6.5 Neoplasms of the uterus and endometrium

Question 1

Post menopausal women who present with bleeding from the genital tract(slide needs to be addeded)

Question 2

Definition

Answer 2

-any bleeding of the genital tract(1)
- appropriate age group(menopausal age)
- Not on HT(hormonal treatment- if the pattern of bleeding changes, 2 types: sequestial which is active hormone(id the cycle isn’t 27 day cycle-fall under ,withdraw and give 7 days placebo, 2 is the continous combined, active horme everyday and should have bleeding
- At least 6 months after cessation of menstruation OR acyclical bleeding in PM woman on HT

Bleeding: rectal/vaginal or hematuria (1)

Question 3

General causes

Answer 3

Systemic:
- Bleeding tendency-warfirin as an e,g
- Endogenous oestrogen
Exogenous: isulin as an e.g
Local
- Benign:
Vulva and vagina: polyp,cervicitis
- Malignant
cervix cancer and menopausal> endometrial cancer
fallopian:unlikely to present to bleedding
2 degress:

Question 4

Approach

Answer 4

• History
  nature of bleeding
  hematuria/rectal bleeding
  associated symptoms
  Drug usage: anything that can cause bleeding (anticoagulant, aspirin/hormonal treatment)
  Risk factors for endometrial Ca(refer back to dyfunction nots)
  Risk factors for cervical Ca (refer back to dysfunction notes)
• Clinical examination
  General examination-BMI,Bb, Bp
  Breasts and thyroid
  Systemic exam
  Abdominal exam
  Gyn exam: speculum-first order
  P.R.
• Special investigations:
  Cervical cytology-provided that the cervix looks normal, abnormal, utilise the forces for getting a specimen.
  Ultrasound
  Sample endometrium

Question 5

What was used 30 years ago

Answer 5

D and C

Question 6

Currently what do we use?

Answer 6

1. TVUS
   Systematic approach:
   Endomentrial line(EL) -ref unit. </+4 mm
   Regular vs irregular
   Presence/Absence of fluid collection

*Evidence: Meta-analysis
-Combined individual patient data
- Threshold </= 4 mm(one being used ,test Q’s) -lies in the negative predictive value, highly unlikely, excluded all nb illnesses,the if greater do other tests
Sensitivity
Specificity
Post-test likelihood
- Threshold </= 3mm
Sensitivity

2. SIS (it does not add, or give tissue diagnosis thus it is rarely done)
   - Dilates the endometrium.

Question 7

> 4mm

Answer 7

Outpatient sampling
1. Pipelle
- measurement of the cavity, indication o f the uterine size.
- exceeds more than 8 now its at 12 it constitutes to cause a perforation
- vaccume space:
Pick up about 90% of cancers

Outpatient hysteroscopy
- patient can be awake
advantage:visualise the cavity
can also remove polyps

Question 8

Histology

Answer 8

• Benign
• Hyperplasia(carries risk: Nb
  simple or complex :glandualr structure:morphology
  with(1-3%) or without atypia(8-29%) (nuclear)
  Maligant(FIGO Grade)
  Atypia:cytology
  *Use this to plan treatment