Uterus and its abnormalities Flashcards
Learn all of gynae through asking questions!
What is the most common genital tract cancer?
Endometrial carcinoma
Prevalence of Endometrial Ca highest at?
60 years
What % Endom Ca happen premenopausally?
15%
What % Endo Ca under 35 years?
<1%
Most common pathology of Endom ca?
Adenocarcinoma of columnar endometrial glands. >90%
Main risk factor principle involved in EndoM ca?
High oestrogen to progesterone ratio
Risk factors for EndoM Ca? (1+6)
Exogenous oestrogens- Obesity, PCOS, Nulliparity, late menopause, Ovarian granulosa cell tumours, tamoxifen
Why is tamoxifen a risk factor for EndoM ca?
Its an oestrogen antagonist in the breast but an agonist in the postmenopausal uterus.
What is the premalignant type of EndoM ca?
Cystic hyperplasia–>Atypical hyperplasia/ endometrial hyperplasia with atypia. Often co-exists with malignancy (40%)
How do you treat Endometrial hyperplasia?
Progestogens with 6 monthly endometrial biopsy OR hysterectomy
What are the wishy washy risk factors for EndoM Ca? 3
Diabetes, Hypertension, Lynch type 2 syndrome
How does Endometrial Ca present?
PMB or IMB/ irregular periods/menorrhagia
Abnormal smear.
How do you stage Endometrial Ca?
Stage 1a,b,c Endometrium, 1/2 myometrium.
Stage 2a,b- Cervical glands, cervical stroma
Stage 3A,B,Ci,ii- outside uterus locally
Stage 4 A,B- Bowel bladder, distant mets
When can you stage an Endometrial Ca?
After hysterectomy
What is diagnostic of an EndoM Ca?
Biopsy
How do you treat stage 1 EndoM Ca?
Hysterectomy and a BSO abdominally or laprascopically.
What do you find in surgery sometimes while operating a stage 1 EndoM ca?
Lymph node involvement- staging!
What do you do for late stage EndoM ca?
Offer External beam radiotherapy
What is vaginal vault radiotherapy?
Stops EndoM Ca recurrence which is very common in first 3 years- but doesnt prolong survival.
What are poor prognostic features of EndoM ca?
Old age, advanced clinical age, Deep myometrial invasion, high tumour grade, adenosquamous histology.
What are uterine sarcomas?
Malignant cancer of the smooth muscle of the uterus
What are the 3 main types of uterine sarcomas?
Leiyomyosarcoma, Endometrial stromal tumour, Mixed mullerian tumours
Endometrial stromal tumours are most common in what age group?
Perimenopausal
Mixed mullerian tumours are most common in what age group?
Old age
How would leiyomyosarcoma present?
rapidly enlarging painful fibroid
Another name for fibroids
leiomyomata
What are leiyomyomata
benign tumours of myometrium
Risk factors for fibroids (4)
More oestrogen- Common near menopause, Afro-caribbean, family history, nulliparous
Types of fibroids and where they form
Subserous polyp, Subserous, Intracavity polyp, Intramural, Submucosal, Cervical
Fibroid growth is dependent upon..
oestrogens and progesterone
What happens to fibroids after menopause
Regress, often calcify
How do fibroids present
Menorrhagia, Intermenstrural loss, dysmenorrhoea, Pressure effects- urinary frequency and retention, subfertility- tual ostia
Complications/natural history of fibroids (5)
Oestrogen dependent enlargement
Calcification
Torsion in pedunculated fibroids. Degenerations due to poor blood supply- red/hyaline/cystic
Leiomyosarcomata
How does red degeneration present?
Pain and uterine tenderness, haemorrhage and necrosis
How do fibroids complicate pregnancy? (6)
Premys, Malpresentation, transverse lie, Obstructed labour, PPH, Red degeneration (severe pain)
Diagnosis of fibroids?
MRI/Laproscopy
Connection between fibroids and vaginal bleeding?
Hb can be low from vaginal bleeds but high because fibroids can produce EPO
How to medically treat fibroids (5)
Conservative- dont treat if asymp, US for malignancy
Medical- Tranexamic acid, NSAIDS, and progestagens for menorrhagia.
GnRH agonists- induces menopause- shrinks fibroids
How to surgically treat fibroids (5)
1) Hysteroscopy- pre treat with GnRH analogues and then TCRF
2) Myomectomy- open/lap with preop gnrh and vasopressin in myometrium to reduce blood loss
3) Hysterectomy- lap/vag/open, 2-3m GnRH
4) UAE- Uterine artery embolization
5) Ablation- MRI guided transcutaneous focussed ultrasound
How do GnRH agonists help in Fibroids
They shrink the fibroid- before surgery/otherwise, reduce vascularity, thin endometrium
What is adenomyosis?
Presence of endometrium and underlying stroma within myometrium.
Risk/associations of adenomyosis?
Age 40, endometriosis, fibroids, oestrogen dependent
How does adenomyosis present?
Absent symptoms or painful, regular and heavy menses
How do you treat adenomyosis?
Medical- IUS
COCP +/- NSAIDS
Surgical- Hysterectomy
GnRH analogue therapy to see if hysterectomy would work
Endometritis is?
Inflammation of the endometrium
Endometritis is caused by?
secondary to STDs, complication of surgery, caesarian/TOP, RPOC, foreign tissue.
Infection in a post menopausal uterus is usually due to….
malignancy
Treatment for endometritis (2)
Antibiotics, occasionally ERPC.
Brief summary of intrauterine polyps
benign tumours in intrauterine cavity, endometrial origin, oestrogen dependent, sometimes derived off fibroids, 40-50 years, Menorrhagia, IMB,prolapse through cervix,resect with diathermy/avulsion.
Haematometra is
blood accumulation in uterus because of outflow obstruction
haematometra is caused by?(3)
Cervical canal obstructed due to fibrosis post endometrial resection, cone biopsy, carcinoma.
congenital uterine malformations usually present with…(4)
recurrent miscarriages, malpresentation, transverse lie and preterm labour
External bean radiotherapy is offered to
patients considered to be high risk for having lymph node involvement after theyve had a hysterectomy
