Approach to Post Menopausal Bleeding and Uterine Cancer Flashcards
1
Q
Aetiology of post menopausal bleeding
A
- atrophy of the genital tract
- genital malignancies
- polyps
- endometrial hyperplasia
- iatrogenic (hormones)
- trauma
- infections
- rarer (systemic disorders - bleeding disorders)
2
Q
Treatment of causes of post menopausal bleeding
A
- atrophy: topical hormonal cream
- polyps: hysteroscopy
- cancer: referral to oncology
- hyperplasia: simple (progestin), complex (surgical - hysterectomy and salpingo-oophorectomy)
3
Q
Primary malignancies of the uterine body
A
- endometrial carcinoma
- carcinosarcomas
- sarcomas
4
Q
Difference between type 1 and type 2 endometrial cancers of the uterus
A
Type 1:
- oestrogen driven
- on a background of hyperplasia
- 6th decade
- Histo = endometroid adenocarcinoma
- oestrogen and progesterone receptor positive
- less aggressive
Type 2:
- not oestrogen driven
- background of atrophy
- > 70 years
- clear cell and uterine papillary serous cancer
- p53 positive
- more aggressive
5
Q
Risk factors for type 1 uterine cancer:
A
- obesity
- wide oestrogen window
- low parity/infertility
- exogenous oestrogen (tamoxifen)
- endogenous oestrogen (PCOS)
6
Q
Cancers associated with Lynch 2 syndrome
A
- endometrial cancer
- breast
- ovarian
- uterine
- hereditary non-polyposis colorectal cancers)
- prostate cancer
7
Q
Metastatic screen after Dx of endometrial cancer
A
- bloods (FBC, renal, liver)
- chest X-ray
- imaging of abdomen
- mammogram, colonoscopy
8
Q
Staging of endometrial cancer
A
1: confined to corpus
2: spread to involve cervical stroma
3: invaded to adnexal structures/ vagina. pelvic lymph nodes
4: invaded bladder/rectum
- distant spread
9
Q
Surgery for endoemtrial cancers
A
- total abdominal hysterectomy
- bilateral salpingo-oophorectomy
- peritoneal washings
- pelvic lymph node dissection
10
Q
Prognosis of carcinosarcoma of the uterus
A
Poor
11
Q
Subtypes of uterine sarcomas
A
- leiomyosarcomas
- adenosarcomas
- endometrial stromal sarcomas
12
Q
Presentation of sarcomas of the uterus
A
- postmenopausal bleeding
- enlarged uterus
