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GYNECOLOGICAL ONCOLOGY . . . CONT.

Pedunculated subserosal

Subserosal

Intramural

Submucosal

Cervical

Pedunculated submucosal

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

Notes

Gynecology 43

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