2.1 Cs Exam4: Endometrial Cancer & Abnormal Uterine Bleeding

Front 1

Define normal bleeding

Back 1

-duration < 7 days

-flow < 80 mL/cycle (< 6 full tampons/pads day)

-occurs approx every 21 days

-no intermenstrual bleeding

-no postcoital spotting

Front 2

define Menorrhagia

Back 2

excessive or prolonged menses (>80ml OR >7 days) occuring at normal intervals

Front 3

define metrorrhagia

Back 3

irregular episodes of uterine bleeding

Front 4

define Menometrorrhagia

Back 4

heavy and irregular bleeding

Front 5

define polymenorrhea

Back 5

abnormally frequent menses at intervals <24 days

Front 6

T/F

Postmenopausal bleeding is always normal.

Back 6

FALSE

always ABNORMAL!!

Front 7

T/F

You should give a pt that has a uterus estrogen only hormone replacement

Back 7

FALSE

because it increases the risk of endometrial cancer

Front 8

what are the Risk factors for endometrial cancer?

Back 8

Obesity
Nulliparity
Late Menopause
Diabetes Mellitus
Hypertension
Breast, colon, or ovarian CA
Chronic unopposed estrogen stimulation (hormone replacement therapy)
Chronic tamoxifen use

Front 9

what are the two sxs presented in a pt w/ endometrial cancer?

Back 9

abnormal vaginal bleeding
vaginal discharge

Front 10

how do you diagnose endometrial cancer? who do you do it in? what is the gold standard? why?

Back 10

endometrial biopsy- sample endometrial tissue
do it in: postmenopausal bleeding and >35 years old w/ irregular bleeding * fastest method, painful

transvaginal US- evaluate endometrial stripe

Gold standard: D&C--> will not miss the lesion or where ever the cancer is (requires anesthesia)

Front 11

on abdominal/ transvaginal US, what are the three stripe thicknesses? what does each stripe mean?

Back 11

Stripe < 4mm
Unlikely risk of endometrial hyperplasia or cancer

Stripe from 5-12 mm
May be normal

Stripe > 5mm
Biopsy
Postmenopausal women

Front 12

what are the complications of dilation and curettage for endometrial cancer?

Back 12

perforation of uterus
bleeding
infection
laceration of the cervix

Front 13

what does Grade mean? Stage?

Back 13

grade is how differentiated it is

((1) well-->poor (3))

stage is how far it has spread

Front 14

what are the four patterns of spread of endometrial cancer? which one is MC?

Back 14

1. direct extension (through myometrium) *MC
2. exfoliation of cells through fallopian tube (ovaries, viscera, parietal peritoneum, omentum)
3. lymphatic spread (pelvic LN --> para-aortic LN)
4. Hematogenous spread (lungs, liver--> uncommon)

Front 15

how do you tx stage 1 endometrial Cancer?

Back 15

E-Lap w/ total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
Peritoneal washings
Pelvic lymph node dissection
Radiation (vault brachytherapy)

Front 16

how do you tx stage 2 endometrial cancer?

Back 16

Same as Stage I if cervix grossly normal
Radical hysterectomy, BSO, staging, external beam radiation

Front 17

what is the follow-up for pts w/ endometrial cancer post-op?

Back 17

every 3 months x 2yrs
every 6 months x 3 yrs
then annually

Front 18

what are the signs and sxs of PCOS?

Back 18

Presents at puberty
Obesity
Hirsutism
Amenorrhea (50%), AUB 30%
Insulin resistance

Front 19

how do you tx PCOS?

hirsutism in PCOS?

insulin resistance?

pts who want to concieve?

Back 19

PCOS: cyclic medroxyprogesterone- 10 mg for 10-12 days a month
hirsutism: spironolactone
insulin resistance: Metformin

concieve: clomid

Front 20

what would you see on EMB in chronic endometritis?

what are the possible causes?

how do you tx?

Back 20

plasma cells on EMB

Possible causes: infection, foreign body, radiation
Tx with antibiotics

Doxycycline 100mg bid for 10-14 days

Front 21

what are three other causes of bleeding besides chronic endometritis?

Back 21

fibroids, endometrial polyps, adenomyosis

Front 22

What are the risk factors for Polys?

Back 22

inc estrogen

Tamoxifen

Obesity

Front 23

Polyps:

Sx

Dx

Tx

Back 23

Sx: metrorrhagia or postmenopausal bleeding

dx: visual pelvic exam or pelvic ultrasounds

Tx: polypectomy (removal)

(only tx if symptomatic)

Front 24

Pt comes in complaining of menorrhagia (or dysmenorrhea) & chronic pelvic pain. During pelvic exam you notice an enlarged globular uterus. Dx?

Tx?

Back 24

Adenomyosis

Tx: hysterectomy

(if not done having children may try hormone, ablation, or UAE)

Front 25

Adenomyosis risk factors

Back 25

parous

history of prior uterine surgeries

Front 26

Pt comes in complaining or menorrhagia, pelvic pain/pressure, and she cannot get pregnant (infertility). On pelvic ultrasound the uterus feels slightly asymmetric & you feel a mass underneath the surface. On PUS (pelvic ultrasound) you see multiple masses in the myometrium. Dx?

TX?

Back 26

Leiomyoma (fibroids)

Tx: Hysterectomy, myomectomy (if still want to have kids), endometrial ablation, uterine artery embolization, or wait for menopause (will shrink)

Front 27

Leiomyoma (fibroids) risk factors

Back 27

African american

early mencharce (before age 10)

red meat/ham

beer

Front 28

Young female pt comes in after second period & has to get a blood transfusion (menorrhagia). In past dental procedures she has had to stay after to wait for bleeding to stop & her gums bleed heavily after flossing. Dx?

Tx?

Back 28

von Willebrand's Disease

Tx: Anti-Fibronolytic, OCP (shortens periods & reduces bleeding), desmopressin