Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Post-menopausal bleeding should prompt referral for investigation as endometrial carcinoma is a possible diagnosis. It arises from glandular endometrium which has been subjected to oestrogen without opposing progesterone. Risk factors therefore reflect states of increased exposure to oestrogen, such as obesity, nulliparity and late menopause. Other than post-menopausal bleeding, endometrial carcinoma may present as abnormal glandular cells on routine cervical smear tests. Tumours arise in the uterine endometrium and grow into the myometrium, cervix, vagina or peritoneum. Diagnosis is aided by transvaginal ultrasound, which reveals thickened endometrium. Endometrial sampling is then used to obtain tissue for a histological diagnosis. Should tissue be insufficient from endometrial sampling, hysteroscopy, dilatation and curettage can be used to obtain tissue. Treatment depends on the stage, with cancer localised to the uterus and cervix amenable to radical hysterectomy. More advanced tumours can be treated with pre-operative/post-operative radiotherapy, or radium brachytherapy. High-dose progesterone can be used to downstage a tumour. Extension outside the pelvis may be treated with systemic chemotherapy.
Peripheral Neuropathies of the Lower Urinary Tract Following Pelvic Surgery and Radiation Therapy
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
Lower urinary tract dysfunction is the most common long-term side effect of radical hysterectomy for cervical and uterine malignancy, with rates of 8%–80% depending on the limits of dissection.13–15 Urodynamic evaluation has shown rates of poor compliance, mixed urinary incontinence, and stress urinary incontinence to be present in 35%, 17%, and 38% percent of patients one year following surgery.13 While patients may not develop complete retention, due to a decrease in midurethral closure pressure, patients may exhibit elevated residuals with decreased urinary flow 2–12 weeks following surgery due to parasympathetic injury to the pelvic splanchnic nerve as well as pudendal nerve injury.16 The onset of post-operative stress urinary incontinence in some patients may be related to destruction of bladder neck support, but also to sympathetic nerve injury to the end branches as they leave the inferior hypogastric plexus.13,15 The development of nerve sparing approaches has led to a reduction in post-operative urinary dysfunction; patients who undergo non-nerve sparing radical hysterectomy have an increased odds ratio of 3.4 for developing poor bladder compliance in one study by Oda et al, which is aligned with single center reports.13 Minimally invasive approaches have also showed some promise in allowing greater magnification of pelvic nerves with improved nerve sparing and post-operative voiding function.13
The Problem of Rising Healthcare Costs and Spending
Kant Patel, Mark Rushefsky in Healthcare Politics and Policy in America, 2019
Data suggest that price is, indeed, a major cost driver in the US. Here are some examples of prices of medical procedures in 2014 (Kamal and Cox 2018). An angioplasty cost over $78,000 in the US compared to about $34,000 in Switzerland. A cesarean-section birth costs, on average, over $16,000 in the US compared to just under $10,000 in Switzerland. An average MRI costs $1,119 in the US compared to $788 in Great Britain. The average price for an appendectomy in the US was nearly $16,000 compared to just over $8,000 in Great Britain. The average knee replacement surgery costs over $28,000 in the US compared to just over $20,000 in Great Britain. The average hip replacement surgery costs just over $29,000 in the US compared to over $19,000 in Australia. Looking at 2008 data, spending per capita on physician services was five times higher in the United States than the average of other industrialized countries (Ginsburg 2012). Medical tourism, discussed above, shows even wider spreads between the United States and other countries (Silver and Hyman 2018). A kidney transplant in the Philippines is one-sixth the cost of a transplant in the US. A hysterectomy in Thailand is one-eighth the cost in the United States. Silver and Hyman (2018) further note that the quality of care and expertise of providers is about as good as can be found in the US. We will consider the importance of medication costs below.
Medical costs for the treatment of cervical cancer at central hospitals in Vietnam
Published in Health Care for Women International, 2018
Anh Duy Nguyen, Minh Van Hoang, Chuong Canh Nguyen
We included the main medical cost items for cervical cancer treatment, including (a) Staff costs (Was calculated based on the total annual payroll for each type of staff), (b) Medicines (Based on standard norms); (c) Medical supplies (Based on standard norms); and (d) Facilities and medical equipment (Straight-line depreciations of facilities and medical equipment. The original total purchase price of fixed assets was obtained from the Finance and Accounting Department at each hospital). Based on the standard treatment protocol, 22 medical services related to cervical cancer treatment were identified (Table 1). We included nine treatment scenarios for our research, including (a) Cryotherapy; (b) Loop electrosurgical excision procedure (LEEP); (c) Conization (for precancer patients or CIN I-III); (d) Radiotherapy (Intra cavity: low dose); (e) Radiotherapy (External beam); (f) Chemotherapy; (g) Radical hysterectomy; (h) In-patient care (for early stage of cancer); and (i) Palliative care (late stage of cancer) (Table 2).
Hysteroscopy Combined with Laser Vaporesection for Endometrial Polyps
Published in Journal of Investigative Surgery, 2022
Hongyan Ren, Hua Duan, Sha Wang, Yanan Chang
The treatment of endometrial polyps can be divided into conservative treatment, drug treatment and surgical treatment [3]. Conservative treatment is often used for small, asymptomatic polyps that may disappear spontaneously [7]. Endometrial polyps have a limited effect with drug therapy. Surgical treatment includes conservative surgery and radical surgery. Although hysterectomy can cure the lesion radically with almost no risk of recurrence, radical surgery is considered to be a more radical treatment compared with minimally invasive surgery [3, 8]. Traditional blind curettage has a low success rate in removing endometrial polyps, and hysteroscopic surgery is safer and more effective in complete removal of endometrial polyps than traditional blind curettage [7, 9–11]. Hysteroscopic endometrial polypectomy has become the gold standard for diagnosis and treatment [12–14]. At present, the commonly used surgical method is hysteroscopic electroresection of endometrial polyps. With the development of laser technology, the treatment of endometrial polyps by hysteroscopic 2 μm laser vaporesection has shown its unique advantages. This study compared the safety and efficacy of hysteroscopic 2 μm laser vaporesection and hysteroscopic electric resection in the treatment of endometrial polyps, providing more reference information for the treatment of endometrial polyps.
Health-related quality of life for early-stage cervical cancer survivors after primary radical surgery followed by radiotherapy versus radical surgery alone
Published in Journal of Obstetrics and Gynaecology, 2022
Runchida Suvannasarn, Tanarat Muangmool, Nahathai Wongpakaran, Kittipat Charoenkwan
From March 2018 through October 2018, the authors invited women diagnosed with early-stage cervical cancer (FIGO stage IA2-IIA), who had primary radical surgery (radical hysterectomy and pelvic lymphadenectomy) with or without postoperative adjuvant pelvic radiation at our institution to participate. Patients with recurrent disease were excluded. Informed consent was obtained from each participant. All participants were asked to complete the assigned quality of life questionnaires. Their clinical, surgical, and pathological data were also obtained via medical records. All data and scores from the quality of life questionnaires were compared between participants with radical surgery alone (group 1) and those with radical surgery followed by postoperative radiation (group 2). Radical hysterectomy was performed using the type B2 or type C technique according to the Querleu–Morrow classification of radical hysterectomy (Querleu et al. 2017). Adjuvant radiation consisted of external-beam pelvic radiotherapy of 46 Gy in 2 Gy fractions. For patients with high-risk pathological factors (pathological evidence of cancer metastasis to pelvic nodes/parametria or involved surgical margins), concurrent chemotherapy (cisplatin 40 mg/m2 once a week) and brachytherapy to the vaginal vault were also added. This project was approved by the Faculty of Medicine, Research Ethics Committee (approval number OBG-2561-05242) before its commencement.
Related Knowledge Centers
- Ovary
- Salpingectomy
- Cervix
- Uterus
- Endometriosis
- Fallopian Tube
- Oophorectomy
- Gynaecology
- Gynecological Surgery
- Caesarean Section