female

Question 1

cervical cancer can spread to the

Answer 1

volon and the bladder as there is only a thin endothelial cell in between them

Question 2

FSH- NOT ON exam

Answer 2

GOES TO THE OVARY -> estrogen-> endometrium -> proliferation of glands (primed for implantation

Question 3

LH- NOT ON EXAM

Answer 3

goes to ovary-> progesterone-> endometrium-> prepares endometrium for implantation

Question 4

hypothalamus release NOT ON EXAM

Answer 4

GnRH -> anterior pituitRY -> fsh and LH

Question 5

Vaginal bleeding

Answer 5

hormonal disorder
- dysfunctional uterine bleeding (DUB)

Genital Neoplasia
- fibroids
= endometrial disease
-cervical disease

Question 6

Uterine Fibroids

Answer 6

Leiomyoma of Uterus
Benign tumors of smooth muscle cells of myometrium
Almost all benign
Most common uterine tumor (20% of women have them)

Clinical Features:
Small tumors – 	asymptomatic
Larger tumors
“mass effect” (compression of rectum & bladder)
Abdominal heaviness
Constipation
Menstrual irregularities & bleeding

Question 7

Dysfunctional Uterine Bleeding (DUB)

Answer 7

Abnormal bleeding in the absence of a well –defined organic lesion in the uterus.
1. Failure of ovulation (anovulation)

Question 8

Endometrial Hyperplasia

Answer 8

Excess of estrogen (unopposed estrogen) for prolonged periods of time

Causes:
Anovulatory cycles around menopause
Exogenous estrogen
Polycystic ovarian disease( just grows and grows (proliferates

Types:

Simple
Complex
Complex with atypia
Precursor to endometrioid carcinoma (20-25% risk)

need to remove the uterus

Question 9

Endometrial Carcinoma- if hyperplaisa continues

Answer 9

Two Types:
1. Endometrioid Carcinoma:
arises in a background of hyperplasia.
Estrogen dependent

2. Serous carcinoma: 
Estrogen independent. 
Arises in a background of atrophic endometrium.
 P53 mutation. 
High grade

Epidemiology

Age 55-65

Risk Factors:
		Obesity
		Diabetes
		Hypertension
		Infertility

Question 10

2. Serous carcinoma:

Answer 10

Estrogen independent. 
Arises in a background of atrophic endometrium.
 P53 mutation. 
High grade
usually older in age (70)

Question 11

1. Endometrioid Carcinoma:

Answer 11

arises in a background of hyperplasia.
Estrogen dependent
(age 55)

Question 12

5 stages of cancer growth: Staging

Answer 12

– Limited to Mucosa
Stage 1 – Invasive confined to Cx
Stage 2 – Beyond Cx, not reaching pelvic wall
Stage 3 – Reaching Pelvic Wall
Stage 4 – Beyond Pelvis ± Metastases
one it reaches the cervix 50% survival\ once it leaves to bladder-20%

Question 13

Carcinoma of Cervix

Answer 13

20% of malignant tumors of female reproductive tract

Mortality reduced by early detection: (Papanicolaou “Pap” Smear)

Question 14

Etiology and pathogenesis- cervical cancer

Answer 14

Human Papillomavirus: (most common) Types 16 and 18

Risk Factors
Sexual Intercourse at Early age
Multiple Sexual Partners
Evidence of HP Virus Infection
Persistent infection by High risk HPV

type of cells: Squamous Cell (lines the vaginal cervic surface)Carcinoma
Originate in Transformation Zone !!!!!(where Endocervix meets Exocervix)(scaumous meets the ___ cells)
Zone of intense cell proliferation (Proliferating cells are susceptible to Viral Infection)
Progresses from low to high grade dysplasia to invasive carcinoma

Question 15

Clinical Features cervicalcancer

Answer 15

Median Age 50 years
Age At Dx of CIN 35 years
Early on
Post-coital Bleeding
Vaginal Discharge

Question 16

Most common cause of abnormal uterine/vaginal bleeding is:

Answer 16

A. dysfunctional uterine bleeding

Question 17

inflammations

Answer 17

Vulvitis
Vaginitis (the first 2- vulvovaginitis)
Cervicitis
Endometritis (PID pelvic inflammatory disease)
Salpingitis
Oophoritis

abnormal implantation, infertility,

Question 18

Pathogenesis of vulvovaginitis

Answer 18

Ascending (More Common)
Sexual Contact
Vagina  Uterus  Fallopian Tubes
Descending
Hematogenous or Lymphatic Spread from other organs  (eg Tb)

Question 19

Etiology- vulvovaginitis

Answer 19

Protozoa: Trichomonas vaginalis
Chlamydial
Chlamydia trachomatis
Cervicitis
Urethritis
PID
Fungal
Candida albicans(fungal infection) (Monilia)
Vulvovaginitis

Question 20

Common Infections

Answer 20

genital herpes and herpes simplex

HPV

Infectious vaginitis - trichomonas, gardnerell, candida

Question 21

Clinical Features

Answer 21

All may be associated with systemic symptoms
Fever
Malaise
General Uneasiness
Local Symptoms
Viruses
Blisters or Warts
Vaginitis
Copious discharge
Chlamydia
Vulvitis, Urethritis, Dysuria
Vaginal Discharge
Local Symptoms
Gonorrhea
Urethritis (Dysuria)
Proctitis
PID
Septicemia
Arthritis

Question 22

Pelvic Inflammatory Disease (PID)

Answer 22

Salpingitis
Red
Swollen
Filled with Pus
Tubo-ovarian Abscess
Lower Abdominal Pain -> Peritonitis

Question 23

Fibrocystic Change- the duct gets blocked - forms a cyst

Answer 23

Consequence of an exaggerated and distortion of the cyclic breast changes that occur normally in the menstrual cycle.
Fibrosis & Cystic Degeneration reactive to Hormonal changes
50% of women show Histologic changes
10 - 15% of women show Clinical Signs

Question 24

sni- etiny??

Answer 24

make the milk

Question 25

Pathogenesis

Answer 25

Main feature is Fibrosis.
Loose connective tissue replaced by dense collagenous connective tissue unresponsive to hormones.
Breast becomes filled with dense broad sheets of collagenous tissue
Fibrous strands may interrupt blood supply  degenerative changes, necrosis & calcification

Question 26

Pathogenesis

Answer 26

Nonproliferative Change:
Ch by increase in fibrous stroma associated with cyst formation.

Proliferative Change:
Nonproliferative + hyperplasia of epithelial cells with in terminal ducts

Question 27

Clinical Features

Answer 27

Asymmetrical changes of
Pain
Nodularity
Sensitivity to palpation
Fine Nodularity on palpation
Fluctuating lumps (= cysts)
Difficult to distinguish from malignancy 			  commonly biopsied

Question 28

Fibroadenoma

Answer 28

Common benign tumor, young females
2 – 5 cm in diameter
Encapsulated, Round, Lobulated, solitary, discrete, movable
Composed of fibrous stroma & glandular epithelium
May represent exaggerated response of breast tissue to sex hormones, especially estrogen

Most common bening in women
Incidence 1 : 10 women
~ 700 new cases in Sask each year
~ 5,000 deaths in Canada each year

Question 29

Carcinoma of Breast

Answer 29

Most common cancer in women
Incidence 1 : 10 women
~ 700 new cases in Sask each year
~ 5,000 deaths in Canada each year

Question 30

Risk Factors

Answer 30

Hormonal
increase with prolonged exposure to E2 (estrogen)
(early menarche – late menopause)
Nulliparous women greater risk
Effect of Anti-Estrogen drugs suggests hormonal influence

Premalignant Fibrocystic Changes
Papillomatosis
Atypical Intraductal Hyperplasia
Progress to Invasive Ca over several years

Race
 in Orientals
Common in Caucasians
 in Jews
Reproductive Hx
 Multiparity, Early age pregnancy
 Breast Feeding

Question 31

Pathology

Answer 31

Infiltrating Duct Carcinoma
Adenocarcinoma with desmoplastic reaction (dense fibrous tissue response to tumor)
Tumor is firm & gritty
-> retraction of nipple

Question 32

Clinical Features

Answer 32

Mass Lesion
80% Detected by Self-examination, Physician palpation, Mammography
Occasionally associated with Enlarged Axillary LN

Detection:
Palpation: 2 – 2.5 cm
Mammography: ~ 0.5 cm
(also look for microcalcification)

Question 33

Diagnosis

Answer 33

Fine Needle Aspiration (Cytology)
Surgical Biopsy (Histology)

Question 34

Prognosis

Answer 34

Stage I (Localized, <2.5 cm)
80 % 5 year Survival
Stage 2 (2–5 cm  local LN spread)
65 % 5 year Survival
Stage 3 (> 5 cm, No distant mets)
40 % 5 year survival
Stage 4 (Distant Mets) – 10 %

Question 35

Fibroadenoma

Answer 35

young pl, 15-35

Question 36

fibrocystic disease

Answer 36

35-55

Question 37

carcinoma

Answer 37

35- 75