Ch. 40 Disorders of the Female Reproductive Organs Flashcards
What are the risk factors for cervical cancer?
Linked to Human Papilloma Virus (HPV) infection Smoking Dietary/nutritional Early age of first sexual intercourse/contact Family history Immunodeficiency Multiparity Oral contraceptives h/o chlamydial or herpes virus infection
`Describe the pathogenesis of cervical cancer
Cell dysplasia can be pre-cancerous (Pap smear)
Long latent period but rapid once starting
Squamous cell carcinoma most common
What are the manifestations of cervical cancer?
Abnormal vaginal bleeding, spotting, discharge (increased after intercourse)
Pain (pelvic, back)
Hematuria, fistulas
What are the treatments for cervical cancer?
Removal of lesion Surgical removal of organs Radiation Chemo-radiation Chemotherapy Brachytherapy
What is pelvic inflammatory disease?
Involves upper reproductive tract (uterus to fallopian tubes to ovaries)
Caused by polymicrobial sexually transmitted organisms (and more rarely, endogenous organisms)
What are the risk factors for pelvic inflammatory disease?
16-24 years old
Multiparity
Multiple sexual partners
h/o PID, IUD use
Why are the risk factors for pelvic inflammatory disease enhanced during menstruation?
The reproductive system “opens up” to allow flow, but also allows microorganisms to travel.
What are the manifestations of pelvic inflammatory disease?
Lower abdominal pain (just after menstruation)
Cervical pain on manipulation
Purulent discharge
Bleeding (especially if on oral contraceptives)
Fever
Elevated WBC, ESR, CRP
What is endometriosis?
Cells from the lining of the uterus flourish elsewhere
What are the risk factors for endometriosis?
Early/altered menarche
Postponed childbearing
Familial
Dysmenorrhea
What are the manifestations of endometriosis?
Pain: pelvic, back, micturition & defication
d/t bleeding during menstruation
Infertility
Ovarian cysts
What are the treatments for endometriosis?
Symptomatic (pain) Endometrial suppression Surgical removal Tissue Hysterectomy Hysterectomy & Bilateral Salpingo Oophrectomy
What is endometrial cancer?
Most common cancer of female reproductive tract (adenocarcinoma type)
What are the risk factors for endometrial cancer?
Post-menopause
Estrogen excess
Nulparity (no pregnancies)
Endometrial hyperplasia
What are the manifestations of endometrial cancer?
Post-menopausal painless bleeding
What are the manifestations of ovarian cysts?
Discomfort, aching
Occasionally can rupture or become infected
What are the types of ovarian cysts?
Follicle doesn’t burst and release ovum
Luteal cyst (from corpus luteum not dissolving)
Dermoid cyst
Benign “teratoma”
Skin, hair, bone, nails, teeth, eyes, thyroid tissue
Chocolate cyst
Caused by endometriosis
How prevalent is polycystic ovary syndrome?
Affects 5-10% of reproductive aged women
What are the risk factors for polycystic ovary syndrome?
Hormonal changes
Chronic anovulation causing ammenorrhea
Obesity
Describe the pathophysiology behind polycystic ovary syndrome
Follicles develop but don’t ovulate
LH levels remain, stimulating androgen production, which stimulates cycle to continue.
What are the manifestations of polycystic ovary syndrome?
Menstrual irregularity
Hyperandrogenism
Infertility
Hyperinsulinemia/insulin resistance
Reason not clear
HypertensionWhat is the treatment for polycystic ovary syndrome
Symptom relief
Weight loss
Oral contraceptives
Spironolactone (inhibits androgen production by adrenal gland).
What are the types of benign ovarian tumors?
Epithelial cell
Endometriomas or “chocolate cysts”
Fibromas
Teratomas/dermoid cyst
What is a functioning ovarian tumor?
A tumor that secretes hormones
What is the result of a functioning tumour that secretes estrogen?
Altered menstrual cycle
What is the result of a functioning tumour that secretes androgens?
Causes masculine characteristics
What is ovarian cancer secondary to?
Secondary to endometrial cancer
What are the risk factors for ovarian cancer?
Nullparity (no pregnancies) Older women (usually) Family history of breast or ovarian cancer
What is the prognosis for ovarian cancer?
High mortality rate as vague symptoms are not recognized early
Up to 75% have metastasized when diagnosed
What are the manifestations of ovarian cancer?
Often asymptomatic
Increased abdominal size (ascites)
Dyspepsia
Bloating, early satiety
What are the treatments for ovarian cancer?
Total hysterectomy & BSO
Possible omentum removal
Chemotherapy
What is the most common female cancer?
Breast cancer (1 in 9)
Describe the pathophysiology behind breast cancer
Normally, BRCA1 or BRCA2 genes suppress tumor growth by repairing DNA that has mutated
Mutation of these genes leads to cancer growth
What are the risk factors for breast cancer?
Increased age
Family history/genetic mutation
h/o benign breast disease
Hormonal changes that influence breast maturation (early menarche, late pregnancy and menopause)
What are the modifiable risks for breast cancer?
Obesity
Physical inactivity
Postmenopausal hormone therapy
Alcohol use
2 drinks/day increases risk by 8.5% (University of Victoria study 2014)
5-10% of those diagnosed can be linked to alcohol use (Canadian Breast Cancer Foundation)
How is breast cancer manifested?
Solitary, painless fixed lesion with pooly defined borders is most common
Upper outer quadrant most common
What are the diagnostic tests for breast cancer?
Mammography
Self-examination
MRI
Biopsy
What are the treatments for breast cancer?
Surgery (radical, modified)
Chemotherapy
Radiation therapy
Hormonal manipulation
