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Reproduction/Sexual Health > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Basic compartments of pelvic cavity

A

Anterior compartment – BLADDER

Middle compartment – UTERUS

Posterior compartment – BOWEL

Lateral Compartment - ADNEXAE

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2
Q

Most common pelvic mass by cavity

A

anterior - bladder tumour, distension
middle - uterine fibroid, adenomyosis, cervical/ovarian mass
posterior - bowel tumour, appenidiceal, diverticulae, hernias
lateral - tubal abscess, ectopic, hydrosalpinx

pregnancy, plevic kidney, ascites

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3
Q

Symptom vs origin in pelvic mass

A

BLEEDING - uterine
PAIN - ovarian
PRESSURE SYMPTOMS- uterine/ovarian
LONG TERM SYMPTOMS (m/y) - benign
SHORT TERM SYMPTOMS (w) - malignant
DOUBLING PAIN WITH NAUSEA - acute

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4
Q

Midline vs forniceal mass on bimanual exam

A

Uterine - midline, in line with cervix
Ovarian - occupying fornices, no movement with cervix

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5
Q

Investigation of pelvic mass

A

Always USS first
MRI best second line (visualise uterus and ovaries)
CT for wider picture and in post-menopausal patients

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6
Q

Tumour markers used to ID pelvic masses

A

Premeno - markers cA125 and AFP,HCG,LDH**

Postmeno - CA125

Not reliable on own, use alongside imaging

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7
Q

Tumour markers other than CA125 used in women <40y

A

Alpha Foeto-protein – raised in embryonal carcinoma

HCG – raised in choriocarcinoma

LDH – raised in dysgerminoma

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8
Q

How to calculate RMI in pelvic mass?

A

A - 1=premeno, 3=post meno
B - no US feature=0, one feature=1, >1 feature=3
C - serum CA125

RMI<30 = 3 in 100
RMI 30-200 = 20 in 100
RMI>200 = 75 in 100

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9
Q

Clin pres of functional cysts

A

Related to ovulation
Rarely >5cm diameter
Usually resolve spontaneously
May cause menstrual disturbance
Consider as differential in acute abdomen as may bleed or rupture
Often asymptomatic

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10
Q

Clin pres of endometriotic cysts

A

PRES:
Severe dysmenorrhea/premenstrual pain
Dyspareunia
Associated with sub fertility
Occasionally asymptomatic
Acute abdomen if ruptures
EXAM:
Tender mass with modularity
Tenderness behind uterus

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11
Q

Mangement benign ovarian tumour

A

CONSERVATIVE
MEDICAL –GnRH analogues, OCP
SURGICAL - lap ovarian cystectomy, oopherectomy, pelvic clearance

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12
Q

Describe borderline tumours

A

Masses grow slowly and may spread but not into stroma or parenchyma of other organs

Specific to pelvis

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13
Q

Management uterine fibroids

A

CONSERVATIVE
MEDICAL - hormonal management of bleeding, GnRH agonists
SURGICAL - myomectomy, hysterectomy
IR - uterine artery emolisation

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14
Q

Pres of endo hyperplasia

A
  • Causes: often unknown; may be persistent oestrogen stimulation
  • Presents with abnormal bleeding (dysfunctional uterine bleeding or
    postmenopausal bleeding).
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15
Q

2 main endo carcinoma and their precursor lesions

A

– Endometrioid carcinoma:
precursor atypical hyperplasia

– Serous carcinoma:
precursor serous intraepithelial carcinoma

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16
Q

Why are people with PCOS more likely to get endo cancer earlier?

A

They don’t ovulate so constantly secreting oestrogen
In a constate proliferative state and rarely reach secretory to release progesterone

17
Q

2 main clinicopath types of endo cancer

A

Endometrioid (and mucinous) – type 1 tumours (80%)
- Related to unopposed oestrogen e.g. PCOS or obesity
- Associated with atypical hyperplasia

Serous (and clear cell) – type 2 tumours
- Not associated with unopposed oestrogen
- Affect elderly post‐menopausal women
- TP53 often mutated

18
Q

Commonest mutations in endo carcinoma

A

PTEN, KRAS, PIK3CA
Can get germline mutation causing microsatellite instability due to Lynch’s

19
Q

Why does obesity put you at higher risk of endo cancer?

A

Adipocytes express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation.

Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher.

Insulin action is often altered in obese women which exerts proliferative effect on endometrium.

20
Q

Med management of endo cancer if surgery is not an option

A

Progestogens
Put in 1 or 2 mirena coils

21
Q

Serous carcinoma on micro

A

Characterised by a complex papillary and/or glandular archietecture with diffuse, marked nuclear pleomorphism

22
Q

Describe endo stromal sarcoma

A

Low or high grade
Very invasive, esp with blood
Rare, cells resemble endometrial stroma. Infiltrate myometrium and often lymphovascular spaces

Presents with abnormal uterine bleeding but initial presentation may be as metastasis e.g. ovary, lung

Stage for prognosis

23
Q

Features of carcinosarcoma

A

High grade carcinomatous and sarcomatous elements
Heterologous elements commonly seen in about 50% cases (rhabdomyosarcoma, chrondrosarcoma, osteosarcoma)
Poor prognosis
Big bulky tumours obstructing uterus

24
Q

Features of leiomyosarcoma

A

A malignant smooth muscle tumour commonly displaying a spindle cell morphology
Rare
Presents with abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
Poor prognosis even if

25
Q

Lymph nodes involved in uterine cancer

A

In uterine cavity - iliac nodes
Fundus - para-aortic and iliac nodes

26
Q

Gold standard surgery for ovarian cancer

A

Midline incision, access both compartments
Optimal debulking

27
Q

Gold standard management for uterine cancer

A

Surgery: Hysterectomy, BSO, PLND (pelvic lymph node dissection in high grade dissection)

28
Q

Management cervical cancer

A

Surgery as good as chemo/radio
Stage 1
LLETZ procedure to cut out cervix at
Hysterectomy if comp family
Stage 2
Hysterectomy or LLETZ with nodes

29
Q

Gold standard management for vulval cancer

A

WIDE LOCAL EXCISION +/- GROIN NODES REMOVAL

30
Q

Indications for radical radiotherapy

A

Cervical Cancer:
- Stage I if medically unfit for surgery
- Stage II, III, IV
Endometrial cancer if medically inoperable
Some vulval cancers

31
Q

Indications for adjuvant radiotherapy

A

Cervical cancers with large tumour diameter, positive margins on resection, positive lymph nodes

Endometrial cancer – grade II, III, IV

Vulval cancer depending on histo

32
Q

Indications of palliative radiotherapy in gynae cancer

A

Pain
Bleeding
Spinal cord compression from spinal mets
Skin mets

33
Q

Indications for chemo in gynae cancer

A

Adjuvant
- Following surgery, if high risk of recurrence

Neoadjuvant
- Before surgery, May have interval debulking surgery

Palliative
- Symptom control

34
Q

Chemo used in gynae cancer

A

Carboplatin and Paclitaxel
Also cisplatin in cervical

Reproduction/Sexual Health (9 decks)

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