The document discusses endometrial hyperplasia and endometrial cancer. It defines endometrial hyperplasia as a spectrum of abnormalities in the endometrial glands and stroma that can progress to cancer. Risk factors for hyperplasia and cancer include unopposed estrogen stimulation and obesity. Diagnosis involves endometrial biopsy and dilation and curettage. Most cases of endometrial cancer are endometrioid adenocarcinomas found in postmenopausal women presenting with abnormal bleeding. Treatment involves surgery, radiation therapy, and systemic therapy.
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A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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It’s work is regulated by androgens which are responsible for male sex characteristics
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
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A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
1. ENDOMETRIAL
HYPERPLASIA AND
MALIGNANT DS OF THE
CORPUS
1
DR. SWATI SINGH
CONSULTANT
DEPARTMENT OF OBS. AND GYN
2. ENDOMETRIAL HYPERPLASIA
• Represent a spectrum of morphologic and
biologic alterations of the endometrial glands
and stroma, ranging from an exaggerated
physiologic state to carcinoma in situ.
• Usually evolve as a result of estrogen
stimulation
• Usually occurs when a patient is exposed to
unopposed estrogen, i;e in the absence of
progestin influence.
• Precede or occur simultaneously with
endometrial ca.
2
4. PROTECTIVE FACTOR
• Multiparity
• Normal weight
• Combined oral contraceptives
• Progesterone therapy
• Menopause <49 years of age
4
5. Endometrial Hyperplasia
• Complex hyperplasia with atypia
– One study found incidence of concomitant
endometrial cancer in 40% of cases
– Hysterectomy or high dose progestin tx
• Simple
– Often regress spontaneously
– Progestin treatment used for treating
bleeding may help in treating hyperplasia as
well
7. MMaannaaggeemmeenntt:
• Progestin therapy
effective in -- endometrial hyperplasia without atypia less
effective -- endometrial hyperplasia with atypia.
EEnnddoommeettrriiaall hhyyppeerrppllaassiiaa wwiitthhoouutt aattyyppiiaa:
cyclical progestin therapy (MPA 10—20 mg/d for 14 d/mth) or
continuous progestin therapy (megestrol acetate 20—40 mg/d )
for 6 months.
CCoommpplleexx oorr aattyyppiiccaall hhyyppeerrppllaassiiaa :
continuous progestin– MPA 200 mg/day or megestrol acetate 40-160
mg/d. Therapy given for 9 mth
Hysterectomy --Women with atypical complex hyperplasia who do
not desire fertility.
7
8. • Endometrial Biopsy should be performed 3—4
wk after completion of therapy to assess
response.
• Atypical hyperplasia treated with
progesterone, periodic Endometrial Biopsy or
TVS is advisable because of presence of
undiagnosed cancer in 25% cases, 29%
progression to cancer and high recurrence
rate.
8
10. Incidence
• Most common gynecological cancer in US.
• Higher in US. Due increased life expectancy
and injudicious use of oestrogen in post
menopausal women
• incidence 1.8 / 10000.
• In Nigeria - 3 cases/year.
• More common between age of 50-60 years.
• Most commonly inherited gynecologic
malignancy.
10
11. RISK FACTORS
IInnccrreeaasseedd rriisskk:
1) Age : 75% are postmenopausal with median age
of 60 years. Incidence increases until about 70
yr
2) Higher socioeconomic status.
3) Higher level of education.
4) Higher among whites than African Americans.
5) Reproductive factors:
nulliparous women have 2—3 times the risk of
parous women.
Infertility and a history of menstrual
abnormalities due to anovulatory cycles
increase the risk. 11
12. 6) Early menarche.
7) Late menopause
8) CORPUS CANCER SYNDROME
Obesity : RR is 2 times if 5-10 kg overweight
and risk rises to 10 times if overweight by 25
kgs.
Diabetes : increases the risk by 1.8 to 2.3
times.
Hypertension.
9) Unopposed estrogen stimulation :
anovulatory disorders: e.g. PCOS
Estrogen producing tm: granulosa
theca cell tm.
Estrogen replacement therapy: inc risk
4-8 times.
12
13. 11) Tamoxifen use : 3-6 fold increased risk. Poor
prognosis
12) HNPCC ( hereditary nonpolyposis colon cancer
syndrome) : inactivation of DNA mismatch repair
genes.
40—60 % lifetime risk of endometrial ca.
13) Family history.
13
14. DDEECCRREEAASSEEDD RRIISSKK
1) Oral contraceptive use: 12 mths of use
decreases risk by 40% and effect persists
for at least 15 yr after the cessation of use.
2) Phytoestrogens.
3) Physical activity.
4) Cigarette smoking.
5) Nonmedicated plastic or copper IUD.
6) Effect of progesterone containing IUDs is
unknown.
14
16. PATHOLOGY
• GGRROOSSSS: uterus small, normal or large in size
due to myohyperplasia, myometrial
involvement, pyometra or associated fibroids
• GGRROOWWTTHH:
1) Localised polyp (friable) with ulceration
and necrosis usually at the fundus
2) Diffuse: spread to myometrium & serosa,
also to the cervix
16
17. CLINICAL FEATURES
PPAATTIIEENNTT PPRROOFFIILLEE:: usually nulliparous, postmenopausal
or h/o delayed menopause; Younger women with PCOD,
infertility, obese, hypertensive & diabetic.
SSYYMMPPTTOOMMSS::
• 90% of patients with ca endometrium present with PMB
or abnormal vaginal bleeding.
• 10% of pt with postmenopausal bleeding have Ca
endometrium.
• Watery & offensive or purulent discharge due to
pyometra,
17
18. SSIIGGNNSS::
• GPE:
pt is usually obese, hypertensive.
Pallor +
LAP – supraclavicular, axillary, inguinal.
breasts examination.
• P/A
There may be ascites.
Abdominal lump due to pyometra, fibroid.
Hepatomegaly.
• P/S: Cx usually healthy. May be bloody or
purulent discharge through ext os.
18
19. BBiimmaannuuaall eexxaammiinnaattiioonn::
Size of the uterus: small, normal or large, usually
mobile. In advanced cases it is fixed and irregular.
Adnexae : mass in case of simultaneous tumour or
secondary growth in ovary.
Parametrium : for induration.
Cul-de-sac : for nodularity.
RReeccttaall eexxaammiinnaattiioonn
19
20. DIAGNOSIS
• Nearly 75% of cases of Ca endometrium
are seen in postmenopausal women and
most common symptom is PMB. All
women in peri and postmenopausal
period with AUB must be investigated
although only about 20% of PMB is due
to malignancy.
20
23. • a Office Endometrial assppiirraattiioonn bbiiooppssyy : first step .
• PIPELLE
• Endorette
• Tao brush
• I-sac cell sampler
• Gravele jet washer
• Vabra aspirator
sensitivity for
atypical hyperplasia - 81%
Ca endometrium - 99.6%
Specificity for hyperplasia or malignancy - 98%
A Pap test is unreliable as only 30 – 50% pt with
ca endometrium have abnormal Pap test results.
23
24. DDiillaattaattiioonn aanndd ccuurreettttaaggee : Gold standard
for endometrial sampling. It is
indicated:
• inadequate sample by aspiration biopsy
• Cervical stenosis or patient intolerance
does not permit adequate evaluation.
• Bleeding recurs after a negative
endometrial biopsy.
false negative : 10%
24
25. Hysteroscopy wwiitthh ccuurreettttaaggee::
• Safe, reliable and quick office procedure. Provides
inspection of endometrial features like colour,
vascularity, thickness and necrotic areas or growths.
• Excellent method for targeted biopsy that one may
miss at D n C or endometrial aspiration.
• Combined use of hysteroscopy and histopathology
gives 100% accuracy.
• Identification of other uterine pathology as polyps,
submucous myomas.
• Pts undergoing hysteroscopy more likely to have
positive peritoneal washings.
25
28. SPREAD
• Direct
• Lymphatic
• Blood borne
Direct : slow growing. Infiltrates the
myometrium, serosa, parametrium & to the
cervix (15%).
Lymphatic: usually late.
Three separate lymphatic pathways:
a) Paracervical and Parametrial – pelvic LN
b) Ovarian – paraaortic LN
c) round ligament –inguinal LN
28
30. SURGICAL STAGING
Increased inaccuracy of clinical staging and the
importance of prognostic factors some of which can be
identified only surgically resulted in introduction of
surgicopathologic staging in 1988.
– Better defines extent of disease (metastases, depth
of invasion, cervix involvement, etc.)
– Minimizes over/under treatment
– Minimally increases perioperative
morbidity/mortality
– Decreases overall Rx risks and costs
– Better allows comparison of therapeutic results
30
31. REVISED FIGO STAGING (2010)
STAGE I: Tumour confined to the corpus uteri
Ia: No or less than half myometrial invasion
Ib: Invasion equal to or more than half of myometrium
Stage II: Cervical stromal invasion but not beyond the uterus
Stage III: Local and/or regional spread of the tumour
IIIa: Tumour invades the serosa of the corpus uteri and/or
adnexa
IIIb: Vaginal and/or parametrial involvement
IIIc: Metastases to pelvic and /or paraaortic lymph nodes
Stage IV: Tumour invades bladder and/or bowel mucosa, and/or
distant metastases
IVa: Tumour invasion of bladder and/or bowel mucosa
IVb: Distant metastases, including abdominal metastases
and/or inguinal lymph nodes
31
33. TREATMENT
• SSUURRGGEERRYY
• RRAADDIIAATTIIOONN TTHHEERRAAPPYY
• SSYYSSTTEEMMIICC TTHHEERRAAPPYY
Treatment is essentialy surgical with postoperative
adjuvant therapy added when unfavourable prognostic
features are found at surgery .
33
34. MMOODDEESS OOFF SSUURRGGEERRYY
Abdominal
Vaginal
Laproscopic
Laprotomy has been the principal surgical approach to
hysterectomy and surgical staging for Ca endometrium.
ABDOMINAL HYSTERECTOMY (LAPAROTOMY):
a) extrafascial
b) Radical
Includes:
thorough exploration of peritoneal contents, pelvic washings,
hysterectomy, BSO, B/L pelvic and paraaortic LN
dissection.
• The uterine specimen should be opened in the perating room
and Tumor size, Depth of myometrial involvement, and
34
cervical extension assessed.
36. Treatment according to clinical staging
STAGE I:
Surgery is the mainstay of treatment.
• Extrafascial hysterectomy with B/l salpingo-oopherectomy
+/- LN node sampling.
• Vaginal hysterectomy in selected cases
• LAVH
Post op vaginal cuff irradiation is given in Ia G3 and Ib
G123.
Primary RT in pts with co-morbidities not fit for surgery.
36
37. Stage II
Two approaches
a) Radical hysterectomy , Bilateral salpingo-oopherectomy,
and pelvic and para-aortic
lympnadenectomy followed by pelvic and vaginal
cuff irradiation.
Radical hysterectomy does not improve pts survival
and often increases morbidity.
b) Combined radiation and surgery: external pelvic
irradiation and intracavitary radium or cesium
followed in 6 wk by TAH and BSO.
Primary surgery f/b post op irradiation is preffered
to pre op irradiation as more accurate surical
taging of the disease is possible. 37
38. Stage III and IV : treatment should be
individualised.
RT, chemotherapy, hormonal therapy or surgery
alone or combination of all these are the Rx
modalities available for the advanced tumours.
A recent GOG trial has demonstrated,
chemotherapy with doxorubicin and cisplatin is
superior to whole abdominal RT.
Combination chemotherapy
• doxorubicain and cisplatin
• Cyclophosphamide, doxorubicain and cisplatin
• Paclitaxel and cisplatin with or without doxorubicin.
38
39. Hormonal therapy is also an option for advanced
stage disease. Especially if hormone receptor
positive tumours.
MPA 400mg IM weekly or oral 150 mg/ day
or megestrol acetate 160 mg/ day.
If there is an objective response the progestin
therapy can be continued indefinitely.
Complete remission of lung metastasis has also
been seen with progestin alone.
Tamoxifen and progesterone – no added benefit.
39
40. • Surgery should be performed to determine
the extent of disease and to remove the bulk
of disease if possible.
• Goal of surgery is eradication of macroscopic
disease.
• Postoperative therapy can be tailored
according to the extent of disease.
• Positive impact of cytoreductive surgery on
survival. ( 3 times greater)
40
42. FFOOLLLLOOWW UUPP
• Education of pts regarding symptoms of recurrence.
• Every 3-4 mths during the first 2 yrs and every 6 mths
thereafter.
• History.
• Physical examination.
• Routine surveillance with pap testing and CXR can not
currently be recommended.
• Serial CA 125 in patients with papillary serous
carcinoma.
42