Female 2 Flashcards
1
Q
What is this describing?
The normal squamocolumnar junction is the anatomical junction of the squamous and the mucinous epithelia.
A
Cervical Transformation Zone
2
Q
The __________ is the macroscopically visible junction between the exocervix and endocervix
A
External os
3
Q
Cervical Transformation Zone:
With age, the mucinous columnar epithelium undergoes squamous metaplasia, where the columnar epithelium is transformed into __________ strat. squamous epithelium.
A
stratified squamous epithelium
4
Q
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.
A
Cervical Transformation Zone
5
Q
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.
A
Exfoliative Cytology
6
Q
The __________ is the cervical cytological test where the most superficial epithelial cells are exfoliated.
A
PAP smear
7
Q
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.
A
Cervicitis
8
Q
What are the common microorganisms involved in cervicitis?
A
- **MC: Staph & Strep
- Chlamydia, Neisseria, Herpes
9
Q
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.
A
Acute Cervicitis
10
Q
Describe the microscopic findings in acute cervicitis
A
infiltrate of polymorphonuclear leukocytes and stromal edema
11
Q
Chronic cervicitis is ________ than acute cervicitis
A
more common
12
Q
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.
A
Chronic Cervicitis
13
Q
- 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.
A
Carcinoma of the Cervix
14
Q
The cause of Cervical cancer is unknown but there are several risk factors that MAY play a role in cervical cancer.
What are they?
A
- Sex at a young age
- Multiple sex partners (prostitutes)
- HPV infection
- Other venereal diseases like Herpes or Syphilis
15
Q
Squamous cell cancer that originates in transformation zone and has intense cell proliferation
A
Cervical cancer
16
Q
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?
A
Cervical Cancer
17
Q
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?
A
Cervical Cancer
18
Q
The lack of normal maturation of squamous epithelium is defined as _______ and graded as either _____, _______, or ______.
A
dysplasia
mild, moderate, severe
19
Q
Severe dysplasia in the cervix may progress to carcinoma that initially is limited to the basement membrane.
What is this called?
A
Carcinoma-In-Situ or CIS
20
Q
How do invasive cervix carcinomas and tumors spread locally?
A
- Cross the basement membrane and invade the underlying connective tissue stroma.
- invade the lymphatics and bloodstream and metastasize to distant sites.
21
Q
Invasive Squamous Cell Cancer
A
22
Q
What does “CIS” or “Cervical Intraepithelial Neoplasia” describe?
A
Preinvasive neoplastic lesions (dysplasia).
23
Q
What does a PAP smear do?
A
detects cervical dysplasia and carcinomas
picks up abnormal cells that are shed from the cervix to the vagina
24
Q
At what stage will cervical cancer metastasize?
A
When the abnormal cells cross the basement membrane.
25
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**
26
What percent of mild and moderate dysplasias, if left untreated will progress to CIS and later to invase cancer?
20-30%
27
How would you treat a cervical lesion that is recognized early? Why?
remove surgically with a **knife, laser or cryotherapy**
to prevent invasive cancer
28
**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**
29
More than \_\_\_\_\_\_% of all CIN lesions contain **HPV**
50
30
What are koilocytes?
**vacuolated cells typical of HPV** infections of the cervix that **show up in cytologic smears**
31
What types of HPV are associated with cervical cancer?
**16, 18**
**31, 33, 34 and 35.**
32
What HPV types are found in **benign lesions like condyloma** and are **NOT related to cancer**?
**Types 6 & 11**
33
Cervical cancer is a ________ \_\_\_\_\_\_\_\_ carcinoma and the **early lesions are barely visible macroscopically.**
**squamous cell**
34
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)_**
35
Describe a **Normal Cervix**
**smooth shiny contour**
36
Describe an **abnormal cervix**
**endophytic invasive tumor**
37
Squamous Cell Carcinoma
Necrosis + tumor
38
**Stage 0 Cervical Cancer**
No gross lesions, **limited to the mucosa**
## Footnote
**CIS**
39
**Stage 1**
Invasive, **confined to cervix**
40
Stage II
Cancer **extends beyond cervix, does not reach pelvic wall or upper vagina.**
41
Stage **III (third)**
Cancer **reaches pelvic wall**, invades lower **third** of vagina
42
Stage IV
cancer spread beyond pelvis, **infiltrated adjacent organs.**
43
Staging of Cervical Cancer
44
What is the **median age of pts diagnosed with invasive cervical cancer?**
**50 y/o**
45
**Median age for pts diagnosed with CIN is \_\_\_\_**
**35**
46
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**
47
Once symptoms of cervical cancer develop, discharge becomes more ________ and \_\_\_\_\_\_\_\_
**purulent & foul smelling**
48
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**
49
What **organs** does **advanced carcinoma** invade most commonly and what does this cause?
**urinary bladder and rectum,** causing **urinary urgency and obstruction.**
50
What is the **most common cause of death** in pts with cervical cancer?
**slowly progressive renal failure** caused by **urinary tract obstruction**
51
cervical cancer metastases **follows the lymph node drainage of the cervix** and involves the _____ lymph nodes
**Pelvic**
52
Where does metastasis take place in the terminal stages?
**abdominal & thoracic organs**
53
**T/F:** good results have been obtained when **Stage I or Stage II lesions** have been treated **surgically, or by irradiation.**
**TRUE**
54
T/F: **adv lesions are treated surgically, in combination with radiation and chemotherapy**, but the results are not too encouraging.
**TRUE**
55
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%**
56
What is **endometriosis**?
**endometrial tissue** that forms **tumor-like nodules outside the uterus**
57
where is endometriosis most often located?
**\*\*ovary or pelvic peritoneum**
outside the pelvis, on **umbilicus, appendix and colon**
58
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**
59
Sites of endometriosis
60
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.**
61
At what age do women get endometriosis?
**3rd & 4th** decades of life
62
Higher incidence of endometriosis in women in _____ socioeconomic groups who tend to marry ______ in life.
**higher**
**later**
63
**T/F:** The pathogenesis of enodometriosis is not clearly understood
**TRUE**
64
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.**
65
Endometriosis Implants on the Ovary
66
Where are most of the foci of endometriosis located?
Close to the orifice of the fallopian tubes
67
How many women of reproductive age have endometriosis?
15-20%
68
The endometric lesions ____ during the mestrual cycle and are infiltrated with _________ at the time of menses.
expand
blood
69
How do **Birth control pills** alleviate symptoms of endometriosis?
They suppress ovulation
70
Can endometriosis cause infertility?
Yes it can, but this is not well understood.
71
Can the treatment for endometriosis cure infertility?
Yes
72
**T/F:** endometriosis is a benign disease that does not progress to cancer.
**TRUE**
73
**Ovarian endometriosis** may present with **large cystic lesions** measuring ______ in diameter
1-5 cm
74
Endometric cysts are fillled with...
brown-red viscous fluid derived from decomposed blood **(chocolate cysts)**
75
**Chocolate cysts (yum)**
**endometriotic cysts** filled with **brown-red viscous fluid** derived from **decomposed blood**
76
What are l**eiomyomas**?
**benign tumors** originating from **smooth muscle cells of the myometrium (fibroids)**
77
How many percent of leiomyomas are benign and how many are malignant?
98% are benign
1-2% malignant
78
What are the most common uterine tumors?
Leiomyomas
79
**20% of women of repro age** have this tumor and in most instances, they are **small and clincially inapparent.**
**What tumor is this?**
leiomyomas
80
**Not seen prepuberty** and **do not develop after menopause**
Most common in **3rd & 4th decades**
More **common in blacks**
Leiomymomas
81
**_Sharply circumscribed_,** **_unencapsulated_ _white-tan whorled masses_ on cut section.**
Consists of **smooth muscle cells arranged in fasicles.**
What tumor?
Leiomyoma
82
What are the **3 types of fibroids in leiomyomas**?
Describe them
1. **Intramural:** embedded _within the myometrium_
2. **Subserosal:** occurs _beneath the covering serosa of the uterus_
3. **Submucosa:** protrube into the _endometrial cavity_
83
symptoms vary depending on their size and location
**small tumors are asymptomatic**
what tumor?
leimyomas
84
**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
85
Why is **infertility** a **complication of the submucosal tumor** in a **leiomyoma**?
they **interfere with the implantation of the embryo**
86
How are fibroids treated?
surgically
87
**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
88
What are **endometrial polyps**?
**benign, localized overgrowths** that **project** from the **endometrial surface** into the **endometrial cavity**
89
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
90
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
91
**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
92
**T/F:** Clinical studies have found an association between hyperestrinism and endometrial cancer, regardless of the source of estrogens.
True
93
**More common in women who:**
1. are taking **exogenous estrogen** in the form of **pills or injections.**
2. Have **estrogen-producing tumors**
3. Are **obese** and **form estrogen** at an **increased rate by fat tissue conversion**. **DM and HTN** are **risk factors** related to obesity.
4. Are **nulliparous(never given birth)** or have **early menarche** and **late menopause**
**What is this?**
Endometrial adenocarcinoma
94
Why do **multiple pregnancies** reduce the **risk of endometrial carcinoma?**
**Progesterone, the dominant pregnancy hormone gives the endometrium long breaks from proliferation.**
95
Estrogens stimulate the proliferation of endometrial glands, which ultimately undergo malignant transformation.
What tumor?
Endometrial Adenocarcinoma
96
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**
97
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**.
98
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.**
99
\_\_\_\_% of all __________ are deteced while the tumor is confined to the uterus, and **affected women have an excellent prognosis.**
**80**
**endometrial cancers**
100
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**
101
\_\_\_\_\_\_\_\_\_\_\_\_\_ has also been implicated in the **pathogenesis of tumors** originating from other hormone-sensitive organs like **breast** and **ovaries**
**hyperestrinism**
102
Women with endometrial carcinoma are also at an increased risk of developing \_\_\_\_\_\_\_\_\_\_\_\_\_\_
carcinoma fo the ovaries and breast
103
most endometrial adenocarcinomas are ________ and grow into the \_\_\_\_\_\_\_
**exophytic**
**endometrium**
104
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
105
Endometrial adenocarcinoma
106
What is the most **important prognostic feature** for endometrial adenocarcinomas?
**stage of the tumors**, based on **size of the tumor** and e**xtent of the tumor spread.**
107
**Stage I:** Endometrial Carcinoma
confined to endometrium
108
**Stage II:** Endometrial adenocarcinoma
extending into cervix and invading endometrium
109
**Stage III:** Endometrial Carcinoma
extending through the wall of the uterus, but not outside the pelvis
110
Stage IV: Endometrial Adenocarcinoma
**infiltrating the bladder or the rectum**, or extending **outside the pelvis.**
111
Staging of Endometrial Adenocarcinoma
112
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
113
**T/F:** Postmenopausal women should be investigated more carefully for Endometrial adenocarcinoma
True
114
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)**
115
Tx for endometrial adenocarcinoma?
**hysterectomy** w/ or without the ovaries **(TAH-BSO)**
116
Pts with **advanced endometrial adenocarcinoma,** or those whose **tumor cannot be resected completely**, or when l**ymph node mets has remained undetected**.
radiation therapy
117
when is **chemo** used in **endometrial cancer**?
inoperable cases
118
