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Gynaecology > Uterus and its abnormalities > Flashcards

Uterus and its abnormalities Flashcards

Learn all of gynae through asking questions!

1
Q

What is the most common genital tract cancer?

A

Endometrial carcinoma

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2
Q

Prevalence of Endometrial Ca highest at?

A

60 years

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3
Q

What % Endom Ca happen premenopausally?

A

15%

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4
Q

What % Endo Ca under 35 years?

A

<1%

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5
Q

Most common pathology of Endom ca?

A

Adenocarcinoma of columnar endometrial glands. >90%

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6
Q

Main risk factor principle involved in EndoM ca?

A

High oestrogen to progesterone ratio

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7
Q

Risk factors for EndoM Ca? (1+6)

A

Exogenous oestrogens- Obesity, PCOS, Nulliparity, late menopause, Ovarian granulosa cell tumours, tamoxifen

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8
Q

Why is tamoxifen a risk factor for EndoM ca?

A

Its an oestrogen antagonist in the breast but an agonist in the postmenopausal uterus.

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9
Q

What is the premalignant type of EndoM ca?

A

Cystic hyperplasia–>Atypical hyperplasia/ endometrial hyperplasia with atypia. Often co-exists with malignancy (40%)

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10
Q

How do you treat Endometrial hyperplasia?

A

Progestogens with 6 monthly endometrial biopsy OR hysterectomy

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11
Q

What are the wishy washy risk factors for EndoM Ca? 3

A

Diabetes, Hypertension, Lynch type 2 syndrome

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12
Q

How does Endometrial Ca present?

A

PMB or IMB/ irregular periods/menorrhagia

Abnormal smear.

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13
Q

How do you stage Endometrial Ca?

A

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

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14
Q

When can you stage an Endometrial Ca?

A

After hysterectomy

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15
Q

What is diagnostic of an EndoM Ca?

A

Biopsy

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16
Q

How do you treat stage 1 EndoM Ca?

A

Hysterectomy and a BSO abdominally or laprascopically.

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17
Q

What do you find in surgery sometimes while operating a stage 1 EndoM ca?

A

Lymph node involvement- staging!

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18
Q

What do you do for late stage EndoM ca?

A

Offer External beam radiotherapy

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19
Q

What is vaginal vault radiotherapy?

A

Stops EndoM Ca recurrence which is very common in first 3 years- but doesnt prolong survival.

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20
Q

What are poor prognostic features of EndoM ca?

A

Old age, advanced clinical age, Deep myometrial invasion, high tumour grade, adenosquamous histology.

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21
Q

What are uterine sarcomas?

A

Malignant cancer of the smooth muscle of the uterus

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22
Q

What are the 3 main types of uterine sarcomas?

A

Leiyomyosarcoma, Endometrial stromal tumour, Mixed mullerian tumours

23
Q

Endometrial stromal tumours are most common in what age group?

A

Perimenopausal

24
Q

Mixed mullerian tumours are most common in what age group?

A

Old age

25
Q

How would leiyomyosarcoma present?

A

rapidly enlarging painful fibroid

26
Q

Another name for fibroids

A

leiomyomata

27
Q

What are leiyomyomata

A

benign tumours of myometrium

28
Q

Risk factors for fibroids (4)

A

More oestrogen- Common near menopause, Afro-caribbean, family history, nulliparous

29
Q

Types of fibroids and where they form

A

Subserous polyp, Subserous, Intracavity polyp, Intramural, Submucosal, Cervical

30
Q

Fibroid growth is dependent upon..

A

oestrogens and progesterone

31
Q

What happens to fibroids after menopause

A

Regress, often calcify

32
Q

How do fibroids present

A

Menorrhagia, Intermenstrural loss, dysmenorrhoea, Pressure effects- urinary frequency and retention, subfertility- tual ostia

33
Q

Complications/natural history of fibroids (5)

A

Oestrogen dependent enlargement
Calcification
Torsion in pedunculated fibroids. Degenerations due to poor blood supply- red/hyaline/cystic
Leiomyosarcomata

34
Q

How does red degeneration present?

A

Pain and uterine tenderness, haemorrhage and necrosis

35
Q

How do fibroids complicate pregnancy? (6)

A

Premys, Malpresentation, transverse lie, Obstructed labour, PPH, Red degeneration (severe pain)

36
Q

Diagnosis of fibroids?

A

MRI/Laproscopy

37
Q

Connection between fibroids and vaginal bleeding?

A

Hb can be low from vaginal bleeds but high because fibroids can produce EPO

38
Q

How to medically treat fibroids (5)

A

Conservative- dont treat if asymp, US for malignancy
Medical- Tranexamic acid, NSAIDS, and progestagens for menorrhagia.
GnRH agonists- induces menopause- shrinks fibroids

39
Q

How to surgically treat fibroids (5)

A

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

40
Q

How do GnRH agonists help in Fibroids

A

They shrink the fibroid- before surgery/otherwise, reduce vascularity, thin endometrium

41
Q

What is adenomyosis?

A

Presence of endometrium and underlying stroma within myometrium.

42
Q

Risk/associations of adenomyosis?

A

Age 40, endometriosis, fibroids, oestrogen dependent

43
Q

How does adenomyosis present?

A

Absent symptoms or painful, regular and heavy menses

44
Q

How do you treat adenomyosis?

A

Medical- IUS
COCP +/- NSAIDS
Surgical- Hysterectomy
GnRH analogue therapy to see if hysterectomy would work

45
Q

Endometritis is?

A

Inflammation of the endometrium

46
Q

Endometritis is caused by?

A

secondary to STDs, complication of surgery, caesarian/TOP, RPOC, foreign tissue.

47
Q

Infection in a post menopausal uterus is usually due to….

A

malignancy

48
Q

Treatment for endometritis (2)

A

Antibiotics, occasionally ERPC.

49
Q

Brief summary of intrauterine polyps

A

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.

50
Q

Haematometra is

A

blood accumulation in uterus because of outflow obstruction

51
Q

haematometra is caused by?(3)

A

Cervical canal obstructed due to fibrosis post endometrial resection, cone biopsy, carcinoma.

52
Q

congenital uterine malformations usually present with…(4)

A

recurrent miscarriages, malpresentation, transverse lie and preterm labour

53
Q

External bean radiotherapy is offered to

A

patients considered to be high risk for having lymph node involvement after theyve had a hysterectomy

Gynaecology (11 decks)

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