Female 2 Flashcards
What is this describing?
The normal squamocolumnar junction is the anatomical junction of the squamous and the mucinous epithelia.
Cervical Transformation Zone
The __________ is the macroscopically visible junction between the exocervix and endocervix
External os
Cervical Transformation Zone:
With age, the mucinous columnar epithelium undergoes squamous metaplasia, where the columnar epithelium is transformed into __________ strat. squamous epithelium.
stratified squamous epithelium
What is the definition of the following?
The area between the original squamocolumnar junction on the exocervix and the new squamocolumnar junction at the internal os.
Cervical Transformation Zone
Define the following:
The study of normal and disease-altered desquamated cells from various body sites.
It is an effective screening procedure for the early detection of premalignant and malignant cervical lesions.
Exfoliative Cytology
The __________ is the cervical cytological test where the most superficial epithelial cells are exfoliated.
PAP smear
What is the following?
Results from infection with endogenous vaginal aerobe and anaerobes
**MC are Strept & Staph but Chlamydia, Neisseria and Herpes may also cause this.
Cervicitis
What are the common microorganisms involved in cervicitis?
- **MC: Staph & Strep
- Chlamydia, Neisseria, Herpes
What disease?
Cervix is grossly red, swollen and edematous, with copious amounts of pus dripping from the external os internal os.
Microscopically, the tissue exhibits an extensive infiltrate of polymorphonuclear leukocytes and stromal edema.
Acute Cervicitis
Describe the microscopic findings in acute cervicitis
infiltrate of polymorphonuclear leukocytes and stromal edema
Chronic cervicitis is ________ than acute cervicitis
more common
What disease?
Cervical mucosa is reddened and hyperemic
true epithelial erosions
Microscopically, stroma is infiltrated by mononuclear cells: lymphocytes and plasma cells, with focal lymphoid follicles.
Chronic Cervicitis
- Accounts for apprx 20% of all malignant tumors of the female reproductive tract.
- Accounts for more deaths than cancer of the uterus, vagina and vulva together.
- The reduced mortality over the past 50 years is due to the early detection of cervical cancer and related preneoplastic conditions by using PAP smears.
Carcinoma of the Cervix
The cause of Cervical cancer is unknown but there are several risk factors that MAY play a role in cervical cancer.
What are they?
- Sex at a young age
- Multiple sex partners (prostitutes)
- HPV infection
- Other venereal diseases like Herpes or Syphilis
Squamous cell cancer that originates in transformation zone and has intense cell proliferation
Cervical cancer
The transformation zone may be widened after:
- cervical trauma (vaginal delivery)
- chronic inflammation
- infection of the transformation zone
These altered, proliferating cells are susceptible to viral infections, so exposure to an oncogenic virus, such as HPV, could induce neoplastic transformation of this zone.
What disease does this result in?
Cervical Cancer
Transformed cells do not respond to normal regulatory stimuli in tissue and therefore, do not mature as the normal cervical cells. They remain undifferentiated and proliferate uncontrollably.
What disease is this seen in?
Cervical Cancer
The lack of normal maturation of squamous epithelium is defined as _______ and graded as either _____, _______, or ______.
dysplasia
mild, moderate, severe
Severe dysplasia in the cervix may progress to carcinoma that initially is limited to the basement membrane.
What is this called?
Carcinoma-In-Situ or CIS
How do invasive cervix carcinomas and tumors spread locally?
- Cross the basement membrane and invade the underlying connective tissue stroma.
- invade the lymphatics and bloodstream and metastasize to distant sites.
Invasive Squamous Cell Cancer
What does “CIS” or “Cervical Intraepithelial Neoplasia” describe?
Preinvasive neoplastic lesions (dysplasia).
What does a PAP smear do?
detects cervical dysplasia and carcinomas
picks up abnormal cells that are shed from the cervix to the vagina
At what stage will cervical cancer metastasize?
When the abnormal cells cross the basement membrane.
Most CIS lesions will progress to ___________ if left untreated and many severe dysplasias will progress to ______ and later to ___________ if left untreated (40-50%)
invasive cancers
CIS
invasive cancers
What percent of mild and moderate dysplasias, if left untreated will progress to CIS and later to invase cancer?
20-30%
How would you treat a cervical lesion that is recognized early? Why?
remove surgically with a knife, laser or cryotherapy
to prevent invasive cancer
T/F: Because it is impossible to predict which CIN’s will progress and become invasive, it is recommeded that all foci of dysplasia be removed preventively.
TRUE
More than ______% of all CIN lesions contain HPV
50
What are koilocytes?
vacuolated cells typical of HPV infections of the cervix that show up in cytologic smears
What types of HPV are associated with cervical cancer?
16, 18
31, 33, 34 and 35.
What HPV types are found in benign lesions like condyloma and are NOT related to cancer?
Types 6 & 11
Cervical cancer is a ________ ________ carcinoma and the early lesions are barely visible macroscopically.
squamous cell
What is used to identify mucosal abnormalities (mosaic pattern) and tortuosity of the vessels in cervical cancer?
How would the mucosa change?
Colposcope
Changes from a smooth, shiny contour to an exo-or endophytic invasive tumor that protrudes into vagina or grows inside cervix (crater-like ulceration)
Describe a Normal Cervix
smooth shiny contour
Describe an abnormal cervix
endophytic invasive tumor
Squamous Cell Carcinoma
Necrosis + tumor
Stage 0 Cervical Cancer
No gross lesions, limited to the mucosa
CIS
Stage 1
Invasive, confined to cervix
Stage II
Cancer extends beyond cervix, does not reach pelvic wall or upper vagina.
Stage III (third)
Cancer reaches pelvic wall, invades lower third of vagina
Stage IV
cancer spread beyond pelvis, infiltrated adjacent organs.
Staging of Cervical Cancer
What is the median age of pts diagnosed with invasive cervical cancer?
50 y/o
Median age for pts diagnosed with CIN is ____
35
Because CIN precedes invasive carcinoma in almost all cases, we can conclude it takes approx _______ years for an invasive cancer to develop.
T/F: During this period, most women are symptomatic and present with increased vaginal discharge or bleeding after intercourse.
15 years
diagnosis of CIN median age: 35
diagnosis of invasive cervical cancer medical age: 50
FALSE: women are asymptomatic during this period
Once symptoms of cervical cancer develop, discharge becomes more ________ and ________
purulent & foul smelling
Is pain a feature of cervical carcinoma?
When would pain occur if it did?
NO, it is not a feature of cervical carcinoma.
It would develop in stage IV
What organs does advanced carcinoma invade most commonly and what does this cause?
urinary bladder and rectum, causing urinary urgency and obstruction.
What is the most common cause of death in pts with cervical cancer?
slowly progressive renal failure caused by urinary tract obstruction
cervical cancer metastases follows the lymph node drainage of the cervix and involves the _____ lymph nodes
Pelvic
Where does metastasis take place in the terminal stages?
abdominal & thoracic organs
T/F: good results have been obtained when Stage I or Stage II lesions have been treated surgically, or by irradiation.
TRUE
T/F: adv lesions are treated surgically, in combination with radiation and chemotherapy, but the results are not too encouraging.
TRUE
Describe prognosis of cervical cancer
Depends on the stage of the tumor
- preinvasive CIN is entirely curable
- Stage IV cancer is lethal & has a 5 yr survival rate of 15%
Stage I: 5 yr survival 87%
Stage II: 5 yr survival 75%
Stage III: 5 yr survival 35%
What is endometriosis?
endometrial tissue that forms tumor-like nodules outside the uterus
where is endometriosis most often located?
**ovary or pelvic peritoneum
outside the pelvis, on umbilicus, appendix and colon
What are the foci of endometrial tissue composed of and what do they respond to?
endometrial glands and stroma
they respond to estrogenic stimulation and proliferate with normal endometrium
Sites of endometriosis
What happens to the endometrial glands during menstruation?
the glands degenerate and bleeding occurs and the blood cannot be discharged because the endometrotic foci are encased by normal connective tissue and peritoneum.
At what age do women get endometriosis?
3rd & 4th decades of life
Higher incidence of endometriosis in women in _____ socioeconomic groups who tend to marry ______ in life.
higher
later
T/F: The pathogenesis of enodometriosis is not clearly understood
TRUE
What is the most popular theory of endometriosis?
What does the theory say?
Regurgitation Theory: endometrial tissue is regurgitated during normal menstruation and, instead of entering the vagina, it is transferred upstream where it enters the abdominal cavity through the fallopian tubes.
The glands implant on the serosa of the ovary or the peritoneum, forming typical red-brown nodules or plaques.
Endometriosis Implants on the Ovary
Where are most of the foci of endometriosis located?
Close to the orifice of the fallopian tubes
How many women of reproductive age have endometriosis?
15-20%
The endometric lesions ____ during the mestrual cycle and are infiltrated with _________ at the time of menses.
expand
blood
How do Birth control pills alleviate symptoms of endometriosis?
They suppress ovulation
Can endometriosis cause infertility?
Yes it can, but this is not well understood.
Can the treatment for endometriosis cure infertility?
Yes
T/F: endometriosis is a benign disease that does not progress to cancer.
TRUE
Ovarian endometriosis may present with large cystic lesions measuring ______ in diameter
1-5 cm
Endometric cysts are fillled with…
brown-red viscous fluid derived from decomposed blood (chocolate cysts)
Chocolate cysts (yum)
endometriotic cysts filled with brown-red viscous fluid derived from decomposed blood
What are leiomyomas?
benign tumors originating from smooth muscle cells of the myometrium (fibroids)
How many percent of leiomyomas are benign and how many are malignant?
98% are benign
1-2% malignant
What are the most common uterine tumors?
Leiomyomas
20% of women of repro age have this tumor and in most instances, they are small and clincially inapparent.
What tumor is this?
leiomyomas
Not seen prepuberty and do not develop after menopause
Most common in 3rd & 4th decades
More common in blacks
Leiomymomas
Sharply circumscribed, unencapsulated white-tan whorled masses on cut section.
Consists of smooth muscle cells arranged in fasicles.
What tumor?
Leiomyoma
What are the 3 types of fibroids in leiomyomas?
Describe them
- Intramural: embedded within the myometrium
- Subserosal: occurs beneath the covering serosa of the uterus
- Submucosa: protrube into the endometrial cavity
symptoms vary depending on their size and location
small tumors are asymptomatic
what tumor?
leimyomas
Large and multiple tumors can produce a mass effect, symptoms related to the compression of the rectum and urinary bladder, especially the subserosal type.
Abdominal heaviness, urinary urgency and constipation are commonly encountered
Tumors located beneath the mucosa tend to grow into the endometrial cavity, causing menstrual irregularities and endometrial bleeding.
What tumor is this?
Leiomyomas
Why is infertility a complication of the submucosal tumor in a leiomyoma?
they interfere with the implantation of the embryo
How are fibroids treated?
surgically
In younger women, tumors can be shelled out (myomectomy) with preservation of the rest of the uterus. Large tumors and multiple tumors usually necessitate hysterectomy.
What tumor?
Leiomyomas
What are endometrial polyps?
benign, localized overgrowths that project from the endometrial surface into the endometrial cavity
Arise from endometrial foci that are hypersensitive to estrogen stimulation or unresponsive to progesterone that, in either case, would not slough during menstruation and would continue to grow.
What tumor?
Endometrial Polyps
Most arise in the fundus, usually solitary and vary in size.
Microscopically have endometrial glands, cystically dilated and hyperplastic, with rich endometrial stroma.
Clinically presents with intermenstrual bleeding, owing to surface ulceration.
Not preneoplastic, but 0.5% harbor adenocarcinomas
What tumor?
Endometrial Polyps
Most common malignant tumor of the female genital tract
Accounts for 50% of all GYN malignancies
Arises from epithelial cells lining the endometrial glands
What is this?
Endometrial adenocarcinoma
T/F: Clinical studies have found an association between hyperestrinism and endometrial cancer, regardless of the source of estrogens.
True
More common in women who:
- are taking exogenous estrogen in the form of pills or injections.
- Have estrogen-producing tumors
- Are obese and form estrogen at an increased rate by fat tissue conversion. DM and HTN are risk factors related to obesity.
- Are nulliparous(never given birth) or have early menarche and late menopause
What is this?
Endometrial adenocarcinoma
Why do multiple pregnancies reduce the risk of endometrial carcinoma?
Progesterone, the dominant pregnancy hormone gives the endometrium long breaks from proliferation.
Estrogens stimulate the proliferation of endometrial glands, which ultimately undergo malignant transformation.
What tumor?
Endometrial Adenocarcinoma
What are exogenous estrogens used for and in who?
they are used extensively today, for replacement therapy in postmenopausal women whose ovaries have reduced capacity for estrogen production
What is the main beneficial effect of estrogen?
prevents bone loss that occurs at an accelerated rate after menopause (post-menopausal osteoporosis), even though its use increases the risk of carcinoma.
Why is estrogen still so widely used for HRT?
the beneficial risks far outweigh the risks for cancer, primarily because endometrial cancer can be detected early and treated successfully.
____% of all __________ are deteced while the tumor is confined to the uterus, and affected women have an excellent prognosis.
80
endometrial cancers
Among older women, at least 15,000 deaths/year are related to _____________, most of which are a consequence of osteoporosis caused by estrogen deficiency.
major bone fractures
_____________ has also been implicated in the pathogenesis of tumors originating from other hormone-sensitive organs like breast and ovaries
hyperestrinism
Women with endometrial carcinoma are also at an increased risk of developing ______________
carcinoma fo the ovaries and breast
most endometrial adenocarcinomas are ________ and grow into the _______
exophytic
endometrium
The tumor appears as a fungating mass protruding into the uterine lumen
The tissue is friable and soft because it consists of atypical glands with very little tissue stroma.
It is more prone to fragmentation and bleeding.
What tumor is this?
Endometrial adenocarcinoma
Endometrial adenocarcinoma
What is the most important prognostic feature for endometrial adenocarcinomas?
stage of the tumors, based on size of the tumor and extent of the tumor spread.
Stage I: Endometrial Carcinoma
confined to endometrium
Stage II: Endometrial adenocarcinoma
extending into cervix and invading endometrium
Stage III: Endometrial Carcinoma
extending through the wall of the uterus, but not outside the pelvis
Stage IV: Endometrial Adenocarcinoma
infiltrating the bladder or the rectum, or extending outside the pelvis.
Staging of Endometrial Adenocarcinoma
Disease of older women, rare before age of 35 but incidence increases steadily thereafter
MC sx: vaginal bleeding occurs as spotting between 2 menstruations, or as prolonged pronounced menstrual bleeding (menorrhagia)
Massive uterine bleeding occurs in later stages (metrorhagia), but it uncommon initially.
What tumor?
Endometrial Adenocarcinoma
T/F: Postmenopausal women should be investigated more carefully for Endometrial adenocarcinoma
True
How is final dx made for endometrial cancer?
endometrial biopsy: minor procedure involving placing a tube through the cervix and scraping the endometrium with a currete (D&C)
Tx for endometrial adenocarcinoma?
hysterectomy w/ or without the ovaries (TAH-BSO)
Pts with advanced endometrial adenocarcinoma, or those whose tumor cannot be resected completely, or when lymph node mets has remained undetected.
radiation therapy
when is chemo used in endometrial cancer?
inoperable cases
