Disease of the Female and Male Genital Tract Flashcards
What is the Vagina?
Muscular canal that connects the uterus to the outside world
What is the Cervix?
Interior top portion of the vagina, which is part of the uterus itself. Protrudes into the vagina. Connects the vagina to the Uterus
What is the Uterus?
A muscular organ that is responsive to hormones and nurtures the developing fetus
What are the Fallopian Tubes?
Two tubular structures that extend from the uterus onto the ovary itself. They allow for the passage of an egg, and ultimately fertilization within the tube and travel of the egg into the uterus
What are the Ovaries?
Two pair organs that produce hormones, and store and release eggs within the female genital tract
What are the 3 layers of the Cervix?
- Endocervix
- Ectocervix
- Transformation Zone
What is the Transformation Zone?
Area of squamous metaplasia where there is a transition from squamous epithelium to glandular (endocervical) epithelium
What is the Endocervix made of?
glandular epithelium
What is the Ectocervix made of?
Squamous epithelium
What is the Cervical Os?
Entrance into the cervix
What is the most common site for cervical neoplasia to occur?
Transformation Zone
How can Cervical Dysplasia be detected?
By a pap test
What are the two different types of Squamous Intraepithelial Lesion (SIL)?
- low grade
- high grade
What are low grade SILs?
- lesions that are low risk of progression to invasive cancer
- responsible for HPV 6, and 11
- also genital warts
What are high grade SILs?
- lesions that are precursor to invasive cancer
- responsible for HPV 16, 18, 31, 33, and 35
What are the major causes of SIL and invasive carcinomas?
- human papillomavirus (HPV)
- sexually transmitted infection
What are the preventions for SIL and Invasive Carcinomas?
- safe sex practices (ex. condom use)
- HPV vaccination
- Cervical screening: pap test
What are the risk factors for HPV infection? (9)
- Young age at first intercourse
- Multiple sex partners
- unprotected intercourse
- smoking
- oral contraceptive use
- pregnancy
- diabetes
- immunosuppression
- poor hygiene
What occurs if a patient has low grade lesions?
Repeat pap test in 6 months since many low grade lesions spontaneously regress
What occurs if a patient has high grade lesions?
- investigated by colposcopy
- direct examination of cervix under magnification and biopsy confirmation
What are 90% of cervical cancers?
squamous cell carcinomas
What are the signs of cervical cancer?
abnormal vaginal bleeding, especially post-coital spotting
How does Cervical Cancer spread?
invades locally into the vagina, rectum, and bladder and metastasize to regional lymph nodes
How are early invasive cervical cancer cases treated?
- local excised (cone excision)
- treated with radical surgery (hysterectomy)
How are advanced cervical cancer cases treated?
Radiotherapy
What is the survival rate for low stage cervical cancer?
around 90%
What is the survival rate for advanced cervical cancer?
less than 20%
When should cervical cytology screening start?
at 21 for women who are or have ever been sexually active
How often should a cervical cytology screening be performed?
if normal, every 3 years
What is the range of ages for cervical cytology screening?
21-69
When can screening be discontinued?
at the age of 70 if there is an adequate negative cytology screening history in the previous 10 years
What is the function of the Uterus?
Nurture a developing fetus
What are the 3 layers of the Uterus?
- Mucosa
- Muscular Wall
- Peritoneal surface
What is the Mucosa layer?
- Inner most layer
- composed of the Endometrium
- made of glands and stroma
What is the Muscular Wall layer?
- layer composed of smooth muscle cells
- composed of the Myometrium
What is the Peritoneal Surface layer?
- layer that connects with the pelvis
- composed of the Serosa
What does the Endometrium undergo every month?
Changes under the influence of estrogen and progesterone produced by the ovary, which in turn is regulated by hormones produced by the hypothalamus and the pituitary gland
What does Estrogen do?
Stimulates the endometrial glands to proliferate
What occurs when ovulation starts?
estrogen production subsides, and progesterone continues to increase
What does the change from estrogen to progesterone cause?
The endometrium converts from the proliferative phase to the secretory phase. This is in preparation for and to receive the nourished, fertilized egg
What occurs if implantation does not occur?
The endometrial lining is shed during the menstrual cycle and the cycle will start over again
What occurs in the cycle if hormones are unbalanced?
The cycle is altered and ovulation is sporadic or doesn’t occur
What is the most common malignancy in the female genital tract?
Endometrial Carcinoma
85% pts have which type of endometrial carcinoma?
Unopposed estrogen stimulation (low stage tumors with good prognosis)
15% pts have which type of endometrial carcinoma?
Estrogen independent (aggressive; more likely to metastasize; worse prognosis)
What are the risk factors for Endometrial Carcinoma? (4)
- failure to ovulate
- Obesity: increased estrogen produced by fat cells
- hormone replacement therapy for menopausal symptoms
- functional tumours: some ovarian tumors can produce estrogen
What are the common presenting symptoms of Endometrial Carcinoma?
- abnormal uterine bleeding
- post-menopausal vaginal bleeding
What is the treatment of Endometrial Carcinoma?
- surgery: hysterectomy
- Radiation and chemotherapy for high stages
What is the most common neoplasm of female genital tract?
Leiomyomas
What are Leiomyomas? (5)
- Commonly referred to as “fibroids”
- benign tumours of smooth muscle
- present in 30-50% of females over 30 years
- present in 75% of hysterectomy specimens
- growth is affected by hormonal alterations
What is the gross appearance of a Leiomyomas?
- round, well circumscribed
- white, whorled nodules
- often multiple
- variable size
What are the variable locations of Leiomyomas?
- submucosal
- intramural
- subserosal
Where are Submucosal Leiomyomas located?
situated in the uterine wall, just under the endometrium
Where are Intramural Leiomyomas located?
Situated in the centre of the muscular wall
Where are Subserosal Leiomyomas located?
situated near the serosa of the uterus
What are the signs and symptoms of Leiomyomas?
- depends on the size, location and number of tumours
- can be asymptomatic
- pelvic pain
- Dysmenorrhea (painful menstruation)
- Infertility
What is the treatment of Leiomyomas?
- none required for asymptomatic
- hysterectomy if patient is symptomatic
What are the cell types within the Ovary?
- surface epithelium
- germ cells
- Stroma and sex cord cells
What are Germ cells responsible for?
Egg production
What are Stroma and sex cord cells composed of and responsible for?
- granulose, theca and leydig cells
- support the germ cells
- produce hormones
- make up the ovaries
What is the function of the Ovary?
- Facilitates maturation of oocytes for ovulation
- production and secretion of sex hormones
What are the most common ovarian tumours in Adults?
Epithelial tumours
What are the most common ovarian tumours in Younger/Adolescents?
Germ cell tumours
What type of ovarian tumour is most common in post-menopausal females?
Carcinoma
What are Benign Epithelial Ovarian Tumours? (2)
- variety of microscopic subtypes (serous, mucinous, etc)
- often large and cystic, but lack solid growth of tumour cells and invasion
What are Malignant Epithelial Ovarian Tumours? (3)
- variety of microscopic subtypes (serous, mucinous, etc)
- Most common form of ovarian cancer
- leading cause of death from gynecologic malignancy
Why does Ovarian Carcinoma have poor prognosis?
- often asymptomatic, or mild, non-specific symptoms until cancer is advanced
- no specific screening test
- more likely to present at an advanced stage
What are the signs and symptoms of Ovarian Carcinoma?
- pelvic pain or discomfort
- increased abdominal girth
- present in post-menopausal women
What is the treatment for Ovarian Carcinoma?
- surgical excision
- Chemotherapy for distant spread
What are the non-modifiable risk factors for Ovarian Carcinoma?
- increasing age
- having children later or never having children
- Family history of ovarian, breast, or colon cancer
What are the modifiable risk factors for Ovarian Carcinoma?
- obesity
- taking hormone therapy after menopause
- smoking
What are Germ Cell Tumours of the Ovary?
- often benign
- forms mature cystic teratomas
What are the different mature tissue types that Germ cell tumours can differentiate into?
- Ectoderm (skin, skin appendages such as hair and sweat glands)
- Endoderm (respiratory and intestinal epithelium)
- Mesoderm (cartilage, bone, fat)
What is the treatment for mature cystic teratoma?
- surgical removal
- as long as all of the tissues are mature, this is curative
What occurs if the cystic teratoma is Immature?
- they are malignant
- may require adjuvant chemotherapy
What is Dysgerminoma?
- most common malignant germ cell tumour
- female equivalent of testicular seminoma in males
What are the common types of cancer that metastasize to the ovaries?
- gastrointestinal tract
- breast
- endometrium
What is Metastatic Carcinoma of the Ovaries?
- cancer that typically involves both ovaries (bilateral)
- prognosis is poor
What is the function of the Fallopian Tubes?
transport the mature ovum toward the uterus
What is an Ectopic Pregancy?
Implantation of an egg in a site other than the endometrial cavity
- most occur in the fallopian tube
- other sites include: Cervix, Ovary, Peritoneal cavity
What is the chance of a Ectopic Pregnancy occuring?
1 in 150
What is the etiology of ectopic pregnancy?
- often no definite cause
- any disease that results in scarring or distortion of the tubes increase the risk: infection, endometriosis, adhesions
What can be done if an ectopic pregnancy is detected early?
- With medications: Methotrexate
- gynaecologist will surgically excise the affected segment of tube
What is Endometriosis?
- Benign endometrial tissue outside the normal location in the uterus
- very common, up to 10% of female population
What are the potential site of Endometriosis?
The ovaries are the most frequently involved (80%), but other areas and pelvic organs may be affected
What occurs with Endometriosis?
- endometrial tissue undergoes the same cyclic menstrual cycle changes that affect regular endometrium
- the blood produced can’t be expelled so it expands to form hemorrhagic nodules or cysts and dense adhesions from scarring
What are the signs and symptoms of Endometriosis?
- Pelvic pain
- Dysmenorrhea
- Infertility
What are the 4 theories for the causation of Endometriosis?
- Retrograde menstruation
- Metaplastic transformation
- Vascular or lymphatic dissemination
- Stem/progenitor cell theory
What is Retrograde Menstruation?
Instead of sheading endometrial tissue out through the uterus and vagina, it goes backward through the fallopian tubes and implants on other organs
What is Metaplastic Transformation?
Transformation of cells in the peritoneum or connective tissue into endometrial cells, which then become functional cells through the menstrual cycle
What is Vascular or Lymphatic Dissemination?
Endometrial tissue travels through blood vessels or lymphatics and deposits elsewhere (benign metastases) within the peritoneal cavity
What is Stem/Progenitor Cell Theory?
Circulating stem cells from the bone marrow differentiate into endometrial tissue and implant elsewhere
What is the treatment of Endometriosis?
- Medications: pain medication, oral contraceptive pill
- Surgery: remove lesional tissue and adhesions
What is Pelvic Inflammatory Disease (PID)?
Infectious and inflammatory disorder of the upper female genital tract
- uterus: endometritis
- fallopian tubes: salpingitis
- ovaries: oophoritis
- adjacent pelvic structure: peritonitis
By which mode of transportation can infection enter the female genital tract causing PID?
- sexual transmission
- insertion of an IUD
- following pregnancy (postpartum infection)
- following medical procedure ex. dilation and curettage
What diseases or injuries could cause PID? (7)
- Pyosalpinx
- Hydrosalpinx
- Strictures or adhesions
- tubo-ovarian abscess
- Chronic salpingitis
- Infertility
- Ectopic pregnancy
What is the treatment for PID?
Intensive antibiotic therapy +/- surgery
What are the different parts of the male genital tract?
- Penis
- Testes and associated structures
- Prostate
What are the different parts of the Penis?
Root: attachment to lower abdomen/pelvic structures
Body/Shaft: cylindrical portion
Glans: cone-shaped end (may be covered by foreskin)
What is the function of the Penis?
- Sexual function
- Urination
What are the sexual functions of the Penis?
- increased blood flow to erectile tissue (corpus cavernosa and corpus spongiosum)
- decreased blood outflow
- leads to erection
- sperm passes through urethra
What are the Testis?
- paired organ located within the scrotum which aids in temperature regulation
- descend from abdominal cavity through inguinal canal during development
- each testis associated with epididymis and vas deferens
What is the function of the Testis?
- production of sperm
- production of testosterone (male sex hormone)
What does the production of sperm entale? (3)
- occurs in the seminiferous tubules
- sperm stored in epididymis, where it matures
- sperm transported to urethra by vas deferens
Describe the anatomy of the Prostate: (5)
- located inferior to the bladder
- urethra passes through it
- about the size of a large walnut
- vas deferens enter prostate, become ejaculatory ducts, which join with the urethra
- seminal vesicles arise from posterior base of prostate
What are the different parts of the Prostate?
- Peripheral zone
- Transition zone
- Central zone
- Anterior fibromuscular stroma
What is the function of the Prostate?
- secretes fluid which becomes part of semen
- helps prolong the lifespan of sperm
- helps control urination and ejaculation
What is the most common cancer in men?
Prostate cancer
What is Prostate cancer?
- cancer of the prostate that is hormone dependent
- affects older men (>50 years)
- increases with older age
What are the risk factors of Prostate Cancer? (5)
- advanced age
- androgen exposure
- family history (2x risk if father/brother with prostate cancer)
- African descent
- Western diet
What are the signs and symptoms of Prostate cancer?
most are asymptomatic
At what age do screenings begin for Prostate Cancer?
at age 50
- Digital rectal examination
- PSA (prostate specific antigen)
How is Prostate Cancer diagnosed?
Prostate biopsy with transrectal ultrasound
What is the treatment for Prostate Cancer? (5)
- Surgery (prostatectomy)
- Radiation (external beam, brachytherapy)
- Chemotherapy
- Hormone therapy (androgen deprivation)
- Active Surveillance
How is the prognosis of Prostate Cancer determined? (4)
- Gleason grade
- staging
- pretreatment PSA
- surgical margin status
Is prognosis of Prostate cancer good or no?
often good. Most men die with prostate cancer, not of prostate cancer
What is Testicular Cancer? (4)
- uncommon malignancy in males
- most common in men age 15-34
- nearly all are germ cell tumours
- peak at 30 years, range teens to 50 years
What are the risk factors for Testicular Cancer?
- Undescended testicle (cryptorchidism)
- Caucasians have 5x risk of African descent
- family history (10x risk)
- Previous cancer in other testicle
What are the signs and symptoms of Testicular Cancer?
- painless enlargement of the testicle
- may present with metastasis
How is Testicular Cancer diagnosed? (5)
- imaging, usually ultrasound
- testicular lesions should NOT be biopsied
- Blood work for tumour biomarkers
- Surgery
- Germ Cell Tumour (GCT) categories
What type of blood work should be done to diagnose Testicular Cancer?
- Beta HCG (pregnancy hormone)
- Alpha fetoprotein (AFP)
- Lactate dehydrogenase (LDH)
What are the different categories of Germ Cell Tumours in males?
- seminoma
- Nonseminomatous (generally worse)
What percent of Testicular Tumours are mixed?
60%
What are the treatments for Testicular Cancer?
- surgery (orchiectomy)
- Chemotherapy
- Radiation
Where do Inflammatory Diseases occur in the male genitalia?
- epididymis
- Testis
What are the different types of Inflammatory Disease that can occur in the male genitalia?
- epididymis
- orchitis
What are the symptoms of Inflammatory Disease of the male genitalia? (5)
- swelling (one or both)
- pain
- fever
- nausea and vomiting
- malaise
What are epididymitis and orchitis often related to?
Urinary tract infections, due to E. Coli and Pseudomonas, often present in men older than 35
What is the causation of Epididymitis and Orchitis in Children? (2)
- congenital genitourinary abnormality
- infection with gram negative rods (E. coli)
What is the causation of Epididymitis and Orchitis in sexually active men, younger than 35 years old?
Sexually transmitted pathogens
- Chlamydia trachomatis, Neisseria gonorrhea
What is Granulomatous (autoimmune) Orchitis?
- Inflammatory disease of the testis
- idiopathic
What are the symptoms and signs of Granulomatous (Autoimmune) Orchitis?
- Sudden onset of tender testicular mass, with fever
- may present as painless testicular mass
- mimics testicular cancer
What type of inflammation does Gonorrhea cause?
Extends from posterior urethra to prostate, seminal vesicles, and epididymis
What type of inflammation does Mumps cause?
- viral illness in school age children (rare involvement of Testicular)
- orchitis in 20-30% of cases in post-pubertal males
Where does Tuberculosis cause inflammation?
In the epididymis
Where does Syphilis cause inflammation?
In the testes first
What is Benign Prostatic Hyperplasia?
- enlargement of the transitional zone
- most common benign prostatic disease in older men
- uncommon in men younger than 40
What are the clinical features of Benign prostatic hyperplasia?
Urinary obstruction
- bladder hypertrophy
- residual urine
What are the signs and symptoms of Benign Prostatic Hyperplasia? (6)
- urinary frequency
- Nocturia (urinating at night)
- difficulty starting and stopping urine stream
- Overflow dribbling
- Dysuria (pain with urination)
- may develop acute urinary retention
What are the treatments of Benign Prostatic Hyperplasia?
- medication
- surgery
