surgico-pathological staging (Removal of primary tumour and tissues involved –> Histological evaluation of these tissues –> Arrive at a disease stage)
  1. If surgically unfit/wish to preserve fertility: Hormonal treatment - progesterone to oppose estrogen
  2. Adjuvant chemo and radiation for patients assessed to be at significant risk for systemic mets

m4 obgyn (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions