GYNECOLOGICAL ONCOLOGY . . . CONT.
Figure 10. Possible Anatomic Locations of Uterine Leiomyomata
Printed with permission from Essentials of Obstetrics and Gynecology. 2nd ed. N.F. Hacker and J.G. Moore (eds.), W.B. Saunders Co., 1992
diagnosis • physical examination • asymmetrically enlarged uterus, mass • ultrasound • hysteroscopy • fractional D&C to rule out uterine cancer treatment • only if symptomatic, rapidly enlarging, large amount of blood loss • treat anemia if present • conservative approach advocated if: • symptoms absent or minimal • tumours < 6-8 cm or stable in size • not submucosal (i.e. submucosal fibroids are more likely to be symptomatic) • virtually all postmenopausal patients would fall into this category • medical approach • GnRH agonist (e.g. leuprolide (Lupron) or danazol (Danocrine) to facilitate surgery (reduces menorrhagia and fibroid size) • antiprostaglandin or OCP therapy for control of pain/bleeding in young patients or in those who do not want surgery • surgical approach • myomectomy (hysteroscopic or transabdominal approach) • abdominal hysterectomy if fibroid > 12 weeks gestational size (i.e. obscures adnexa) and child-bearing completed • embolization of fibroid blood supply (new therapy) • expectant management in pregnancy • never operate on fibroids during pregnancy
Endometrial Carcinoma epidemiology • most common gynecological malignancy (40%) • 1 in 100 women • mean age = 60 years • 20% mortality
MCCQE 2000 Review Notes and Lecture Series