PMB and Endometrial Ca

Question 1

What is the definition of post menstrual bleed?

Answer 1

Bleed over 1 year after amenhorroea

Question 2

How likely is it that a PMB is endometrial cancer?

Answer 2

10-15%

Question 3

What are your key differentials?

Answer 3

PALM-COEIN
PALM are structural, COEIN are not
Polyp
Adenomysosis/atrophic vaginitis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory dysfunction (endometrial atrophy)
Endometrial hyperplasia
Iatrogenic
No cause

Question 4

What should you ask in history of presenting complaint for a PMB?

Answer 4

Duration of bleeding
Quantity of bleeding
Timing
Previous episodes
Sexual history
Are you still using contraception?
Smears

Question 5

What are the risk factors for endometrial cancer?

Answer 5

Early menarche/late menopause
Nulliparity
HRT
Tamoxifen
Obesity/HTN/PCOS
Age >50
Family hx of breast cancer or HNPCC or EC

Question 6

What investigations should you do for PMB?

Answer 6

FBC with iron, smear/swab and transvaginal ultrasound
If transvaginal ultrasound shows an endometrial thickness of greater than 4mm then refer on for outpatient pipelle plus hysteroscopy plus dilatation and curettage
If endometrial thickeness less than 4mm, just follow up

Question 7

How do we treat endometrial hyperplasia?

Answer 7

Progesterone only pill
Mirena
Hysterectomy plus BSO

Question 8

Why does the cytology found on biopsy matter?

Answer 8

Simple cells have a much lower risk of future malignancy than complex, whether they have atypia or not

Question 9

Most likely type of endometrial cancer?

Answer 9

adenocarcinoma (85%)

Question 10

What are the stages of endometrial cancer?

Answer 10

Stage one: confined to endometrium
Stage two: growth extended to the cervix
Stage three: in adnexa, vagina or pelvic lymph nodes
Stage four: in bladder, rectum, or beyond pelvis

Question 11

How do we treat endometrial cancer?

Answer 11

Hysterectomy, BSO and pelvic/para-aortic node removal, plus radiotherapy