Surgery Uterus Flashcards
third most common genital tract malignancy
endometrial ca
risk factors for endometrial ca
- estrogen excess / unopposed estrogen
- early menarche
- nulliparity, infertility, pcos
- obesity
- diabetes
- tamoxifen
- lynch and cowden syndrome
protective factors for endometrial ca
- estrogen-progestin oc
- at least 3 mos breastfeeding
- childbearing at older age
- smoking
- exercise
- coffee and green tea
s/sx for endometrial ca
- heavy menstrual bleeding
- vaginal discharge
- postmenopausal with endometrial cells on pap smear
- premenopausal with atypical glandular cells on pap smear
- pelvic pressure and discomfort (late stage)
indications for endometrial biopsy
- postmenopausal bleeding
- premenopausal: persistent abnormal bleeding with history of chronic anovulation
- hormone therapy with bleeding
- tamoxifen w bleeding
- > 35 yo with atypical endometrial cells on pap smear
most common cause of bleeding in postmenopausal women
atrophy
for patient with initial postmenopausal bleeding you can __
- transvaginal uts then endometrial sampling
- directly endometrial sampling
if there’s only one test, do endometrial sampling
t/f any vaginal bleeding in postmenopausal woman requires assessment to exclude malignancy
true, can be assessed with endometrial biopsy or transvaginal ultrasonography
t/f for pts with endometrial thickness less/= 4 mm, you need to do endometrial biopsy
false, 1 in 917 is low risk
t/f for pts with emt >4 mm, endometrial sampling is required
true
t/f recurrent bleeding always required further evaluation with endometrial sampling
true, even if emt is thin
t/f ultrasound measurement of endometrial thickness in premenopausal women is required
false, has no diagnostic value
decision to evaluate endometrium in below 45 yo is based on__
symptoms, risk factors, and clinical presentation
t/f women with pcos have a 3 fold increased risk and 9% lifetime risk for endometrial ca
true
indications for endometrial sampling in premenomausal women
- persistent abnormal bleeding
- hx of pcos/ chronic anovulation
- thickened endometrium on uts
t/f for pts on hormone therapy with bleeding, endometrial sampling can be done without uts
true, thickness doesnt matter
primary therapeutic effect of tamoxifen
antiestrogen, rr is 2-3x higher
t/f asymptomatic women on tamoxifen should undergo routine screening
false, only biopsy if they bleed
correlation between emt and abnormal pathology in asymptomatic tamoxifen users is poor because of __
tamoxifen induced subepithelial stromal hypertrophy
management for pre vs post menopausal women taking tamoxifen
premenopausal: routine gyne care and watch for bleeding
post meno: monitor for bleeding more often
normal histo in cervix
squamous cells
if patient has atypical endometrial cells at pap smear do ___
endometrial and endocervical sampling
if no pathology, do colposcopy
if patient has glandular cells (regardless of hpv result) on pap smear do __
colposcopy with ecc
if more/= 35 yo or <35 or at risk for endometrial neoplasia, do endometrial biopsy
first step when suspecting endometrial pathology is ___
endometrial biopsy
gold standard for endometrial ca diagnosis
hysteroscopic guided endometrial biopsy
t/f d&c > hysteroscopic guided d&c
false
indication for d&c
- if under anesthesia and hysteroscopy is not available
- pt cannot afford hysteroscopy
- can scrape entire uterine cavity even if blind
2009 figo stading for endometrial ca
IA no invasion or less than half myometrial invasion IB more/= to hald of myometrium II invades cervical stroma but does not extend beyond uterus IIIA invades serosa and/or adnexa IIIB vaginal metastases IIIC1 pelvic ln IIIC2 para-aortic ln IVA bladder and/or bowel mucosa IVB distant metastases
management for endometrial ca
primary surgical approach: peritoneal fluid cytology, extrafascial hysterectomy with bilateral salpingooophorectomy, pelvic and paraaortic lymphadenectomy
adjuvant: radio, chemo, hormonal
t/f molecular profile of a tumor may better define prognosis and response to treatment
true
pts can have same stage but different responses to tx
