217 - Diseases of the Uterus Flashcards Preview

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Flashcards in 217 - Diseases of the Uterus Deck (13)
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1

What is the typical presentation of endometrial cancer?

Post-menopausal vaginal bleeding

 

In this setting, endometrial cancer is a diagnosis of exclusion

Requires an exensive workup, but all post-menopausal women who present with new bleeding need to be worked up

2

List 3 common presenting symptoms of endometriosis

  • Dysmenorrhea (painful menses)
  • Pain with intercourse
  • Chronic pelvic pain

May also have a hx of infertility

 

 

3

A "chocolate" blood-filled cyst is most consistent with which uterine pathology?

Endometriosis

4

A patient with heavy, painful menstrual bleeding is found to have a diffusely enlarged uterus.

What is the most likely diagnosis?

Adenomyosis

(Basically, endometriosis confined to the myometrium)

 

 

5

List 4 hormonal treatments for endometriosis

  • OCPs
    • Combined or Progestin-only 
  • GnRH agonist (leuprolide)
  • Danazol (not used often)
  • Aromatase inhibitors

 

6

List 4 risk factors for endometriosis

  • Early menarchy
  • Nulliparity
  • Long menses
  • Mullarian abnormalities

 

7

List 3 risk factors and 1 protective factor for leiomyoma

  • Risk
    • Obesity
    • Alcohol intake
    • Dietary factors
  • Protective
    • Parity (at lease 1 pregnancy beyond 20 weeks)

8

What is the first-line imaging method used to evaluate endometriosis?

What findings will be consistent with this diagnosis?

Ultrasound

  • Unilocular cyst
  • Homogenous, low echogenicity
  • Poor or mild vascular flow

 

Do an MRI if not sure after US

9

What is the "standard of care" treatment for endometrial cancer?

In which patients would we elect to use a different treatment?

Hysterectomy w/bilateral salpingo-oophorectomy + lymph node assessment

 

Select patinets may be managed differently:

  • Pre-menopausal patinets who want to have kids
    • Use progesterone therapy
    • Only an option for low-grade/type 1 tumors
  • Pts who are poor surgical candidates
    • Progesterone therapy for type 1 tumor
    • Pelvic radiation for type 2 tumor

 

10

Is endometriosis considered a pre-malignant lesion?

No

  • Highest risk of transmformation to epithelial ovarian cancer is in post-menopausal women
    • Clear cell and endometroid epithelial ovarian cancer are most common

 

11

In what clinical scenario do endometrial polyps have the highest risk of malignancy?

Postmenopausal bleeding (5% risk of malignancy)

 

  • In other settings, endometrial polyps are very rarely malignant

12

What is the most common tumor of reproductive aged women?

What are the symptoms (5)

Leiomyoma (fibroid)

  • Heavy/prolonged bleeding
  • Bulk/pressure
  • Pain
  • Infertility
  • Recurrent pregnancy loss

 

13

What causes a leiomyoma?

Transformation of normal myocytes into abnrormal myocytes

 

Probably due to some kind of "hit" or acquired mutation