uterine leiomyoma and cancer – Flashcards
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false
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t/f the majority of women with leiomyomas have symptoms
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leiomyoma
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most common indication for a hysterectomy?
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false, but basically true because less than 1% develop into leiomyosarcoma
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t/f a leiomyoma is always benign
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pain, menorrhagia, pressure ..all dependent on size and position of leiomyomata
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symptoms of leiomyoma?
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when a hemorrhage occurs because the fibroid is growing rapidly
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when do you get red degeneration?
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bleeding heavier and longer menstrual flow
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most common presenting symptom of someone with a fibroid?
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greater than 80mL
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menorrhagia definition?
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subserosal, intramural, submucous, pedunculated
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types of fibroids?
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uterus tries to "push" the fibroid through the cervix
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why would someone have a protruding mass through the cervix with a known fibroid?
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firm/hard, irregularly shaped, mobile
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what does a fibroid feel like on physical exam?
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ultrasound, r/o ovarian mass and uterine mass
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best way to confirm suspicion of fibroids?
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younger patient who still wants fertility
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who would be an ideal candidate for a myomectomy to remove their fibroids?
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greater blood loss, slightly more complicated, fibroid can re-occur elsewhere
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risks of myomectomy
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no, not advisable
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t/f it is ok to get prego after having a uterine fibroid embolization
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done having kids, failed other conservative managements
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when do you choose hysterectomy for treatment of fibroids?
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MRI focuses beam of ultrasound waves to heat tissue to cause tissue necrosis-for fibroids
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what is MRI guided ultrasound ablation?
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bedrest,strong analgesics, tocolysis if it causes preterm labor
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if degeneration of fibroid occurs during pregnancy what do you do?
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lol "pregnant with a fibroid", is it a boy or a girl? its a fibroid. ...but yea sllllightly higher chance
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t/f you have a higher chance of miscarriage and preterm labor when you are pregnant with a fibroid
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endometrial cancer
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most common GYN malignancy?
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endometrial cancer
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what is an "estrogen dependent" cancer
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estrogen stimulated overgrowth of the endometrium
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pathophysiology of endometrial cancer?
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glandular (ovary), peripheral (estrone-fat, conversion of androstenedione), tumor
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endogenous sources of estrogen?
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meds
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exogenous sources of estrogen?
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3/4 diagnosed in postmenopausal women
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endometrial cancer is most likely found in what age group?
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6 mo of "unopposed" estrogen
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how do you get endometrial hyperplasia?
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false, 20-30% risk for malignant transformation, needs treatment
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t/f atypical endometrial hyperplasia does not carry any malignant potential
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abnormal bleeding over age 35
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most common indication for histologic eval of endometrial cavity to diagnose hyperplasia?
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provera for 10-12 days per month
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treatment of endometrial hyperplasia with no atypia?
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hysterectomy or mega-dose progestin and periodic sampling- if they dont want surgery
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treatment for endometrial hyperplasia with atypia?
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true
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t/f most endometrial polyps are benign
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bleeding
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most common symptom of endometrial polyps?
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hysteroscopic resection or D&C
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how do you treat endometrial polyps?
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adenocarcinoma
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90% of endometrial cancers are?
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with early disease and good histologic type
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95% 5 year survival for what patients with endometrial cancer?
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hysterectomy and BSO, can use radiation pre or post op depending on stage of CA
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treatment of endometrial cancer?
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false - hysterectomy
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t/f endometrial cancer responds very well to chemo
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recurrent disease
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when is high dose progestin therapy used in endometrial cancer?
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ovaries, fallopian tubes, broad ligament and mesosalpinx, embryonic remnants, non-gyn structures
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what does the adnexa include?
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bowel (divertic), bladder (UTI), ureters (stones), appendix(appendicitis)
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non gyn structures in the adnexa? keep disease of these in your differential
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nope - only during reproductive years (still only 50% are able to be felt)
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should you be able to feel an ovary in premenarche or post menopause?
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3/4 its functional cyts 1/4 non functional- 90% of these benign, 10% malignant
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3/4 of the time ovarian enlargements in reproductive age pts are? 1/4 they are?
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when the normal follicle fails to rupture
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when would you get a functional cyst?
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order a pelvic sono
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if you have a functional cyst over 5cm what should you do?
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serous, mucinous, endometroid, brenner
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epithelial cell neoplasms?
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benign cystic teratoma (dermoid), dysgerminoma
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germ cell neoplasms?
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granulosa, sertoli-leydig
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stromal cell neoplasms?
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benign cystic teratoma (dermoid cyst)
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most common tumor found in all age groups?
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unilateral surgical excision
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how do you treat a dermoid cyst?
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female type-granulosa type-estrogen production (early puberty) male type-sertoli-leydig-androgens-hirsuitism
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benign stromal cell tumors can develop into two types of tumors?
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benign fibroma of the ovary with asictes and right unilateral hydrothorax
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what is meigs syndrome?
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fasle
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t/f a fibroma produces hormones
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ovarian cancer
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highest mortality rate of all gyn cacners?
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low parity, decreased fertility, delayed childbearing
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risk factors for ovarian CA?
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it spreads into peritoneal cavity very easily and doesn't cause symptoms until late stage
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why is ovarian cancer usually caught late stage?
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Ca125-elevated in 80% of epithelial cancers and only in 50% of stage 1 cancers
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tumor marker for ovarian cancer?
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yes
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can Ca125 be elevated in non-malignant conditions?
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no usually unilateral
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t/f a dygerminoma is usually bilateral
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less than 10cm and no other sign of spread
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when do you remove a dygerminoma?
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granulosa cell tumor, can secrete large amts of estrogen
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most common gonadal stromal tumor?
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unilateral oopherectomy
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treatment of a unilateral granulosa cell tumor?
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tumor from other site metastasizing to ovary
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what is a krukenberg tumor?
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bad
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is the prognosis of krukenberg tumors good or bad?
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cystadenocarcinoma
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most common fallopian tube ca?
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post-menopausal bleeding followed by a watery vaginal discharge
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most common complaint of fallopian tube carcinoma?
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when the masses are less than 1 cm
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when is chemo the most effective for ovarian and fallopian tube CA?
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molar pregnancy hydatidiform mole can lead to gestational trophoblastic disease
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disorder derived from abnormal placental proliferation
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no fetus only placental tissue
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what is a complete mole?
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chromosomal abnormal fetus and focal trophoblastic proliferation
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what is a partial mole?
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46XX, empty egg fertilized by 2 sperm...completely dads fault
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genetic composition of a complete mole?
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triploidy, 46XXX- one haploid maternal set and two haploid paternal sets
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genetic composition of partial mole?
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complete mole
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"snowstorm" appearance on sonogram?
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visual disturbances, severe N/V, marked prego induced HTN, clinically Hyperthyroid
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S&s of complete mole?
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nope less common
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t/f bleeding is a common symptom of partial moles?
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sono-basc diagnostic. also quantitative HCG, chest Xray, hemoglobin and hematocrit, type and Rh
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how do you work up a partial mole?
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dilation and suction curettage followed by gentle sharp curettage
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treatment of partial mole?
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bilaterally enlarged cysts caused by over stimulation of Hcg, regresses after molar pregnancy is evacuated
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thecalutein cysts?
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true
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t/f GTN is highly sensitive to chemo
