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Reproductive Exam 2 > Endometrial Hyperplasia > Flashcards

Endometrial Hyperplasia Flashcards

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1
Q

endometrial hyperplastic changes are usually assocated with what hormonal problem

A

unopposed estrogen stimulation

- means not stabilized by progesterone so it keeps growing

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2
Q

how does endometrial hyperplasia present as microscopically

A
  • prolifertaion of glands and stromal
  • crowding of glands
  • increase mitosis
  • prominent nucleoli
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3
Q

what is endomet hyperplasia aka

A

pre-cancer of the endometrium

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4
Q

another word for cystic

A

simple

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5
Q

another word for complex

A

adenomatous

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6
Q

name the 4 different classifications of endomet hyperplasia

A
  • Simple Endometrial Hyperplasia
  • Complex Endometrial Hyperplasia
  • Simple Endometrial Hyperplasia with atypia
  • Complex Endometrial Hyperplasia with atypia
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7
Q

what are the characteristics of Simple Endometrial Hyperplasia

A

regular glandular pattern
NO CYTOLOGIC ATYPIA
1% will progress to cancer

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8
Q

what are the characteristics of Complex Endometrial Hyperplasia

A

Irregular glands crowded back to back
NO ATYPIA
3% will progress to cancer

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9
Q

what are the characteristics of Simple Endometrial Hyperplasia with atypia

A

regular glandular patterns
CYTOLOGIC ATYPIA
8% will progress to cancer

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10
Q

what are the characteristics of Complex Endometrial Hyperplasia with atypia

A

irregular crowded glands
CYTOLOGIC ATYPIA
29% will progress to cancer

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11
Q

how does a pt with endomet hyperplasia present s/s

A

irregular uterine bleeding

-infrequent is missed periods is common

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12
Q

what is the etiology of a missed menses

A

endometrial lining during the menstrual cycle changes from proliferative to secretory endometrium

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13
Q

what do women who are prone to hyperplasia do or dont have

A

DONT have progesterone to ensure that there is a synchronized menstrual cycle

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14
Q

Which hormone can a girl lack and still have a period

A

progesterone

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15
Q

endometroisis patients have hormone imbalance, causing what

A

lining in one area of the uterus to become thicker faster than antoher area
-eventually outgrows blood supply

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16
Q

so what happens d/t the ischemia of the lining

A

its going to break off and eventually bleed abnormally

  • thus different sections of the uterus will have inconsistent endometrial lining thickening
  • lack of concerted shedding of lining
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17
Q

what is is called when the wall gets so think with blood it “hangs” off the uterine wall

A

endometrial polyp

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18
Q

is it healthy shedding of lining if a pt has 1 concerted period every 3 month

A

Yes

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19
Q

girls on BCP will have lighter, shorter, less crampy periods because

A

the pills are designed to not allow to have the tissue grow in the first place

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20
Q

if you’re on BCP are you at risk of developing hyperplasia

A

NOPE

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21
Q

what is the risk factor for endometrial hyperplasia

A

over 35 years old

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22
Q

how do you diagnose endometrial hyperplasia

A

endometrial sampling
office visit - endometrial biopsy w/o dilation
outpts surgery - D&C

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23
Q

can a pap smear show hyperplasia

A

not really

BUT it can show AGUS results

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24
Q

pap smear is usually used for what

A

cervical problems

  • AGUS (abnl glandular cells of undetermined signfi)
  • with AGUS need to do endometrial biopsy and endo cervical canal biopsy to see where the cells are coming from
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25
how do you treat endometrial hyperplasia
hormonal D&C follow by hormonal hysterectomy
26
hormonal tx for endometrial hyperplasia
becoming a carcinoma is low, so giving more progestin can REVERSE this
27
when do you use D&C followed by hormonal for endometrial hyperplasia
if you have lots of or severe form
28
when do you do a hysterectomy for endometrial hyperplasia
in most severe form (complex with atypia will be treated aggressively) or no longer at birthing age
29
treatment can be affected by what three things
pts age maintaining fertility histiologic type of hyperplasia
30
what is the 4th most common cancer for woman
endometrial cancer
31
which age group is does endometrial cancer occur
50-59 year old 75% occur in post-menopausal -not ovulating anymore
32
how are women able to make estrogen even after menopause
via the adrenal glands
33
what mostly occurs in chunkers women and how does it happen
endometrial hyperplasia | -converting androsteindione to estrone (or E3 estriol, i dk) in all that adipose tissues
34
what happens to post meno skinny bitches
suffer more symptoms of menopause BUT they dont develop endometrial hyperplasia
35
if a woman is still making estrogen but lack progesterone, what can you do
give them progestrone | -giving cyclic progestin will ensure they have at least one good period every 1-3 months
36
what does giving depo or low dose bcp allow
continuous progesterone administration | -which will stop the normal hormonal production of pulsatile motion
37
what are the risk factors of endometrial cancer
``` Early menarche Late menopause Unopposed estrogen Nulliparity Obesity Diabetes Tamoxifen use Other pelvic cancer ```
38
what is the MOST at risk factor
unopposed estrogen - chronic anovulation - extra-genital estrogen production
39
how is Tamoxifen a risk factor
its used for blocking the estrogen receptors in the breast but has OPPOSITE effect on the ovaries/uterus
40
when is the peak time for women to develop endometrial hyperplsia and carcinoma
40-50's (perimenopausal)
41
what are the s/s of endometrial cancer
- abnl uterine bleeding - pre-menopausal: menorrhagia or metrorrhagia - post-meno: bleeding of any amt is always anbl and needs to be investigated
42
how do you diagnose endometrial cancer
>35 years old with irregular bleeding - endometrial biopsy - D&C
43
how do you stage endometrial cancer
FIGO surgical staging
44
what is the FIGO staging
Stage 1: limited to UTERUS Stage 2: extension to CERVIX Stage 3: PELVIC extension Stage 4: mucosa of BLADDER/BOWEL or distant metastases
45
what is menorrhagia
excessive uterine bleeding
46
what is metrorrhagia
irregular uterine bleeding
47
what needs to be done for a lymphatic spread to lymph nodes
post-operative radiology
48
which stage has the best 5 year survival rate of endometrial cancer
stage one 75-90%
49
the other stage survival rates
Stage two 15% - 60% Stage three 7% - 35% Stage four 3% - 10%
50
what is the most COMMON spread patteren
direct extension to adjacent tissues
51
in cases with deep myometrial invasion, where is teh lymphatic spread usually
pelvic and para-aortic nodes
52
which spread is less likely
hematogenous spread
53
what is the most common histologic type
adenocarcinoma - 60%
54
other histological types
``` Adenocanthoma- 22% Clear cell- 6% Papillary serous- 5% Secretory- 1.5% Adenosquamous carcinoma- 7% ```
55
why is staging needed
to tell us where it is, where it started, where it spread
56
prognosis : staging of tumor
Myometrium invasion Peritoneal cytology Lymph nodes Adnexal involvement
57
what does grading of tumor mean
nuclear atypia of the tissue involved in the cancer - Grade 1 – well differentiated carcinoma - Grade 2 – moderately well differentiated - Grade 3 – undifferentiated, or poorly differentiated histiologic differentiation
58
how do you treat endometrial cancer
surgery radiation chemotherapy
59
what 2 types of radiation can be done
1. external beam 2. intra-cavitary* - done before hysterectomy - treating and closing down any lymph spread before hysterectomy
60
is chemo used regularly
no | -usually reserved for recurrence (rescue therapy)
61
which down there cancer is much more aggressive than endometrial carcinoma
uterine sarcoma (muscle --> myometrium)
62
uterine sarcoma prognosis
POOR! stage 1 has 50% 5 yr survival rate

Reproductive Exam 2 (5 decks)

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