QuestionSBA
QuestionChoice
Six-to-eight weeks is the typical period of time needed for open abdominal wounds to heal fully. During this time, patients are advised to rest and not do any heavy lifting for the abdominal muscles and surrounding tissues to heal. Returning to heavy lifting earlier than this risks wound dehiscence.
53029
c
1–2 weeks
QuestionChoice
Six-to-eight weeks is the typical period of time needed for open abdominal wounds to heal fully. During this time, patients are advised to rest and not do any heavy lifting for the abdominal muscles and surrounding tissues to heal.
53031
e
5–7 d
QuestionChoice
Six-to-eight weeks is the typical period of time needed for open abdominal wounds to heal fully. During this time, patients are advised to rest and not do any heavy lifting for the abdominal muscles and surrounding tissues to heal. Returning to heavy lifting earlier than this risks wound dehiscence.
53028
b
2–4 weeks
QuestionChoice
Six-to-eight weeks is the typical period of time needed for open abdominal wounds to heal fully. During this time, patients are advised to rest and not do any heavy lifting for the abdominal muscles and surrounding tissues to heal. Delaying return to work beyond this is not usually necessary. Furthermore, remaining stationary for prolonged periods, as may be the case if you are off work, increases the risk of certain postoperative complications, such as deep vein thrombosis.
53030
d
12–16 weeks
QuestionChoice
This is the typical period of time needed for open abdominal wounds to heal fully. During this time, patients are advised to rest and not do any heavy lifting for the abdominal muscles and surrounding tissues to heal. Other complications of hysterectomy include temporary bowel, vaginal and bladder disturbances, such as constipation, urinary retention and vaginal bleeding. If the ovaries have been removed, they will experience severe menopausal symptoms, such as hot flushes and emotional disturbance.
53027
a
6–8 weeks
QuestionComment
how do people know the weeks for these things esp DVLA rules? in real life you'd just google it
26014
QuestionComment
guessed
27060
User
subscriber
lil' aneurysm
QuestionComment
Keeping a patients confidence in you as a doctor is quite important. Common sense but there's also research into this. A patients perception of their doctor has significant effects on their adherence to treatment, following of medical advice and actually medical outcomes themselves (likely in part the placebo effect coming into play enhanced by the doctor - patient relationship).

All this to say, being able to tell a patient something off the top of your head is much better than saying 'I don't know, I'd have to Google that' if you want them to trust you with their health 
54354
User
subscriber
Supine Metabolism
User
subscriber
RNA Retrograde
QuestionComment
You are sitting on the other side of the table in the GP for a reason....

55651
User
subscriber
TheSecretSayer
Concept
Chapter
# Summary
  
 
Endometrial cancer is a malignancy that occurs in the endometrium of the uterus. It is the sixth most common cancer in women and the 15th overall. Key risk factors include exposure to unopposed oestrogen, obesity, early menarche, late menopause, nulliparity, polycystic ovary syndrome, and oestrogen-only hormone replacement therapy. Common signs and symptoms include postmenopausal bleeding, abnormal vaginal bleeding, dyspareunia, pelvic pain, weight loss, anaemia, and abdominal discomfort. Diagnostics primarily include transvaginal ultrasound and endometrial biopsy. Management strategies are dependent on the stage of the cancer and can involve surgical interventions, radiotherapy, and chemotherapy.
  
 
# Definition
  
 
Endometrial cancer is a malignancy that originates from the endometrium, the inner lining of the uterus.
  
 
# Epidemiology
  
 
Endometrial cancer is the sixth most commonly diagnosed cancer in women globally and stands 15th in overall cancer occurrences. There were approximately 380,000 new cases reported worldwide in 2018.
  
 
# Aetiology
  
 
The main risk factor for endometrial cancer is exposure to unopposed oestrogen. This includes:
  
 
  - Nulliparity
  - Obesity
  - Early menarche
  - Late menopause
  - Polycystic ovary syndrome
  - Oestrogen-only hormone replacement therapy

Family history of endometrial, ovarian, breast or colorectal cancers, Lynch syndrome or PTEN syndromes are also risk factors for endometrial cancer.    
 
# Signs and Symptoms
  
 
Clinical manifestations of endometrial cancer may vary, but the most common include:
  
 
  - **Postmenopausal bleeding**
  - Abnormal vaginal bleeding, such as intermenstrual bleeding
  - Dyspareunia
  - Pelvic pain
  - Abdominal discomfort or bloating
  - Weight loss
  - Anaemia
  
 
On bimanual pelvic examination, an enlarged uterus (due to presence of a mass) may be detected, although the gross uterus size may remain unchanged in some cases.
  
Endometrial cancer is staged using the FIGO Staging System (from 0 to IV). 
 
# Differential Diagnosis
  
 
Given the clinical features of endometrial cancer, several conditions must be considered in the differential diagnosis:
  
 
- **Uterine fibroids:** characterised by heavy menstrual bleeding, pelvic pressure or pain, frequent urination, and constipation.
- **Endometrial polyps:** symptoms may include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual periods, and vaginal bleeding after menopause.
- **Cervical cancer:** signs can include abnormal vaginal bleeding (including intermenstrual and postcoital bleeding), postmenopausal bleeding, and pelvic pain.
  
 
# Investigations
  
 
**Bedside:**

* Bimanual and speculum examination 

**Bloods:**

* FBC (for anaemia) 
* LFTs (for liver or bone involvement)
* U&Es (for renal involvement) 

**Imaging:**

* Transvaginal ultrasound scan (for endometrial thickness measurement) 
      * **If thickness is >4mm**, investigate further with invasive tests 
* CT of chest, abdomen, pelvis (for staging)
* MRI or uterus, pelvis, abdomen (for extent of involvement)

**Invasive:**

* Endometrial biopsy (via hysteroscopy or pipelle) 

**Two Week Wait (2WW) Referral Criteria:**

* Women aged 55 years or older with post-menopausal bleeding
* *Consider* referral if woman is under age of 55  
  
 
# Management
  
 
The management of endometrial cancer is dependent on the stage of the disease:
  
 
  - For cancer limited to the uterus, a hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy can be curative. This may be done laparoscopically or as an open procedure. 
  - In cases where the cancer has spread outside of the uterus, treatment often involves a combination of surgery, radiotherapy, and chemotherapy.
  
 
# Complications

* Chemotherapy complications: toxicity (e.g. mouth ulcers, GI bleeding, diarrhoea, peripheral neuropathy)
* Radiotherapy complications: vaginal atrophy and stenosis, bowel and bladder fistulae 
* Surgical complications: infertility, menopause, bladder instability 

# Prognosis 

5-year prognosis depends on stage at diagnosis:

* Localised: >90%
* Distant: >20% 

# NICE Guidelines

[Click here for NICE Guidance](https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/endometrial-cancers) 

# References
  
[BMJ Best Practice](https://bestpractice.bmj.com/topics/en-gb/266)  
 
[BGCS Guidance](https://www.bgcs.org.uk/wp-content/uploads/2021/11/British-Gynaecological-Cancer-Society-v13-for-website-with-figure1.pdf)
936
987
Endometrial cancer
Topic
26
Gynaecology
Condition
249
Endometrial cancer
UkmlaTopic
18
Obstetrics and gynaecology
10666
Patients recovering from open hysterectomy should avoid heavy lifting for 6–8 weeks to ensure proper healing of abdominal wounds.
A 62-year-old patient is 3 d post-open hysterectomy and recovering on the surgical ward. The operation was without complications and she is recovering well. The patient would like to know when she can return to work. Her job involves lifting heavy boxes and operating heavy machinery in a warehouse.

What is the advised recovery period for this patient before they return to work?
a