OB-Chapter 46

what is the most common genital tract malignancy in the US?

-ovarian CA
-uterine CA
-endometrial CA
-adenexal CA

when do most women develop endometrial carcinoma ? (according to the book, pg. 456)

-perimenopausal
-menopausal
-postmenopausal
-A & C

if a 37 y.o. female presents with irregular menses may need what?

-ocp's
-endometrial biopsy
-pelvic ultrasound

what is the most common cause of post menopausal bleeding?

-HRT
-atrophy
-endometrial CA
-polyps
-hyperplasia

what is an abnormal thickening of the uterine lining?

hyperplasia may be a precursor to?

-carcinoma
-endometriosis
-endometritis

estrogen dependent hyperplasia and carcinoma is generally found in women in __ state with unopposed estrogen.

-hypoestrogenic
-hyperestrogenic

what is the basic problem with estrogen dependent hyperplasia and carcinoma?

what is the cause of exogenous, estrogen dependent hyperplasia and CA?

-ERT
-glandular
-extraglandular

what are endogenous causes of estrogen dependent hyperplasia and CA?

-epithelial
-glandular
-extraglanduar
-ERT
-a and c
-b and c

what are the classifications of hyperplasia?

if either a simple or complex hyperplasia returns with atypia, what do you do?

what type of endometrial carcinoma is more common in younger perimenopausal women with a histroy of unopposed endogenous or exogenous estrogen stimulation?

-estrogen dependent
-estrogen independent

what type of endometrial carcinoma occurs spontaneously, characteristically in thin, oler postmenopausal women without unopposed estrogen excess, arising in an atrophic endometrium rather than a hyperplastic one.

-estrogen dependent
-estrogen independent

if a woman has simple hyperplasia without atypia, what does this mean ?

extraglandular unapposed estrogen comes from what peripheral estrogen source (within the body)?

-fat
-liver oxidation
-lymphatics

what is described as "overgrowth of glandular and stromal elements, that rarely progresses to carcinoma unless accompanies by atypia"

-simple hyperplasia
-complex hyperplasia

what hyperplasia is at the greatest risk of CA?

-simple hyperplasia with atypia
-complex hyperplasia w/o atypia
-complex hyperplasia w/ atypia
-simple hyperplasia w/o atypia

what process is described as "proliferation of glandular rather than stromal elements, appear more crowded on histologic slide" is what?

-simple hyperplasia
-complex hyperplasia

what are common risk factors for estrogen dependent hyperplasia and carcinoma?

of the risk factors for estrogen dependent hyperplasia and carcinoma...which is the highest?

-late menopause
-unopposed ERT
-nulliparity
-obesity
-tamoxifen
-DM

which of the following is not a risk factor for estrogen dependent hyperplasia and CA?

-tamoxifen
-nulliparity
-late menopause
-raloxifen

what are other risk factors for estrogen dependent hyperplasia and carcinoma?

what condition is seen in ..."older postmenopausal women with atrophic endometrium and no apparent risks, it is poorly differentiated, and has a poorer prognosis"

-estrogen independent carcinoma
-estrogen dependent carcinoma
-hyperplasia with atypia

if a pt. > age 35 presents with DUB/AUB what is the first test of choice?

-ultrasound
-endometrial biopsy
-pap smear

what is the first diagnostic test you do when evaluating a woman for AUB?

what is the gold standard test for AUB?

-endometrial biopsy
-D & C
-pelvic laparoscopy

if the office EB is not possible or it's findings are inadequate for evaluation, what is the next step?

if the EB in a postmenopausal woman is insufficient for adequate evaluation, what do you do?

what is a more useful diagnostic tool in the evaluation of AUB in the postmenopausal woman?

-EB
-D & C/hysteroscopy
-pelvic ultrasound/transvaginal
-pap smear

pelvic ultrasound w/transvag probe helps in the evaluation of ???

-ovarian cancer
-polyps
-fibroids
-b & c
-all of the above

t/f

pap smear is not reliable in detectin endometrial pathology, however endometrial cells, especially atypical type warrart further evaluation

at what point if a woman is on tamoxifen is it appropriate to do a EB?

what is the management of simple and complex hyperplasia without atypia?

what is the MOA of progesterone therapy in the treatment of hyperplasia w/o atypia?

what is the management of hyperplasia with atypia?

how are many endometrial polyps best seen?

-CT
-ultrasound
-EB

what percent of endometrial polyps are malignant?

-2%
-5%
-7%
-8%

what is the treatment of endometrial polyps?

this is the epidemiology of what condition?
-usually seen in postmenopausal women
-15-20% perimenopausal
-5-10% premenopausal
-80-90% of women w/ this condition present with bleeding

-endometrial ca
-ovarian ca
-cervical ca

__ is "spreads first by local invation through myometrium, endocervical canl, then through lymphatics and then hematogenous spread.

__ invasion of more than 1/3 of uterine wall is consistent with lymphatic dissemination.

-endometrial
-myometrial

endometrioid
villoglandular
secretory
mucinous papillary serous
clear cell
squamous
mixed are all the __ types of endometrial cancer.

what is the most common histological type of endometrial cancer?

-mucinous
-papillary serous
-endometroid

what is the most important prognostic factor?

-depth of invasion of myometrium
-histologic grade

of the histologic grading system, what are they?

what is the primary treatment of endometrial carcinoma?

-chemotherapy
-excision

what surgery is done in the treatment of endometrial CA?

what is the incidence of recurrence at the vaginal apex after a simple hysterectomy?

-2-4%
-5-10%
-10-15%

most patients get lymph node sampling now...of what ?

what is the tx of recurrent endometrial carcinoma?

is hormone replacement therapy indicated in the tx of endometrial ca?