Disorders of the uterus

Question 1

What is the other term for adenomyosis?

Answer 1

Endometriosis interna, presence of the endometrium and its underlying stroma within the myometrium.

Question 2

When is adenomyosis most common?

Answer 2

In women at 40 years

Question 3

What is adenomyosis associated with?

Answer 3

Endometriosis and fibroids

Question 4

Is adenomyosis oestrogen dependent?

Answer 4

yes

Question 5

What are the clinical features of adenomyosis?

Answer 5

painful, regular, heavy menstruation is common. uterus may be mildly enlarged and tender

Question 6

What is the investigation for adenomyosis?

Answer 6

MRI (NOT USS)

Question 7

What is the treatment for adenomyosis?

Answer 7

non-steroidals or progestogens to control menorrhagia and dysmenorrhoea but hysterectomy often required.

Question 8

What are the causes of endometritis?

Answer 8

Often secondary to STIs, as a complication of surgery (eg c-section/termination), or caused by IUD or products of conception.

Question 9

What are the clinical features of endometritis?

Answer 9

Persistent, often heavy vaginal bleeding, pain, tender uterus, open os, fever may be absent but septicaemia may ensue.

Question 10

What investigations are needed to confirm endometritis?

Answer 10

Vaginal and cervial swabs, FBC (pelvic USS may not be very reliable)

Question 11

How to you treat endometritis?

Answer 11

Broad-spec ABs and/if needed evacuation of retained products of conception (ERPC)

Question 12

At what age are the presence of intrauterine polyps most common?

Answer 12

Between 40 and 50 ( when oestrogen levels are high)

Question 13

When are polyps commonly found in post-menopausal women?

Answer 13

Women who are on tamoxifen for breast ca.

Question 14

What are the symptoms of polyps?

Answer 14

IMB and menorrhagia, can occasionally prolapse through the vagina

Question 15

Which investigations are needed to diagnose polyps?

Answer 15

USS or hysteroscopy because of abnormal bleeding

Question 16

What is the most common genital tract cancer?

Answer 16

Endometrial carcinoma

Question 17

When is endometrial cancer most prevalent?

Answer 17

60 years

Question 18

What percentage of endometrial cancer occurs pre-menopausely?

Answer 18

15%

Question 19

Is it more benign than ovarian cancer?

Answer 19

no, it is stage for stage the same prognosis as ovarian cancer

Question 20

What is the common pathology of endometrial cancer?

Answer 20

Commonly adenocarcinoma or columnar endometrial gland cells (90%)

Question 21

Another common type of endometrial cancer is adenosquamos carcinoma, what is its prognosis in comparison?

Answer 21

Poorer

Question 22

What is the aetiology behind endometrial cancers?

Answer 22

A high ratio of oestrogen to progesterone, when there is a state of ‘unopposed oestrogen’.

Question 23

What are the risk factors for endometrial cancer?

Answer 23

Obesity (androgens -oestrogens), exogenous oestrogens without a progestogence increase risk x6, PCOS, late menopause, ovarian granulosa and theca (osetrogen secreting tumour), tamoxifen.

Question 24

What is protective for endometrial cancer?

Answer 24

COCP and pregnancy

Question 25

What are endogenous causes of excess oestrogen?

Answer 25

PCOS & obesity, oestrogen secreting tumours, nulliparity and late menopause.

Question 26

What are the exogenous causes of excess oestrogen?

Answer 26

Unopposed oestrogen therapy and tamoxifen

Question 27

What are the miscellaneous causes of endometrial cancer?

Answer 27

Diabetes, hypertension (not independent), history of breast or ovarian cancer and lynch type II syndrome

Question 28

What is Lynch type II syndrome?

Answer 28

HNPCC associated with cancers of the GI or reproductive system.

Question 29

Is there premalignant disease for endometrial cancer?

Answer 29

Yes, unopposed or erractic oestrogen can cause 'cystic hyperplasia'. If there is further stimulation this can lead to atypical hyperplasia.

Question 30

What are the symptoms of premalignant endometrial cancer?

Answer 30

Menstrual abnormalities, such as PMB.

Question 31

If pre-malignant disease is recognised what is indicated?

Answer 31

This is seldom recognised but a hysterectomy is indicated.

Question 32

In women with PMB, what percentage are at risk of carcinoma?

Answer 32

10%

Question 33

In premenopausal women, how does endometrial carcinoma present?

Answer 33

IMB, or occasionally recent onset menorrhagia

Question 34

What is the commonest cause of PMB?

Answer 34

Atrophic vaginitis

Question 35

Which lymph nodes may be affected in endometrial cancer?

Answer 35

Pelvic and para-aortic

Question 36

What is seen in stage 1 endometrial ca?

Answer 36

Lesions confined to the uterus. 1a-endometrium only, 1b- deepest invasion<0.5 myometrial thickness, 1c- deepest invasion is >0.5 myometrial thickness

Question 37

What is seen in stage 2 endometrial ca?

Answer 37

Lesions confined to uterus and cervix. 2a- in endocervical glands only 2b- in cervical stroma

Question 38

What is seen in stage 3 endometrial ca?

Answer 38

Tumour invades through uterus 3a- invades serosa and/or adnexae and/or positive cytology 3b- vaginal masses 3c- metastases to pelvic/para-aortic lymph nodes

Question 39

What is seen in stage 4 endometrial ca?

Answer 39

Further spread to 4a- bowel or bladder 4b- distant mets

Question 40

What percentage present at stage 1 and what is the treatment?

Answer 40

75% and laparotomy with TAH and bilateral salpingo-oophorectomy. Also lymph node biopsy to determine stage. If lymph node involvement then external beam radiotherapy used. This reduces recurrence but does not prolong survival- used for palliation of symptoms.

Question 41

Where is recurrence of endometrial cancer most commonly seen?

Answer 41

In the vaginal vault in the first 3 years

Question 42

What factors would lead to a poorer prognosis with endometrial cancer?

Answer 42

Older age, advanced stage, deep myometrial invasion, high tumour grade and adenosquamos histology.

Question 43

What is the 5-year survival rate of endometrial ca?

Answer 43

75%

Question 44

What operation should a jehovahs witness who wants a surgical management of mennorhagia have?

Answer 44

sub-total abdominal hysterectomy (where cervix is left in situ)