Uterine Disease Flashcards
What is endometriosis?
foci of endometrial glands and stoma outside uterine body
Where can endometrial tissue be in endometriosis?
on an ovary, in rectovaginal pouch, uterosacral ligaments, pelvic peritoenum
What is a chocolate cyst?
endometrial tissue on an scary in endometriosis
When is the term adenomyosis used, instead of endometriosis?
when these foci of endometrial glandular tissue are found in the uterine wall muscle
What is the presentation of endometriosis?
asymptomatic pelvic pain - classically cyclical secondary dysmenorrhea deep dyspareunia sub fertility
What are some complications of endometriosis?
cyst formation infertility malignancy ectopic pregnancy adhesions
What do you find on vaginal examination in endometriosis?
fixed retroverted uterus
uterosacral ligament nodules
general tenderness
enlarged, boggy tender uterus - adenomyosis
What is the first line investigation in endometriosis?
laparoscopy - find adhesions, cysts, peritoneal deposits
What is the treatment of endometriosis?
asymptomatic - no treatment support - join a society reduce stress analgesia/NSAIDs hormonal therapy: to suppress ovulation - CCP, progestogens (not in adolescents, reduce bone density) surgery, laparoscopy
What is endometritis?
uterine infection
When can endometritis occur?
is uncommon unless barrier to ascending infection is broken e.g. after miscarriage, TOP, childbirth, IUS or IUD insertion
What can endometritis also involve apart from uterus?
tubes and ovaries
What is the presentation of endometritis?
lower abdominal pain
fever
uterine tenderness on bimanual palpation
What are the investigations for endometritis?
cervical swabs and blood cultures
What is the treatment of endometritis?
antibiotics e.g. doxycycline with metronidazole, 7 days
What are uterine fibroids?
leiomyomas - benign smooth muscle tumours of the uterus
What happens to uterine fibroids in pregnancy, on the combined pill and during menopause?
pregnant and combined pill - enlarge
menopause - atrophy
as they are oestrogen dependent
What is a uterine fibroid called if its under the peritoneum?
subserosal
What is a uterine fibroid called if its under the endometrium?
submucosal
What are symptoms of a uterine fibroid?
asymptomatic menorrhagia fertility problems pain mass pressure symptoms
How are uterine fibroids diagnosed?
USS
MRI - precise localisation
Hb if heavy bleeding
How are uterine fibroids treated?
often no treatment needed
hysterectomy (menorrhagia) - if family complete
myomectomy, uterine artery embolisation, hysteroscopic resection
What is more common, endometrial or cervical cancer?
cervical
What are the majority of endometrial cancers?
adenocarcinoma
What are the 2 main groups of endometrial carcinomas?
type 1: endometroid/mucinous carcinoma
type 2: serous/clear cell carcinoma
What is the precursor for endometroid/mucinous carcinoma?
atypical hyperplasia
What is the precursor for serous/clear cell carcinoma?
serious intraepithelial carcinoma
What mutations are found in type 1 endometrial carcinomas?
PTEN
KRAS
PIK3CA
What mutations are found in type 2 endometrial carcinomas?
TP53
What are risk factors for endometrial carcinoma?
early menarche late menopause HRT tamoxifen obesity smoking PCOS breast cancer nulliparity
What is the presentation of endometrial carcinoma?
usually after menopause
abnormal bleeding - PMB, IMB
What are the investigations for endometrial carcinoma?
examination usually normal
transvaginal USS
uterine sampling - depending on endometrial thickness on USS
pipelle biopsy or dilatation and curettage
At what thickness on USS should you sample the endometrium?
post menopause: >5mm thick (<5mm normal in postmenopausal women)
pre menopause: >16mm
What is the treatment of endometrial carcinoma?
total hysterectomy with bilateral sapling-oopherectomy and or radiotherapy
What is Lynch syndrome?
cancer predisposition syndrome - increased risk of colorectal, endometrial and ovarian cancers
What is the inheritance pattern of Lynch syndrome?
autosomal dominant
Describe serous endometrial carcinoma
post menopausal women
aggressive
spreads along fallopian tubes/peritoneum
Describe endometriod endometrial carcinoma
associated with Lynch syndrome
associated with high oestrogen - HRT, early menarche , late menopause
What is protective against endometrial cancer?
CCP
having children
What 3 cancers does Lynch syndrome predispose to?
colorectal - HNPCC
endometriod endometrial cancer
clear cell ovarian cancer
