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67 Cards in this Set
- Front
- Back
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what are the Risk factors for endometrial cancer?
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Obesity
Nulliparity Late Menopause Diabetes Mellitus Hypertension Breast, colon, or ovarian CA Chronic unopposed estrogen stimulation (hormone replacement therapy) Chronic tamoxifen use |
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T/F
You should give a pt that has a uterus estrogen only hormone replacement |
FALSE
because it increases the risk of endometrial cancer |
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21-50 pounds overweight ____ risk of endometrial cancer.
>50 pounds overweight _____ risk of endometrial cancer. |
3x
10x |
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define Menorrhagia
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excessive or prolonged menses (>80ml OR >7 days) occuring at normal intervals
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define metrorrhagia
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irregular episodes of uterine bleeding
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define Menometrorrhagia
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heavy and irregular bleeding
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define polymenorrhea
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abnormally frequent menses at intervals <24 days
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T/F
Postmenopausal bleeding is always normal. |
FALSE
always ABNORMAL!! |
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what are the two sxs presented in a pt w/ endometrial cancer?
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abnormal vaginal bleeding
vaginal discharge |
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what is usually normal in a pt w/ endometrial cancer?
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external genitalia, vagina, cervix, and sometime the normal size.
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how do you diagnose endometrial cancer? who do you do it in? what is the gold standard? why?
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endometrial biopsy- sample endometrial tissue
do it in: postmenopausal bleeding and >35 years old w/ irregular bleeding Gold standard: D&C--> will not miss the lesion or where ever the cancer is |
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on abdominal/ transvaginal US, what are the three stripe thicknesses? what does each stripe mean?
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Stripe < 4mm
Unlikely risk of endometrial hyperplasia or cancer Stripe from 5-12 mm May be normal Stripe > 5mm Biopsy Postmenopausal women |
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what are the complications of dilation and curettage for endometrial cancer?
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perforation of uterus
bleeding infection laceration of the cervix |
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what does Grade mean? Stage?
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grade is how differentiated it is
stage is how far it has spread |
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what are the four patterns of spread of endometrial cancer? which one is MC?
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direct extension- MC
exfoliation of cells through fallopian tube (ovaries, viscera, parietal peritoneum, omentum) lymphatic spread (pelvic LN --> para-aortic LN) Hematogenous spread (lungs, liver--> uncommon) |
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enlarged uterus + ascites + fibroids =
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endometrial cancer
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how do you tx stage 1 endometrial Cancer?
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E-Lap w/ total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
Peritoneal washings Pelvic lymph node dissection Radiation (vault brachytherapy) |
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how do you tx stage 2 endometrial cancer?
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Same as Stage I if cervix grossly normal
Radical hysterectomy, BSO, staging, external beam radiation |
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why do we need to know if the pt has had her uterus removed?
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75% of recurrent dz in 2 years if they had endometrial cancer. Mc location is on the vaginal vault
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what is the follow-up for pts w/ endometrial cancer post-op?
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every 2 months x 2yrs
every 6 months x 3 yrs then annually |
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what is leiomysarcoma
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pure uterine sarcoma
Average age 55 years Discovered E-lap for fibroid Consider if fast growing fibroid* Tx with TAH BSO If a fibroid grows fast think cancer |
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how do you distinguish leiomyoma from leiomyosarcoma?
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Distinguished from leiomyoma by mitotic count, coagulative necrosis and cellular atypia
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what is endometrial stromal tumors?
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Endometrial stomal nodule
Endometrial stromal sarcoma High grade endometrial sarcoma |
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what is the mixed uterine sarcoma?
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Mixed Müllerian Sarcoma
40% of uterine sarcoma 50% w/ met dz at diagnosis Lymphatic spread |
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how do you tx endometrial hyperplasia w/o nuclear atypia? w/ Nuclear atypia?
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non atypia: D & C can be therapeutic
Progestin treatment nuclear atypia: Potential for progression to adenocarcinoma Hysterectomy If dx by EMB, do D&C to r/o adenocarcinoma |
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what is leiomysarcoma
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pure uterine sarcoma
Average age 55 years Discovered E-lap for fibroid Consider if fast growing fibroid* Tx with TAH BSO If a fibroid grows fast think cancer |
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how do you distinguish leiomyoma from leiomyosarcoma?
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Distinguished from leiomyoma by mitotic count, coagulative necrosis and cellular atypia
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what is endometrial stromal tumors?
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Endometrial stomal nodule
Endometrial stromal sarcoma High grade endometrial sarcoma |
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what is the mixed uterine sarcoma?
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Mixed Müllerian Sarcoma
40% of uterine sarcoma 50% w/ met dz at diagnosis Lymphatic spread |
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how do you tx endometrial hyperplasia w/o nuclear atypia? w/ Nuclear atypia?
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non atypia: D & C can be therapeutic
Progestin treatment nuclear atypia: Potential for progression to adenocarcinoma Hysterectomy If dx by EMB, do D&C to r/o adenocarcinoma |
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what would you see on EMB in chronic endometritis? what are the possible causes? how do you tx?
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plasma cells on EMB
Possible causes: infection, foreign body, radiation Tx with antibiotics Doxycycline 100mg bid for 10-14 days |
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what are three other causes of bleeding besides chronic endometritis?
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fibroids, endometrial polyps, andomyosis
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what can cause fibroids? endometrial polyps? adenomyosis?
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fibroids-
OCP and NSAIDS myomectomy hysterectomy endometrial polyps: removal during hysteroscopy adenomyosis: medical tx hysterectomy |
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what are the nonfunctional causes of Abnormal uterine bleeding?
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trauma
infectious neoplasm vascular endocrine iatrogenic other: pregnancy, abortion, liver dz |
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abnormal hairgrowth (hirsuitism) can be indicative of what abnormal uterine bleeding disorder?
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Polycystic ovarian syndrome
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how do you tx massive intractable uterine bleeding inpatient?
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25 mg estogen IV q4h x 24 hours
Follow with 2.5 mg oral estrogen x 25 days adding 10 medroxyprogesterone for last 10 days withdrawal bleed |
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how do you tx intractable uterine bleeding but they are hemodynamically stable?
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OCP taper – 3 pills x 3 days; 2 pills x 3 days; then 1 pill per day; start new pack
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if the pt is desiring pregnancy but is having intractable uterine bleeding, what can you give them?
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Medroxyprogesterone 5-10mg for 2 weeks every month
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what are the two main contraindications for using hormonal contraception?
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smoking and > 35--> increased risk of thrombophlebitis
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what are the indications for endometrial ablation? contraindications?
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Indications
Failed medical therapy Poor surgical risk for hysterectomy Contraindications to medical treatment Bleeding on HRT Contraindications Endometrial hyperplasia (relative) Any gynecologic cancer (absolute) |
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how do you tx massive intractable uterine bleeding inpatient?
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25 mg estogen IV q4h x 24 hours
Follow with 2.5 mg oral estrogen x 25 days adding 10 medroxyprogesterone for last 10 days withdrawal bleed |
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how do you tx intractable uterine bleeding but they are hemodynamically stable?
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OCP taper – 3 pills x 3 days; 2 pills x 3 days; then 1 pill per day; start new pack
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if the pt is desiring pregnancy but is having intractable uterine bleeding, what can you give them?
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Medroxyprogesterone 5-10mg for 2 weeks every month
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what are the two main contraindications for using hormonal contraception?
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smoking and > 35--> increased risk of thrombophlebitis
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what are the indications for endometrial ablation? contraindications?
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Indications
Failed medical therapy Poor surgical risk for hysterectomy Contraindications to medical treatment Bleeding on HRT Contraindications Endometrial hyperplasia (relative) Any gynecologic cancer (absolute) |
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what are the signs and sxs of PCOS?
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Presents at puberty
Obesity Hirsutism Amenorrhea (50%), AUB 30% Insulin resistance |
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What would LH/FSH level look like in someone with PCOS?
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3:1
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what is hyperandrogenism?
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increased androgen secretion from ovarian theca cells
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what other studies will show PCOS besides LH/FSH?
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U/S - Multiple follicular cysts in ovaries
LH/FSH level >= 3/1 Hyperinsulinemia DHEA > 8000 (adrenal tumor) Testosterone > 200 (ovarian tumor) Prolactin (pituitary tumor) 17-hydroxyprogesterone (Congenital adrenal hyperplasia) |
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T/F
in von willebrand's dz, they have a prolonged partial thromboplastin. |
True
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how do you tx PCOS? hirsutism in PCOS? insulin resistance?
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PCOS: cyclic medroxyprogesterone- 10 mg for 10-12 days a month
hirsutism: spironolactone insulin resistance: Metformin |
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what do you give pts w/ PCOS who want to induce ovulation?
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clomiphene
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what two types of bone cells are derived from osteoprogenitor cells? what type of bone cell is derived from a hematopoeitic progenitor cells?
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osteoblasts and osteocytes; Osteoclasts
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what regulates osteoclast formation and function?
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directly or indirectly via paracrine molecular mechanism
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what blocks RANK-RANK-L interaction between the osteoblast and the osteoclast precursor?
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osteoprotegerin
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T/F
Osteoclast cannot be a functioning osteoclast w/o an osteoblast |
TRUE
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what is the histological unit of the bone?
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osteon
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what two types of bone cells are derived from osteoprogenitor cells? what type of bone cell is derived from a hematopoeitic progenitor cells?
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osteoblasts and osteocytes; Osteoclasts
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what regulates osteoclast formation and function?
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directly or indirectly via paracrine molecular mechanism
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what blocks RANK-RANK-L interaction between the osteoblast and the osteoclast precursor?
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osteoprotegerin
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T/F
Osteoclast cannot be a functioning osteoclast w/o an osteoblast |
TRUE
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what is the histological unit of the bone? what is the functional unit of the bone?
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osteon; Basic multicellular UNit (BMU)
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what provides the strength of the bone? what must hydroxyapatite be attached to?
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bone matrix. Hydroxyapatite must be attached to calcium otherwise the bone will be very soft and brittle.
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what are the proteins of bone matrix?
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collagenous protein (osteoblast-derived proteins-90%)
Non-collagenous Proteins (osteocalcin & Alkaline phosphatase) |
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what is a specific serum marker for osteoblast activity?
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osetocalcin & alkaline phosphatase. High AP --> High osteoblast activity.
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what non-collagenous proteins help cell formation and differentiation of bone?
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collagenase Growth factors, cytokines and IL-1, IL-6, and prostaglandins
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T/F
Osteoid tissue in an adult person is a pathology. |
TRUE
in kids and infants it is considered normal. |
