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    16.uterine Disorders (B.m.a)

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    Jimmy Maina
    1. Endometrial polyps and uterine fibroids are common benign uterine tumors that can cause bleeding. Endometriosis involves endometrial tissue growing outside the uterus which can cause pain and infertility. Adenomyosis involves endometrial tissue invading the uterine wall causing pain and heavy periods. 2. Common uterine cancers include endometrial cancer, usually presenting with postmenopausal bleeding, and cervical cancer, often caused by HPV and presenting with abnormal bleeding. Prevention involves HPV vaccination and regular Pap smears.

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    16.uterine Disorders (B.m.a)

    Uploaded by

    Jimmy Maina
    63 views35 pages
    1. Endometrial polyps and uterine fibroids are common benign uterine tumors that can cause bleeding. Endometriosis involves endometrial tissue growing outside the uterus which can cause pain and infertility. Adenomyosis involves endometrial tissue invading the uterine wall causing pain and heavy periods. 2. Common uterine cancers include endometrial cancer, usually presenting with postmenopausal bleeding, and cervical cancer, often caused by HPV and presenting with abnormal bleeding. Prevention involves HPV vaccination and regular Pap smears.

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    16.UTERINE DISORDERS (B.M.A)

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    1. Endometrial polyps and uterine fibroids are common benign uterine tumors that can cause bleeding. Endometriosis involves endometrial tissue growing outside the uterus which can cause pain and infertility. Adenomyosis involves endometrial tissue invading the uterine wall causing pain and heavy periods. 2. Common uterine cancers include endometrial cancer, usually presenting with postmenopausal bleeding, and cervical cancer, often caused by HPV and presenting with abnormal bleeding. Prevention involves HPV vaccination and regular Pap smears.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views35 pages

    16.uterine Disorders (B.m.a)

    Uploaded by

    Jimmy Maina
    1. Endometrial polyps and uterine fibroids are common benign uterine tumors that can cause bleeding. Endometriosis involves endometrial tissue growing outside the uterus which can cause pain and infertility. Adenomyosis involves endometrial tissue invading the uterine wall causing pain and heavy periods. 2. Common uterine cancers include endometrial cancer, usually presenting with postmenopausal bleeding, and cervical cancer, often caused by HPV and presenting with abnormal bleeding. Prevention involves HPV vaccination and regular Pap smears.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 35

    UTERINE DISORDERS

    1. Endometrial polyps

     Arediscrete outgrowths of endometrium,


    attached by a pedicle
     They may be pedunculated (has stalk) or sessile
    (no stalk)
     Can cause intermenstrual bleeding
     Theyshould be removed in women over the age of
    40, premenopausal and menopausal women.
    2. Uterine fibroids

    A fibroid is a benign tumor of uterine smooth


    muscle
     Also called a leiomyoma or myoma
     They appear as firm, whorled tumor
     Fibroids are estrogen dependent.
    Classification of fibroids

     Based on the location within the layers of the uterus.


    a) Submucous fibroid- located adjacent to and bulging into
    the endometrial cavity
    b) Intramural fibroid- centrally within the myometrium
    c) Subserosal fibroid- at the outer border of the
    myometrium
    d) Pedunculated fibroid- attached to the uterus by a narrow
    pedicle containing blood vessels
    Risk factors

     Nulliparity
     Obesity
     Positive family history
     Race- African
     Olderage- incidence of leiomyomas increases as
    the woman gets older
    Clinical features

     Majority are asymptomatic


     Clinical features include:
     Firm pelvic mass
     Menstrual disturbance
     Pressure symptoms, esp. urinary frequency
    Investigations

     Ultrasound
     Hb- will be low
    Treatment

     Conservative management for asymptomatic


    fibroids
     Gonadotrophin releasing hormone (GRH) agonists
    for heavy menstrual bleeding
     Myomectomy (uterus is preserved) or
    hysterectomy where a bulky fibroid uterus causes
    pressure symptoms
     Uterine artery embolization- involves injection of
    polyvinyl alcohol pellets into the uterine artery
    3. Endometriosis

     Is a condition in which the endometrial tissue lies outside the


    endometrial cavity
     Endometriotic tissue responds to cyclical hormonal changes and
    therefore undergoes cyclical bleeding and local inflammatory reaction
     Repeated bleeding and healing leads to fibrosis
     The cyclical damage causes adhesions between associated organs
    causing pain and infertility.
     Common sites involved include:
     Uterosacral ligaments
     Umbilicus
     Pleural cavity
     Abdominal scars
    Clinical features
     Dysmenorrhea
     Deep dyspareunia- endometriosis in the pouch of
    Douglas
     Lower back pain
     Lower abdominal and pelvic pain
     Infertility
     Local symptoms for distant sites e.g., cyclical
    epistaxis with nasal deposits, cyclical rectal
    bleeding with bowel deposits.
    Investigations

     Transvaginal ultrasound- ovarian endometriosis


     MRI for small lesions in deep tissues
     Laparoscopy
    Management
     It is impossible to guarantee complete cure
     Medical treatment:
     Analgesics- NSAIDS for dysmenorrhea and pelvic pain
     COCs initially for 6 months; if symptoms are relieved,
    continued indefinitely or until pregnancy is desired
     Progestogens e.g., medroxyprogesterone acetate,
    levonorgestrel intrauterine systems (LNG-IUS)
     Gonadotrophin releasing hormone agonists
    Cont’d

     Surgical treatment:
     Conservative surgery- laparoscopic surgery with
    diathermy, laser vaporization or excision
     Definitesurgery- hysterectomy and bilateral
    salpingoophorectomy (removal of ovaries and tubes
    4. Adenomyosis

     Isa condition where endometrial tissue/ glands


    invade the myometrium
     Incidence is highest in women 40-50 years.
    Clinical features

     Severe secondary dysmenorrhea


     Increased menstrual blood loss (menorrhagia)
     Enlarged, firm, and tender uterus
    Investigations

     Ultrasound
     MRI scan- more definitive
    Treatment

     Treatments that induce amenorrhea will relieve


    pain and excessive bleeding e.g., COCs, POPs
     Hysterectomy is the only definitive treatment
    MALIGNANT DISORDERS OF THE UTERUS

    1. Endometrial cancer
    2. Cervical cancer
    1. Endometrial cancer

     Adenocarcinoma is the most common type of cancer


    affecting the uterus
     Staging:

    I. Stage I endometrial cancer: confined to endometrium


    II. Stage II cancer: also involves the cervix
    III. Stage III: reaches the vagina or lymph nodes
    IV. Stage IV: spread to the bowel; or bladder mucosa
    and/ or beyond the pelvis
    Risk factors

     Women in reproductive age


     Nulliparity
     Family history
     Uterine polyps
     Late menopause
     Chronic conditions e.g., DM and HTN
     Tamoxifen
    Clinical manifestations

     Post-menopausal bleeding
     Watery, bloody vaginal discharge
     Low back pain
     Abdominal and low pelvic pain
     Palpable uterine mass or uterine polyp
     Enlarged uterus if the cancer is advanced
    Investigations

     Serum tumor markers to assess for metastasis-


    AFP, CA-125
     Transvaginal ultrasound
     Endometrial biopsy
     Chest X-ray
     MRI of the abdomen and pelvis
     Liver and bone scans
    Management

     Surgical management:
     Stage I disease- total hysterectomy and bilateral
    salpingoophorectomy (removal of uterus, fallopian tubes, and
    ovaries)
     StageII- radical hysterectomy with bilateral pelvic lymph
    node dissection and removal of the upper third of the vagina
     Brachytherapy- prevent disease recurrence
     Chemotherapy- palliative treatment in advance and
    recurrent disease, with distant metastasis
    2. Cervical cancer

     The ectocervix is covered with squamous cells


     The endocervical canal is lined with columnar
    (glandular) cells
     Thesquamocolumnar junction (SCJ) is the
    transformation zone where most cell
    abnormalities occur- because of rapid cell division
     Papanicolaou (PAP) tests sample cells from both
    areas as a screening test for Ca cervix.
    Cervical Intraepithelial Neoplasia (CIN)

     Premalignant changes are described on a


    continuum from atypia (suspicious) to CIN to
    Carcinoma In-Situ (CIS)
     CIS is the most advanced premalignant change
     CIS is cancer that has extended through the full
    thickness of the epithelium of the cervix.
    CIN

     CIN is graded on a scale of 1 to 3 depending on


    the appearance of the cervical tissue under a
    microscope:
    1. CIN 1 (Mild dysplasia): little abnormal tissue
    2. CIN 2 (moderate dysplasia): more tissue appears
    abnormal
    3. CIN 3 (severe dysplasia and CIS): most tissue
    looks abnormal
    Origin

     Most cervical cancers arise from the squamous


    cells on the outside of the cervix.
     Theother cancers arise from the mucus-secreting
    glandular cells (adenocarcinoma) in the
    endocervical canal.
    Spread

     By direct extension to the vaginal mucosa, lower


    uterine segment, parametrium, pelvic wall,
    bladder, and bowel.
     Distantspread can occur through lymphatic
    spread and circulation to the liver, lungs, or
    bones.
    Etiology and risk factors
     Most cases of ca cervix are caused by HPV (Human Papilloma Virus), especially
    strains 16 and 18.
     The risk factors include:
     Girls and young women
     HPV infection
     Multiparity
     HIV/AIDS
     Family history of ca cervix
     Multiple sexual partners
     Early sexual debut (<18 yrs)
     History of STIs
     Obesity
     Intrauterine exposure to DES (Diethylstilbestrol)- synthetic estrogen
    Clinical manifestations

     Pre-invasive cancer is often asymptomatic


     Invasive cancer presents with painless vaginal
    bleeding, spotting between menstrual periods or
    after sexual intercourse.
     Increased vaginal discharge
     Indurated cervix
     Stony hard and enlarged cervix
     Large fungating mass
    Cont’d

     Metastatic disease may present with:


     Unexplained weight loss
     Dysuria

     Rectal bleeding
     Coughing

     Pelvic pain
     Hematuria

     Chest pain
    Diagnosis

     Colposcopy- acetic acid solution (VIA VILLI)


     Endocervical biopsy- for histology
    Management
     Surgery for early disease:
     Loop Electrosurgical Excision Procedure (LEEP)- diagnostic and
    therapeutic procedure
     Laser therapy
     Cryotherapy
     Conization- cone biopsy
     Hysterectomy- total hysterectomy for treatment of microinvasive
    cancer
     Radial hysterectomy and bilateral pelvic lymph node dissection for
    cancer that has extended beyond the cervix (but not pelvic walls)
     Radiotherapy- invasive cervical cancer
     Chemotherapy- adjunctive therapy
    Health promotion for Ca Cervix
     HPV vaccines:
    1. Gardasil- a quadrivalent vaccine against HPV 16, 18, 31, and 38.
    Given to adolescents at 0, 2, and 6 months IM in the deltoid
    muscle
    2. Cervarix- bivalent against HPV 16 and 18. Given 0.5mls at 0, 1,
    and 6 months.
     Girls and young women (9-26 years) should get HPV
    vaccine before their first sexual contact.
     Boys and young men (9-26 Yrs) are also given to prevent
    genital warts (caused by HPV strains 6 and 11) and prevent
    anal cancer (caused by HPV strains 16 and 18).
    Cont’d

     Immunity lasts 10 years, and re-immunization may


    be required.
     Periodic pelvic examinations and Pap tests to
    screen for ca cervix early.
     Screening starts at the ae of 21 years.
     Women between 21-65 years should have a Pap
    smear test every 3 years.

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