Chapter 40: Disorders of the Female Reproductive System Flashcards
Discuss the risk factors associated with 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
Relate the importance of Papanicolaou smear in early detection and decreased incidence of deaths from cervical cancer.
Diagnosis of cervical cancer requires pathologic confirmation. Pap smear results demonstrating squamous intraepithelial lesions often require further evalu- ation by colposcopy, during which a biopsy sample may be obtained from suspect areas and examined microscopically
Describe the methods used in the treatment of cervical cancer.
Removal of lesion Surgical removal of organs Radiation Chemo-radiation Chemotherapy Brachytherapy
Describe the pathology and manifestations of pelvic inflammatory disease
-Involves upper reproductive tract (uterus to Fallopian tubes to ovaries)
Caused by polymycrobial sexually transmitted organisms
More rarely, endogenous organisms = causing infection
-After entering the upper reproductive tract, the organisms multiply rapidly in the favorable environment of the sloughing endometrium and ascend to the fallopian tube.
Risk Factors 16-24 years old Multiparity Multiple sexual partners h/o PID, IUD use Risk factors enhanced during menstruation
Manifestations: dyspareunia Lower abdominal pain (just after menstruation) Cervical pain on manipulation Purulent discharge Bleeding (esp if on oral contraceptives) Fever Elevated WBC, ESR, CRP
Describe the pathology and manifestations of endometriosis.
Cells from the lining of the uterus flourish elsewhere
-ectopic
-Causes is unknown, but 10-15% of postmenopausal women have this
-cyst development interferes with blood flow/tissue
How did it get there? – retrograde, dormancy, lymphatics
Risk Factors Early/altered menarche Postponed childbearing Familial Dysmenorrhea
Manifestations – dependant on site Pain: pelvic, back, micturition, defecation D/t bleeding during menstruation Infertility Ovarian cysts
Treatment: Symptomatic (pain) Endometrial suppression Surgical removal Tissue Hysterectomy Hysterectomy & BSO
Cite the major early symptoms of endometrial cancer.
post menopausal painless bleeding
Describe the manifestations of cystocele, rectocele, and uterine prolapse.
Cystocele
Herniation of bladder into vagina
-Difficulty emptying bladder, frequency
Rectocele
Herniation of rectum into vagina
-Discomfort, difficulty defecating
Uterine prolapse
Bulging of uterus into vagina
-Discomfort, irritation of exposed membranes of cervix/vagina
State the underlying causes of ovarian cysts.
Common, but often benign
Manifestations:
Discomfort, aching
Occasionally can rupture or become infected
Types:
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
Describe polycystic ovary syndrome.
Affects 5-10% of reproductive aged women
Risks:
Hormonal changes
Chronic anovulation causing amenorrhea
Obesity
Pathophysiology:
Follicles develop but don’t ovulate
LH levels remain, stimulating androgen production, which stimulates cycle to continue
(The elevated LH level results in increased androgen production, which in turn prevents normal follicular development and contributes to a vicious cycle of anovulation and multiple cyst formation.)
Manifestations: Menstrual irregularity hyperandrogenism Infertility Hyperinsulinemia/insulin resistance -Reason not clear obesity? hypertension
Treatment: Symptom relief Weight loss Oral contraceptives Spironolactone (inhibits androgen production by adrenal gland)
State the reason that ovarian cancer may be difficult to detect in an early stage, risk factors, manifestation
2nd to endometrial cancer
Risk Factors:
Nullparity
Older women (usually)
Family history of breast or ovarian cancer
High mortality rate as vague symptoms are not recognized early
Up to 75% have metastasized when diagnosed
Manifestations: Often asymptomatic Increased abdominal size (ascites) Dyspepsia Bloating, early satiety
Treatment:
Total hysterectomy & BSO
Possible omentum removal
chemotherapy
- Define the terms amenorrhea, hypomenorrhea, oligomenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia.
Amenorrhea = absence menstruation
Hypomenorrhea = scanty menstruation
Oligomenorrhea = infrequent menstruation
Poly = frequent, less than 21 days apart
Metrorrhagia = bleeding between periods
Menorrhagia = excessive bleeding
Menometrorrhagia = heavy bleeding between and during periods
Differentiate between primary dysmenorrhea and secondary dysmenorrhea
Primary dysmenorrhea is caused by prostagladin excess. Prostaglandins are potent smooth muscle stimulants that cause intense uterine contractions.
Secondary dysmenorrhea is menstrual pain caused by structural abnormalities or disease processes such as endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUDs, or PID. In women with secondary dysmenorrhea, the pain often lasts longer than the menstrual period; it may begin before menstrual bleeding begins; and it may become worse during menstruation.
Cite the risk factors for breast cancer, manifestation and cause
Most common female cancer (1 in 9)
Normally, BRCA1 or BRCA2 genes suppress tumor growth by repairing DNA that has mutated
Breast cells supplied with extra estrogen or growth factor receptors prone to cancer
Risk Factors: (many diagnosed have none!)
Increased age
Family history/genetic mutation
h/o benign breast disease
Hormonal changes that influence breast maturation (early menarche, late pregnancy, or menopause)
Modifiable Risk Factors: Obesity Physical inactivity Postmenopausal hormone therapy Alcohol use
Describe the methods used in the diagnosis and treatment of breast cancer
Detection: Solitary, painless fixed lesion with poorly defined borders Upper outer quadrant most common Mamography Self-examination MRI Biopsy
Classification
Size/nodal involvement/metastasis
Treatment: Surgery (radical, modified) Chemotherapy Radiation therapy Hormonal manipulation
SURGERY:
Lumpectomy (wide local excision)
Partial or segmental mastectomy or quadrantectomy
Total mastectomy
Modified radical mastectomy – breast, lymph
Radical mastectomy – breast, lymph, muscles
Describe Benign Ovarian Tumours
Benign Tumors (80% are!) Epithelial cell Endometriomas or “chocolate cysts” Fibromas Teratomas/dermoid cyst -Serous/sebaceous/hair/teeth
Functioning tumors: secrete hormones
- Estrogens: alter menstrual cycle
- Androgens: cause masculine characteristics
