Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
Colposcopy training part 1 ,DR. SHARDA JAIN Dr. Jyoti Agarwal / Dr. Jyoti Bha...Lifecare Centre
Definition used in the consensus guidelines ASCCP +24 organizations 2013
Colposcopy
Colposcopy is the examination of the cervix , vagina and, in some instances the vulva, with the colposcope after the application of a 3--5% acetic solution coupled with obtaining colposcopically – directed biopsies of all lesions suspected of representing neoplasia
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
Management of ovarian masses e Clinical situations & recommendations Apollo Hospitals
Adenexal mass is a common clinical presentation. This clinical situation is a problem that affects women of all ages. The biggest challenge is that one should not miss out on a diagnosis of malignant ovarian tumor. An ovarian mass or cyst that raises the suspicion of malignancy is a common dilemma in a gynecological practice. In the United States, a woman has a 5-10% lifetime risk of undergoing surgery for a suspected ovarian neoplasm and an estimated 13e21% chance of this turning into a diagnosis of ovarian cancer. Most of the adnexal masses are benign but the first responsibility of the treating gynecologist is to exclude malignancy. Management decisions often are influenced by the age and family history and presentation of the patient.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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 ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ocular injury ppt Upendra pal optometrist upums saifai etawah
SCREENING ENDOMETRIAL CANCER-OSAMA WARDA
1.
Early
detection
of
Endometrial
Cancer
Osama M Warda MD
Prof. OBS/GYNE
Mansoura University
2. Epidemiology
According to ACS 2015:
O Endometrial cancer: most common female pelvic genital
cancer .
O The life time risk of developing it is 2.4% (In USA).
(No recent available statistics in EGYPT)
O Age: - Peak incidence in the 6th & 7th decade of life
- Only 2-5% occur before 40 years.
O Higher survival rate due to early diagnosis ( 75%
diagnosed in Stage I).
O Estrogen has been implicated as a causative factor.
osama warda 2
3. O Endometrial hyperplasia is the precursor of
endometrial cancer which is the most common
gynecological malignancy in the Western world .
O The incidence of endometrial hyperplasia is
estimated to be at least three times higher than
endometrial cancer.
(GTG 67: feb 2016))
osama warda 3
4. 1- increased body mass index (BMI) ; with excessive
peripheral conversion of androgens in adipose tissue to
estrogen;
2- Anovulation associated with the peri-menopause or
polycystic ovary syndrome (PCOS)
3- Estrogen-secreting ovarian tumors, e.g. granulosa
cell tumors (with up to 40% prevalence of endometrial
hyperplasia);
4- drug-induced endometrial stimulation, e.g. the
use of systemic ERT or long-term tamoxifen
osama warda 4
5. Risk
Factors
OLD AUNT:
Obesity
Late menopause
Diabetes mellitus
Another cancer; ovary, endometrium, colon
Unopposed estrogen
Tamoxifen prolonged use
osama warda 5
6. Early
detection/screening
(NCI-‐USA)
Transvaginal Ultrasound
O Benefits: There is no evidence that
screening by ultrasonography reduces
mortality from endometrial cancer. Most
cases of endometrial cancer (85%) are
diagnosed at low stage because of
symptoms, and survival rates are high.
osama warda 6
7. Early
detection/screening
(NCI-‐USA)
Transvaginal Ultrasound
O Harms: Based on solid evidence,
screening asymptomatic women will result in
unnecessary additional biopsies because of
false-positive test results. Risks associated
with false-positive tests include anxiety and
complications from biopsies.
osama warda 7
8. Early
detection/screening
(NCI-‐USA)
Endometrial Sampling (Biopsy)
O Benefits: There is inadequate evidence that
screening by endometrial sampling (i.e.,
biopsy) reduces mortality from
endometrial cancer. Most cases of
endometrial cancer (85%) are diagnosed
at low stage because of symptoms, and
survival rates are high.
osama warda 8
9. Early
detection/screening
(NCI-‐USA)
Endometrial Sampling (Biopsy)
O Harms: Based on solid evidence,
endometrial biopsy may result in
discomfort, bleeding, infection,
and rarely, uterine perforation.
osama warda 9
10. Early
detection/screening
(ACS
2015)
O There is no standard or routine screening test
for women at average risk.
O Most cases (68%) are diagnosed at an early
stage because of postmenopausal bleeding.
O Women are encouraged to report any
unexpected bleeding or spotting to their
physicians.
osama warda 10
11. Early
detection/screening
(ACS
2015)
O ACS recommends that at the time of menopause, ALL
women should be told about the risks and symptoms
of endometrial cancer. Women should report any
unexpected vaginal bleeding or spotting to their
doctors.
O ACS recommends that women with known or
suspected Lynch syndrome be offered annual
screening with endometrial biopsy and/or trans-
vaginal ultrasound beginning at age 35.
osama warda 11
13. it is irregular proliferation of the
endometrial glands with an increase
in the gland to stroma ratio when
compared with proliferative
endometrium.
osama warda 13
14. 1- Endometrial hyperplasia develops when
estrogen, unopposed by progesterone, stimulates
endometrial cell growth by binding to estrogen
receptors in the nuclei of endometrial cells.
2- other elements such as immunosuppression
and infection may also be involved.
osama warda 14
15. O The most common presentation of endometrial
hyperplasia is abnormal uterine bleeding; includes
- heavy menstrual bleeding,
-inter-menstrual bleeding,
- irregular bleeding,
- unscheduled bleeding on HRT
- postmenopausal bleeding
osama warda 15
16. Classification
- WHO 1994 :
(i) simple hyperplasia,
(ii) complex hyperplasia,
(iii) Simple hyperplasia with atypia and
(iv) complex hyperplasia with atypia.
The association of cytological atypia with an increased
risk of endometrial cancer has been known since 1985.
osama warda 16
17. Classification
Endometrial intraepithelial neoplasia (EIN)
classification (2003): NOT popular
The EIN diagnostic schema comprises 3
Categories :
1-benign (endometrial hyperplasia),
2- premalignant (a diagnosis of EIN based upon
five subjective histological criteria) and
3- malignant (endometrial cancer)
osama warda 17
18. Classification
The 2014 revised WHO classification:
- Simply separates endometrial hyperplasia into 2
groups based upon the presence or absence of
cytological atypia, (i) hyperplasia without atypia and
(ii) atypical hyperplasia;
- The complexity of architecture is no longer part of the
Classification.
osama warda 18
19. [D]
The revised 2014 WHO classification
of endometrial hyperplasia is
recommended.
osama warda 19
22. Diagnosis
O Histological examination via outpatient endometrial
sampling [B]
O Diagnostic hysteroscopy should be considered if
biopsy failed or non diagnostic, or endometrial
hyperplasia has been diagnosed within a polyp or
other discrete focal lesion. þ
O Trans-vaginal ultrasound may have a role in diagnosing
endometrial hyperplasia in pre- and postmenopausal
women. þ
osama warda 22
23. Diagnosis
There is insufficient evidence
evaluating (CT), (MRI) or biomarkers
as aids in the management of
endometrial hyperplasia and their use
is not routinely recommended. [B]
osama warda 23
25. E
H
without
a
t
y
p
ia
Initial
counseling
- Women should be informed that the risk of EH without
atypia progressing to endometrial cancer is less than
5% over 20 years and that the majority of cases of
endometrial hyperplasia without atypia will regress
spontaneously during follow-up. [B]
-Reversible risk factors such as obesity and the use of
HRT should be identified and addressed if possible. þ
osama warda 25
26. E
H
without
a
t
y
p
ia
initial
counseling
Observation alone with follow-up endometrial biopsies to
ensure disease regression can be considered,
especially when identifiable risk factors can be reversed.
However, women should be informed that
treatment with progestogens has a higher disease
regression rate compared with observation alone.
[C]
osama warda 26
27. E
H
without
a
t
y
p
ia
Medical
treatment;
is indicated in women who fail to
regress following observation alone
and in symptomatic women with
abnormal uterine bleeding þ
osama warda 27
28. EH
without
atypia
Medical
treatment;
- Progestogens ; Both continuous oral
and local intrauterine (levonorgestrel-
releasing intrauterine system [LNG-IUS])
are effective in achieving regression
of endometrial hyperplasia without
atypia [A]
- osama warda 28
29. EH
without
atypia
Medical
treatment;
- The LNG-IUS should be the first-line
medical treatment because compared
with oral progestogens it has a higher
disease regression rate with a more
favorable bleeding profile and it is
associated with fewer side effects. [A]
osama warda 29
30. EH
without
atypia
Medical
Treatment
Continuous progestogens should
be used (medroxy-progesterone
10–20 mg/day or norethisterone
10–15 mg/day) for women who
decline the LNG-IUS. [B]
osama warda 30
31. EH
without
atypia
Medical
Treatment
Cyclical progestogens should not
be used because they are less
effective in inducing regression of
EH without atypia compared with
continuous oral progestogens or
the LNG-IUS [A]
osama warda 31
32. EH
without
atypia
Duration
of
treatment
and
follow
up
O Treatment with oral progestogens or
the LNG-IUS should be for a
minimum of 6 months in order to
induce histological regression of
endometrial hyperplasia without
atypia. [B]
osama warda 32
33. EH
without
atypia
Duration
of
treatment
and
follow
up
If adverse effects are tolerable and
fertility is not desired, women should
be encouraged to retain the LNG-IUS
for up to 5 years as this reduces the
risk of relapse, especially if it
alleviates abnormal uterine bleeding
symptoms. þ
osama warda 33
34. EH
without
atypia
Duration
of
treatment
and
follow
up
O Outpatient endometrial biopsy is
recommended after a diagnosis of
hyperplasia without atypia. [C]
O Endometrial surveillance should be arranged
at a minimum of 6-monthly intervals. At least
two consecutive 6-monthly negative biopsies
should be obtained prior to discharge. [D]
osama warda 34
35. EH
without
atypia
Duration
of
treatment
and
follow
up
In women at higher risk of relapse, such as
women with a BMI of ≥ 35 or those treated
with oral progestogens, 6-monthly endometrial
biopsies are recommended. Once two
consecutive negative endometrial biopsies
have been obtained then long-term follow-up
should be considered with annual endometrial
biopsies [D]
osama warda 35
36. EH
without
atypia
Surgical
management
O Hysterectomy should not be considered as a first-line treatment
for hyperplasia without atypia as most cases respond to
progestogens [C]
O Hysterectomy is indicated in women not wanting to preserve
their fertility when: [C]
(1) progression to atypical hyperplasia occurs during follow-up,
(2) no histological regression of hyperplasia in 12 ms. treatment,
(3) there is relapse of endometrial hyperplasia after treatment
(4) persistence of bleeding symptoms,
(5) the woman not compliant to progestogen or follow-up .
osama warda 36
37. EH
without
atypia
Surgical
management
O Postmenopausal women ; should be offered a bilateral
salpingo-oophorectomy together with total
hysterectomy. þ
O For pre-menopausal women, the decision to remove the
ovaries should be individualised; however, bilateral
salpingectomy should be considered as this may
reduce the risk of a future ovarian malignancy. [D]
osama warda 37
38. EH
without
atypia
Surgical
management
O Endometrial ablation is not recommended for the
treatment of endometrial hyperplasia because:
- complete endometrial destruction not ensured
- resulting adhesion perclude future endometrial
surveillance [D]
osama warda 38
39. EH
with
Atypia
Surgical
management
A laparoscopic approach to total
hysterectomy is preferable to an
abdominal approach as it is
associated with a shorter hospital
stay, less postoperative pain and
quicker recovery. [B]
osama warda 39
40. EH
with
Atypia
Surgical
management
O No benefit from intraoperative frozen section analysis
of the endometrium or routine lymphadectomy. [C]
O Post-menopausal women with atypical hyperplasia
should be offered bilateral salpingo-oophorectomy
together with the total hysterectomy. þ
osama warda 40
41. EH
with
Atypia
Surgical
management
O For premenopausal women, the decision to remove
the ovaries should be individualized; however,
bilateral salpingectomy should be considered as this
may reduce the risk of a future ovarian malignancy. [D]
O Endometrial ablation is not recommended because of
the same reasons mentioned before. [C]
osama warda 41
42. EH
with
Atypia
women
wishing
fertility
or
unsuitable
for
surgery
MANAGEMENT
O Should be counseled about the risks of underlying
malignancy & subsequent progression to endometrial
cancer. þ
O Pretreatment investigations should aim to rule out
invasive endometrial cancer or co-existing ovarian
cancer. þ
osama warda 42
43. Special
cases
O Women wishing fertility or unsuitable for
surgery.
O EH & fertility management
O EH & HRT
O EH- in women on adjuvant treatment for
breast cancer
osama warda 43
44. EH
with
Atypia
Women
wishing
fertility
or
unsuitable
for
surgery
MANAGGEMENT
O First-line treatment with the LNG-IUS should be
recommended, with oral progestogens as a second-
best alternative . [B]
O Once fertility is no longer required, hysterectomy should
be offered in view of the high risk of relapse. [B]
osama warda 44
45.
EH
with
Atypia
Women
Not
undergoing
hysterectomy
FOLLOW
UP
O Routine endometrial biopsies every 3 month until 2
consecutive negative endometrial biopsies obtained [D]
O For asymptomatic women with 2 negative endometrial
biopsies --- Long term follow up with 6-12 months
biopsy until hysterectomy is performed þ
osama warda 45
46. EH
and
fertility
management
O Disease regression should be achieved on at least one
endometrial sample before women attempt to conceive. þ
O Assisted reproduction may be considered as the live birth rate is
higher and it may prevent relapse compared with women who
attempt natural conception. [C]
O Regression of endometrial hyperplasia should be achieved before
ARTas this is associated with higher implantation and clinical
pregnancy rates. [B]
osama warda 46
47. EH
and
HRT
O Systemic estrogen-only HRT should not be used in women
with a uterus. [A]
O All women taking HRT should be encouraged to report any
unscheduled vaginal bleeding promptly. !
O women on sequential HRT preparation and
wishing to continue HRT are advised to shift to
LNG-IUS or a continuous combined HRT
preparation [B]
osama warda 47
48. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
O Women taking tamoxifen should be informed about the
increased risks of developing endometrial hyperplasia and
cancer. They should be encouraged to report any abnormal
vaginal bleeding or discharge promptly. [D]
O Women taking aromatase inhibitors (such as anastrozole,
exemestane and letrozole) should be informed that these
medications are not known to increase the risk of endometrial
hyperplasia and cancer. þ
osama warda 48
49. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
There is evidence that the LNG-IUS prevents
polyp formation and that it reduces the
incidence of endometrial hyperplasia in women
on tamoxifen. The effect of the LNG-IUS on
breast cancer recurrence risk remains uncertain
so its routine use cannot be recommended.
[A]
osama warda 49
50. EH-‐
in
women
on
adjuvant
treatment
for
breast
cancer
O Endometrial hyperplasia confined to an
endometrial polyp, complete removal of uterine
polyp (s) is recommended & endometrial biopsy
should be obtained to sample the background
endometrium [D]
O Subsequent management according to the
histological classification of EH þ
osama warda 50