Symptoms of advanced cervical cancer
Post-coital bleeding
Foul smelling discharge
Intermenstrual bleeding
Advanced weight loss
Majority of cervical cancer types
Squamous cell carcinoma
- More differentiated= more keratin production
- Correlated with how closely it resembles cell of origin
Sources of oestrogen
Ovaries
Adrenal glands
Subcutaneous fat
Follicular phase of ovary
Proliferative phase of the endothelium
- Approx 7 days
Tubular glands, mitotic activity
Dense stroma (differentiated)
Secretory phase of endothelium
Early phase, Day 15-16
- Presence of corpus luteum
- Subnuclear vacuolation
Late phase
- Long, cork-screw glands
Indications for hysterectomy
Fibroid uterus
Early cervical carcinoma
Endometrium carcinoma
Ovarian cancer
Uterine prolapse
Dysfunctional uterine bleeding.
Best time to sample endometrium for infertility investigation
Luteal phase- Day 16 onwards
- After ovulation, when you can tell if ovulation has occurred.
Dysfunctional uterine bleeding
Bleeding without mechanical cause
Examples
- Menorrhagia
- Intermenstrual bleeding
- Polymenorrhoea
- Metrorrhagia
Fibroid uterus
Most common tumour of the uterus
- Leiomyoma (benign)
Malignant- leiomyosarcoma
Leiomyoma clinical presentation
Abnormal uterine bleeding (Metrorrhagia)
Pain (dysmenorrhoea)
Urinary symptoms (pressure effects)
Impaired infertility (recurrent miscarriage)
Pregnancy
- Preterm labour
- Obstructed labour
Mirena and DUB
Secretion of progesterone–> Suppresses endometrial proliferation–> Less bleeding
Subserosal fibroid complications in pregnancy
Preterm labour
Obstructing/ complicated labour
Acute abdomen (severe pain) from infarction
Investigations for carcinoma of the endometrium
Hysteroscopy + biopsy
Ultrasound- assess thickness
MRI -local spread
CT- Local and distant spread
Poorly differentiated cancers
Have poorer prognosis
- High rate of proliferation
- increased propensity to invade blood vessels and lymphatics
Lower uterine segment and C-section
Used because
- Thinner and easier to suture
- Easier to control bleeding
- Reduced risk of rupture
Post-partum haemorrhage causes
Uterine atony
- Does not close off intra-myometrial vessels
- Usually due to prolonged labour
Retained products of conception
Clotting abnormalities
