Surgery Uterus

Question 1

third most common genital tract malignancy

Answer 1

endometrial ca

Question 2

risk factors for endometrial ca

Answer 2

• estrogen excess / unopposed estrogen
• early menarche
• nulliparity, infertility, pcos
• obesity
• diabetes
• tamoxifen
• lynch and cowden syndrome

Question 3

protective factors for endometrial ca

Answer 3

• estrogen-progestin oc
• at least 3 mos breastfeeding
• childbearing at older age
• smoking
• exercise
• coffee and green tea

Question 4

s/sx for endometrial ca

Answer 4

• heavy menstrual bleeding
• vaginal discharge
• postmenopausal with endometrial cells on pap smear
• premenopausal with atypical glandular cells on pap smear
• pelvic pressure and discomfort (late stage)

Question 5

indications for endometrial biopsy

Answer 5

• postmenopausal bleeding
• premenopausal: persistent abnormal bleeding with history of chronic anovulation
• hormone therapy with bleeding
• tamoxifen w bleeding
• > 35 yo with atypical endometrial cells on pap smear

Question 6

most common cause of bleeding in postmenopausal women

Answer 6

atrophy

Question 7

for patient with initial postmenopausal bleeding you can __

Answer 7

• transvaginal uts then endometrial sampling
• directly endometrial sampling

if there’s only one test, do endometrial sampling

Question 8

t/f any vaginal bleeding in postmenopausal woman requires assessment to exclude malignancy

Answer 8

true, can be assessed with endometrial biopsy or transvaginal ultrasonography

Question 9

t/f for pts with endometrial thickness less/= 4 mm, you need to do endometrial biopsy

Answer 9

false, 1 in 917 is low risk

Question 10

t/f for pts with emt >4 mm, endometrial sampling is required

Answer 10

true

Question 11

t/f recurrent bleeding always required further evaluation with endometrial sampling

Answer 11

true, even if emt is thin

Question 12

t/f ultrasound measurement of endometrial thickness in premenopausal women is required

Answer 12

false, has no diagnostic value

Question 13

decision to evaluate endometrium in below 45 yo is based on__

Answer 13

symptoms, risk factors, and clinical presentation

Question 14

t/f women with pcos have a 3 fold increased risk and 9% lifetime risk for endometrial ca

Answer 14

true

Question 15

indications for endometrial sampling in premenomausal women

Answer 15

• persistent abnormal bleeding
• hx of pcos/ chronic anovulation
• thickened endometrium on uts

Question 16

t/f for pts on hormone therapy with bleeding, endometrial sampling can be done without uts

Answer 16

true, thickness doesnt matter

Question 17

primary therapeutic effect of tamoxifen

Answer 17

antiestrogen, rr is 2-3x higher

Question 18

t/f asymptomatic women on tamoxifen should undergo routine screening

Answer 18

false, only biopsy if they bleed

Question 19

correlation between emt and abnormal pathology in asymptomatic tamoxifen users is poor because of __

Answer 19

tamoxifen induced subepithelial stromal hypertrophy

Question 20

management for pre vs post menopausal women taking tamoxifen

Answer 20

premenopausal: routine gyne care and watch for bleeding

post meno: monitor for bleeding more often

Question 21

normal histo in cervix

Answer 21

squamous cells

Question 22

if patient has atypical endometrial cells at pap smear do ___

Answer 22

endometrial and endocervical sampling

if no pathology, do colposcopy

Question 23

if patient has glandular cells (regardless of hpv result) on pap smear do __

Answer 23

colposcopy with ecc

if more/= 35 yo or <35 or at risk for endometrial neoplasia, do endometrial biopsy

Question 24

first step when suspecting endometrial pathology is ___

Answer 24

endometrial biopsy

Question 25

gold standard for endometrial ca diagnosis

Answer 25

hysteroscopic guided endometrial biopsy

Question 26

t/f d&c > hysteroscopic guided d&c

Answer 26

false

Question 27

indication for d&c

Answer 27

• if under anesthesia and hysteroscopy is not available
• pt cannot afford hysteroscopy
• can scrape entire uterine cavity even if blind

Question 28

2009 figo stading for endometrial ca

Answer 28

IA no invasion or less than half myometrial invasion
IB more/= to hald of myometrium
II invades cervical stroma but does not extend beyond uterus
IIIA invades serosa and/or adnexa
IIIB vaginal metastases
IIIC1 pelvic ln
IIIC2 para-aortic ln
IVA bladder and/or bowel mucosa
IVB distant metastases

Question 29

management for endometrial ca

Answer 29

primary surgical approach: peritoneal fluid cytology, extrafascial hysterectomy with bilateral salpingooophorectomy, pelvic and paraaortic lymphadenectomy

adjuvant: radio, chemo, hormonal

Question 30

t/f molecular profile of a tumor may better define prognosis and response to treatment

Answer 30

true

pts can have same stage but different responses to tx