Uterine Anomalies Flashcards
What are fibroids?
Benign tumours of the the smooth muscle cells of the uterine myometrium. (leiomyomata)
They can be:
-Subserosal: growing on the outside of the uterus.
- Intramural: growing in the uterine wall (most common)
- Submucosal: growing in the uterine lining
- Pedunculated: growing on small stalks on the inside or outside of the uterus
What are the risk factors for developing fibroids?
Afro-carribean
FH
Unopposed oestrogen (less common in parous women and those who have taken the COCP)
What are the symptoms associated with fibroids?
50% are asymptomatic
Symptoms include:
- Menorrhagia (most common symptom)
- Dysmenorrhoea
- Urinary symptoms (frequency,retention)
- Hydronephrosis
How are fibroids diagnosed?
Clinical history + transvaginal or abdominal USS.
If unsure of diagnosis MRI can be used.
What are some complications associated with fibroids?
Torsion of a pedunculate fibroid
Complications in pregnancy (bleeding, obstruction, premature labour)
Small risk of malignancy (0.1%)
How can fibroids be managed?
Expectant management: monitoring over time with examination and USS.
Medical management:
- NSAIDs and tranemexic acid
- COCP or mirena to help excessive bleeding
- GnRH agonists can be used to shrink fibroid and can induce amenorrhoea. (only licensed for 6 months as reduces bone density)
Surgical management:
- Hysteroscopic or laparoscopic* myomectomy (removal of fibroids)
- Hysterectomy
*more likely to preserve fertility
What are the indications for intervention in fibroids?
Bulky symptoms
Excess bleeding
Concern of malignancy due to rapid growth
Causing hydronephrosis
Distortion of the uterine cavity in a women contemplating pregnancy
What is an endometrial adenoma and what are they also known as?
An endometrial polyp: a focal growth of endometrial tissue.
Malignant in less than 1%
Which women are more likely to have endometrial adenomas?
Related to oestrogen exposure therefore more common in:
- Older women greater than 40
- Nulliparous women
What problems can endometrial polyps cause and how are they treated?
They can cause menorrhagia and intermenustral bleeding.
They are related by resection with dithermy.
What is a haematometra?
This is when menstrual blood accumulates in the uterus because of an outflow obstruction.
Embryologically how is the uterus formed?
By fusion of the 2 mullerian ducts.
If these fail to fuse properly there can be a range of congenital uterine abnormalities.
What is didelphys?
When there is failure of the mullein ducts to fuse causing there to be 2 separate uterine cavities.
What is a unicorniate uterus?
Where one of the success failed leaving a single duct shaped uterus.
What is a bicornuate uterus?
A heart shaped uterus, depending on the degree it can affect pregnancy.
What are uterine sarcomas?
They are malignant tumours of the connective tissue in the uterus.
What are the 3 different types of uterine sarcoma?
Leiomyosarcoma (malignant fibroid) metastasis to the lung is common.
Endometrial stromal sarcoma (most common in perimenopausal women)
Mixed mullerian tumours: derived from embryological tissue
present with irregular or postmenopausal bleeding.
What is the most common endometrial cancer?
Adenocarcinoma (of the columnar endometrial glands) accounts for 90%
What are the risk factors for developing endometrial cancer?
Obesity (peripheral androgen conversion to oestrogen)
Reduced progesterone production aka unopposed oestrogen (nullparity, early menarche/late menopause, PCOS, never taking the COCP)
Genetic predisposition (HNPCC)
What is the pre malignant state of endometrial Ca?
Unopposed oestrogen can cause cystic hyperplasia followed by atypical hyperplasia.
How does endometrial Ca present?
Post menopausal bleeding (1 in 10 will have endometrial Ca)
Premenopausal women may have new onset menorrhagia, intermenustral bleeding or irregular bleeds.
Smear testing may contain some cervical glandular changes.
What is the prognosis of endometrial cancer?
Stage for stage same as ovarian cancer however tends to be caught early.
What is needed for a diagnosis of endometrial Ca?
Endometrial biopsy (needed for staging)
Imaging involves:
TVUSS + MRI (if mets are likely)
How is endometrial Ca managed?
Surgery: hysterectomy and bilateral salpingectomy.
Note lymph node removal is not indicated until stage 3
Radiotherapy: used post surgery in high risk patients
Describe the different stages of endometrial ca?
- Uterus only +/- myometrial invasion
- Cervix also
- Pelvic/para aortic lymph nodes
- Bowel, bladder or distant spread.
