217 - Diseases of the Uterus Flashcards Preview

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


List 3 common presenting symptoms of endometriosis

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

May also have a hx of infertility




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



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

What is the most likely diagnosis?


(Basically, endometriosis confined to the myometrium)




List 4 hormonal treatments for endometriosis

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



List 4 risk factors for endometriosis

  • Early menarchy
  • Nulliparity
  • Long menses
  • Mullarian abnormalities



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)


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

What findings will be consistent with this diagnosis?


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


Do an MRI if not sure after US


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



Is endometriosis considered a pre-malignant lesion?


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



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


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



What causes a leiomyoma?

Transformation of normal myocytes into abnrormal myocytes


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