Disorders of the Female Reproductive System Flashcards
Disorders of the Uterine Cervix: Cervical Cancer (Risk Factors)
Risk Factors
- 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
Cervical Cancer : Pathogenesis & Manifestations
Pathogenesis
- Cell dysplasia can be pre-cancerous (Pap smear)
- Long latent period but rapid once starting
- Squamous cell carcinoma most common
Manifestations
- Abnormal vaginal bleeding, spotting, discharge (increased after intercourse)
- Pain (pelvic, back, leg)
- Hematuria, fistulas
Treatment of Cervical Cancer
- Removal of lesion
- Surgical removal of organs
- Radiation
- Chemo-radiation
- Chemotherapy
- Brachytherapy (inplant medication right into the cervix)
Pelvic Inflammatory Disease
- Involves upper reproductive tract
- Uterus to fallopian tubes to ovaries
- Caused by polymycrobial sexually transmitted organisms
- And more rarely, endogenous organisms
Risk Factors - 16-24 years old - Multiparity - Multiple sexual partners - h/o PID, IUD use risk for PID is enhanced during menstruation
Pelvic Inflammatory Disease Manifestations
- Lower abdominal pain (just after menstruation)
- Cervical pain on manipulation
- Purulent discharge
- Bleeding (especially if on oral contraceptives)
- Fever
- Elevated WBC, ESR, CRP
Endometriosis
- Cells from the lining of the uterus flourish elsewhere
- Ectopic
- Cause is unknown, but 10-15% of premenopausal women have this
> Common sites for growth:
1. Ovary
2. Rectum
3. Uterus
4. bladder
Endometriosis Risk Factors and Manifestations
> Risk Factors
- Early/altered menarche
- Postponed childbearing
- Familial
- Dysmenorrhea (painful menstruation)
> Manifestations
- Pain: pelvic, back, micturition, & defecation d/t bleeding during menstruation
- infertility
ovarian cysts
Endometriosis treatment
- Symptomatic (pain)
- Endometrial suppression
- Surgical removal
- Tissue
- Hysterectomy
- Hysterectomy & BSO
Endometrial Cancer & Risk factors and manifestations
- Most common Ca of female reproductive tract (adenocarcinoma type)
> Risk Factors - Post-menopause - Estrogen excess - Nulparity - Endometrial hyperplasia (cell changes in the endometrium) > Manifestations - Post menopausal painless bleeding
Disorders of Uterine Support
- Cystocele
Herniation of bladder into vagina (difficulty empyting 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)
Ovarian Cysts Manifestations & Types
- Common, but often benign
> Manifestations - discomfort, aching
- Occasionally can rupture or become infected
> Types:
1. Follicle doesn’t burst and release ovum
2. Luteal cyst (from corpus luteum not dissolving)
3. Dermoid cyst - Benign “teratoma”
- Skin, hair, bone, nails, teeth, eyes, thyroid tissue
4. Chocolate cyst (caused by endometriosis)
Polycystic Ovary Syndrome Risks & Pathophysiology
- 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
Polycystic Ovary Syndrome Manifestations
- Menstrual irregularity
- Hyperandrogenism (male pattern baldness in women)
- Infertility
- Hyperinsulinemia/insulin resistance
- Hypertension
Polycystic Ovary Syndrome Treatment
- Symptom relief
- Weight loss
- Oral contraceptives (to control hormonal levels)
- Spironolactone (inhibits androgen production by adrenal gland)
Ovarian Tumors
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
Ovarian Cancer & Risk Factors
- 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
Ovarian Cancer Manifestations & Treatment
Manifestations - Often asymptomatic - Increased abdominal size (ascites) - Dyspepsia - Bloating, early satiety Treatment - Total hysterectomy & BSO - Possible omentum removal - Chemotherapy
Menorrhea
A = absence Hypo = scanty Oligo = infrequent Poly = frequent Dys = painful
…rrhagia
Metro = bleeding between periods
Meno = excessive bleeding
Menometro = heavy bleeding between and during periods
Breast Cancer
- Most common female cancer (1 in 9)
- Normally, BRCA1 or BRCA2 genes suppress tumor growth by repairing DNA that has mutated
- Mutation of these genes leads to cancer growth
- Breast cells supplied with extra estrogen or growth factor receptors prone to cancer
Breast Cancer Risk Factors
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 menopause)
Breast Ca Modifibale Risk Factors
Modifiable Risk Factors - Obesity - Physical inactivity - Postmenopausal hormone therapy Alcohol use: 2 drinks/day increases risk by 8.5% 5-10% of those diagnosed can be linked to alcohol use)
Breast CA detection
- Solitary, painless fixed lesion with poorly defined borders is most common
- Upper outer quadrant most common
1. Mamography
2. Self-examination
3. MRI
4. Biopsy
Breast Cancer Classification & Tx
Classification
- Size/nodal involvement/metastasis
Treatment
- Surgery (radical, modified)
- Chemotherapy
- Radiation therapy
- Hormonal manipulation
Breast Ca Surgery
- Lumpectomy (wide local excision)
- Partial or segmental mastectomy or quadrantectomy
- Total mastectomy
- Modified radical mastectomy (leave some of the muscle behind)
- Radical mastectomy (take all the tissue out)
