Uterine Disease

Question 1

What is endometriosis?

Answer 1

foci of endometrial glands and stoma outside uterine body

Question 2

Where can endometrial tissue be in endometriosis?

Answer 2

on an ovary, in rectovaginal pouch, uterosacral ligaments, pelvic peritoenum

Question 3

What is a chocolate cyst?

Answer 3

endometrial tissue on an scary in endometriosis

Question 4

When is the term adenomyosis used, instead of endometriosis?

Answer 4

when these foci of endometrial glandular tissue are found in the uterine wall muscle

Question 5

What is the presentation of endometriosis?

Answer 5

asymptomatic 
pelvic pain - classically cyclical 
secondary dysmenorrhea 
deep dyspareunia 
sub fertility

Question 6

What are some complications of endometriosis?

Answer 6

cyst formation 
infertility 
malignancy 
ectopic pregnancy 
adhesions

Question 7

What do you find on vaginal examination in endometriosis?

Answer 7

fixed retroverted uterus
uterosacral ligament nodules
general tenderness
enlarged, boggy tender uterus - adenomyosis

Question 8

What is the first line investigation in endometriosis?

Answer 8

laparoscopy - find adhesions, cysts, peritoneal deposits

Question 9

What is the treatment of endometriosis?

Answer 9

asymptomatic - no treatment 
support - join a society 
reduce stress
analgesia/NSAIDs
hormonal therapy: to suppress ovulation - CCP, progestogens (not in adolescents, reduce bone density)
surgery, laparoscopy

Question 10

What is endometritis?

Answer 10

uterine infection

Question 11

When can endometritis occur?

Answer 11

is uncommon unless barrier to ascending infection is broken e.g. after miscarriage, TOP, childbirth, IUS or IUD insertion

Question 12

What can endometritis also involve apart from uterus?

Answer 12

tubes and ovaries

Question 13

What is the presentation of endometritis?

Answer 13

lower abdominal pain
fever
uterine tenderness on bimanual palpation

Question 14

What are the investigations for endometritis?

Answer 14

cervical swabs and blood cultures

Question 15

What is the treatment of endometritis?

Answer 15

antibiotics e.g. doxycycline with metronidazole, 7 days

Question 16

What are uterine fibroids?

Answer 16

leiomyomas - benign smooth muscle tumours of the uterus

Question 17

What happens to uterine fibroids in pregnancy, on the combined pill and during menopause?

Answer 17

pregnant and combined pill - enlarge
menopause - atrophy
as they are oestrogen dependent

Question 18

What is a uterine fibroid called if its under the peritoneum?

Answer 18

subserosal

Question 19

What is a uterine fibroid called if its under the endometrium?

Answer 19

submucosal

Question 20

What are symptoms of a uterine fibroid?

Answer 20

asymptomatic 
menorrhagia 
fertility problems 
pain 
mass
pressure symptoms

Question 21

How are uterine fibroids diagnosed?

Answer 21

USS
MRI - precise localisation
Hb if heavy bleeding

Question 22

How are uterine fibroids treated?

Answer 22

often no treatment needed
hysterectomy (menorrhagia) - if family complete
myomectomy, uterine artery embolisation, hysteroscopic resection

Question 23

What is more common, endometrial or cervical cancer?

Answer 23

cervical

Question 24

What are the majority of endometrial cancers?

Answer 24

adenocarcinoma

Question 25

What are the 2 main groups of endometrial carcinomas?

Answer 25

type 1: endometroid/mucinous carcinoma | type 2: serous/clear cell carcinoma

Question 26

What is the precursor for endometroid/mucinous carcinoma?

Answer 26

atypical hyperplasia

Question 27

What is the precursor for serous/clear cell carcinoma?

Answer 27

serious intraepithelial carcinoma

Question 28

What mutations are found in type 1 endometrial carcinomas?

Answer 28

PTEN KRAS PIK3CA

Question 29

What mutations are found in type 2 endometrial carcinomas?

Answer 29

TP53

Question 30

What are risk factors for endometrial carcinoma?

Answer 30

``` early menarche late menopause HRT tamoxifen obesity smoking PCOS breast cancer nulliparity ```

Question 31

What is the presentation of endometrial carcinoma?

Answer 31

usually after menopause | abnormal bleeding - PMB, IMB

Question 32

What are the investigations for endometrial carcinoma?

Answer 32

examination usually normal transvaginal USS uterine sampling - depending on endometrial thickness on USS pipelle biopsy or dilatation and curettage

Question 33

At what thickness on USS should you sample the endometrium?

Answer 33

post menopause: >5mm thick (<5mm normal in postmenopausal women) pre menopause: >16mm

Question 34

What is the treatment of endometrial carcinoma?

Answer 34

total hysterectomy with bilateral sapling-oopherectomy and or radiotherapy

Question 35

What is Lynch syndrome?

Answer 35

cancer predisposition syndrome - increased risk of colorectal, endometrial and ovarian cancers

Question 36

What is the inheritance pattern of Lynch syndrome?

Answer 36

autosomal dominant

Question 37

Describe serous endometrial carcinoma

Answer 37

post menopausal women aggressive spreads along fallopian tubes/peritoneum

Question 38

Describe endometriod endometrial carcinoma

Answer 38

associated with Lynch syndrome | associated with high oestrogen - HRT, early menarche , late menopause

Question 39

What is protective against endometrial cancer?

Answer 39

CCP | having children

Question 40

What 3 cancers does Lynch syndrome predispose to?

Answer 40

colorectal - HNPCC endometriod endometrial cancer clear cell ovarian cancer