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SP16- Gen Path Exam 3 > Female- Gynecologic and Breast Disease > Flashcards

Female- Gynecologic and Breast Disease Flashcards

1
Q

What are the 6 parts of the gynecologic system?

A
  1. fallopian tubes
  2. uterus
  3. ovaries
  4. cervix
  5. vagina
  6. labium minus
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2
Q

Most disorders of the vulva and vagina are ________ and associated with discomfort. Serious malignancies or complications are _______.

A

inflammatory

uncommon

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3
Q

______ is inflammation of the external female genitalia caused by contact irritation, allergic reaction, infection, or trauma.

A

Vulvitis

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4
Q

______ is inflammation of the vaginal canal and results in production of vaginal discharge. Vaginal discharge is also known as _______.

A

Vaginitis

leukorrhea

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5
Q

Vaginitis can be due to a variety of _____, _____, or ______ organisms.

A

bacterial, fungal, parasitic

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6
Q

True or False: Diabetes can predispose a woman to vaginitis.

A

True,

systemic antibiotic therapy can also predispose

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7
Q

What type of epithelium lines a normal cervix?

A

Non-keratinized squamous epithelium

appearance of white patches at the surface = bad news

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8
Q

The _____ acts as a barrier to the ingress of vaginal microflora into the uterus.

A

cervix

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9
Q

What else does the cervix do (other than act as a barrier)?

A
  1. allows escape of menstrual flow

2. dilates for accommodation of childbirth

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10
Q

Diseases of the cervix are either ______ or ______.

A

Inflammatory (cervicitis)

Neoplastic

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11
Q

What is cervicitis?

A

cervical inflammation that can result in purulent vaginal discharge

  • could represent a specific infection (STD)
  • could represent a non-specific infection
  • could require a biopsy to rule out cancer
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12
Q

Which cervical tumor has historically been a major cause of cancer deaths in women?

A

squamous cell carcinoma

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13
Q

True or False: The incidence of Cervical Squamous Cell Carcinoma has increased over the last 50 years, just like Gonorrhea infections.

A

False, Cervical Squamous Cell Carcinoma has PLUMMETED over the last 50 years. However, gonorrhea has indeed increased recently

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14
Q

Why has the incidence of cervical cancers decreased in the last 50 years?

A

thanks to the Papanicolaou (pap) Smear (introduced in 1940)

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15
Q

There are millions of cases of CIN diagnosed annually. What does CIN stand for?

A

Cervical Interepithelial Neoplasia

-nearly all cases of squamous cell carcinoma arise from these precursor epithelial changes

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16
Q

The Pap smear is a ______ test that detects precancerous cells through examination of exfoliated cells collected from the ______.

A

screening

cervix

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17
Q

It is often considered standard of care to co-screen for ______ during a pap smear.

A

high-risk HPV subtypes

remember which types cause venereal warts? 6 &11

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18
Q

What is a colposcopy?

A

procedure that allows for direct examination of the cervix through illumination and magnification

  • acetic acid is applied
  • abnormalities appear as white patches upon acid exp.
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19
Q

Cervival Interepithelial Neoplasia is commonly the precursor to SCC. What is the peak age for CIN?

A

30 years

*Not all CIN progress to SCC. If they do progress, it’s often 15 years later (45 years old)

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20
Q

What are the three levels of CIN?

A

(degree of epithelial dysplasia seen microscopically)

CIN I: Mild Dysplasia
CIN II: Moderate Dysplasia
CIN III: Carcinoma in situ

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21
Q

Cervical neoplasia is highly related to which STD?

A

HPV

  • transmitted via direct contact
  • High Risk Types (16/18) associated with cancer
  • Low Risk Types (6/11) associated with condyloma (warts)
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22
Q

Which are the high risk types of HPV?

A

16 and 18

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23
Q

What are the four risk factors that put a woman at higher risk for HPV?

A
  1. Early age of first intercourse
  2. Multiple sexual partners
  3. male partner with multiple previous sexual partners
  4. prolonged infection with high-risk HPV (16 and 18!!)
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24
Q

True or False: Many women harbor HPV but only a minority develop cancer

A

True

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25
Q

What is the treatment for Squamous cell carcinoma/CIN?

A
  • laser vaporization or excisional biopsy

- surgery +/- radiation and chemotherapy (invasive forms)

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26
Q

The five year survival rate for early (stage 0) cervical squamous cell carcinoma is ______, but for late (stage 4) the rate is _______.

A

100%

10%

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27
Q

True or False: HPV vaccines have been safe and effective in preventing HPV infection.

A

True

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28
Q

What are the three common HPV vaccines in use today?

A 
Gardasil
Cervarix
Gardisil 9 (covers about 92% of high risk types!)
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29
Q

The _____ _______ is the location of the majority of female reproductive tract diseases (often chronic and recurrent)

A

Uterine Corpus

body of the uterus

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30
Q

The body of the uterus is made up of what two layers?

A
  1. Myometrium

2. Endometrium

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31
Q

The myometrium is made up of interlacing bundles of ______.

A

smooth muscle

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32
Q

The endometrium is the _______ lining of the uterus and will change under _______ influence.

A

glandular

hormonal

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33
Q

Most endometrial diseases will present with abnormal uterine _______.

A

bleeding

34
Q

What are three types of abnormal uterine (menstrual) bleeding?

A
  1. Menorrhagia: abnormally heavy
  2. Metrorrhagia: bleeding between cycles
  3. Dysmenorrhea: unusually painful
35
Q

The “functional endometrium” is made up of ____ and _____.

A

glands and stroma

36
Q

True or False: The functional endometrium involved with endometriosis is located within the uterus.

A

False:
functional endometrium –> OUTSIDE the uterus
=continues to function as it would if it were in the correct place (sloughs, bleeds, etc) but the blood has no way to exit

37
Q

True or False: Endometriosis primarily affects women of reproductive years.

A

False: only 10% of this age group, mostly it affects women with infertility (50%)

38
Q

What are the effects of endometriosis (remember, this is the movement of functional endometrium from inside to outside of the uterus)?

A

Intrapelvic bleeding and organization of blood leads to widespread FIBROSIS and periuterine ADHESIONS (weird tissue causes organs to stick together)
= extreme dysmenorrhea and pelvic pain

39
Q

Large blood filled cysts, associated with endometriosis, will transform into ________ cysts as blood ages.

A

“chocolate”

40
Q

______ ______= overgrowth of endometrium

A

endometrial hyperplasia

41
Q

What causes endometrial hyperplasia?

A

excess exposure to estrogen (endogenous or exogenous)

42
Q

Stages of endometrial hyperplasia are mild, moderate, and _____.

A

atypical hyperplasia

43
Q

True or False: Endometrial hyperplasia has the potential to develop into squamous cell carcinoma.

A

False,
sorry that was tricky. HAHA
I’m not laughing at you…I’m telling you that
(H)yperplasia –> (A)denocarcinoma

44
Q

Endometrial hyperplasia (and adenomas) have a high concentration of what type of tissue?

A

glandular

45
Q

True or False: Uterine tumors arise only from the endometrium.

A

False, may arise from the myometrium or endometrium

46
Q

What are the three most common uterine tumors?

A
  1. endometrial polyps
  2. smooth muscle tumors (fibroids)
  3. carcinomas
47
Q

What is the most common benign tumor in females?

A

fibroids (leiomyoma)

  • tumor of myometrial smooth muscle origin
  • occurs in 30 to 50% of women of reproductive age
  • growth stimulated by estrogen
  • could be asymptomatic or cause menorrhagia
48
Q

What is the most common female genital tract cancer in the US?

A

Endometrial Carcinoma

49
Q

When is endometrial carcinoma typically diagnosed?

A

between 55 and 65 years old (after menopause)

50
Q

_______ is the most common type of endometrial carcinoma and is associated with excess estrogen or endometrial hyperplasia.

A

endometrioid

not to be confused with fibroids which is benign

51
Q

The prognosis of endometrial carcinoma is _____% 5-year survival for stage I and ______% 5-year survival for stages III and IV.

A

90

20

52
Q

True or False: Non-neoplastic cysts of the ovaries are common but are not generally a serious problem.

A

True

53
Q

Of the ovarian disorders, ________ represents the most significant disease.

A

neoplasia

54
Q

What is polycystic ovarian disease?

A
  • common hormonal disorder (5-10% reproductive age)
  • causes multiple cystic follicles to form along the walls of the ovaries
  • follicles produce excess ANDROGENS and ESTROGENS
55
Q

What are the common clinical signs of Polycystic Ovary Disease?

A 
oligomenorrhea (irregular menstruation)
hirsutism (excess hair)
acne
fertility problems
obesity
increased risk for type II diabetes/hypertension
56
Q

Are malignant ovarian tumors more likely to develop from Surface epithelial cells, stromal cells, or germ cells?

A

surface epithelial (90%)

57
Q

Ovarian carcinoma is the _____ leading cause of cancer deaths in women.

A

5th

58
Q

True or False: Nulliparity (not bearing offspring) is a risk factor for ovarian carcinoma.

A

TRUE

59
Q

Ovarian carcinomas are related to family history 5-10% of the time. The mutation occurs in which gene?

A

BRCA genes (BRCA1/BRCA2)

60
Q

If ovarian carcinoma spreads outside of the ovary, the 10-year survival rate is less than _____%.

A

15%

dangerous because most are asymptomatic until large

61
Q

What is a teratoma?

A

a tumor of all three germ layers

ectoderm, mesoderm, endoderm

62
Q

Malignant cystic teratomas are rare. _____% are benign and often found on pelvic examination.

A

90

63
Q

Benign cystic teratomas are also called ______ _____. Why are these bizarre?

A

dermoid cysts
-they often contain mature elements that shouldn’t be there like teeth, hair, skin, bones, cartilage, respiratory epithelium, etc.

64
Q

Palpable nodules/masses of the breast tissue are extremely common. How often are these nodules cancerous?

A

10% are cancer

65
Q

Breast nodules are commonly the result of ______ change that arises during the reproductive years due to exaggeration and distortion of normal cyclic breast changes.

A

fibrocystic

66
Q

_______ is the most common BENIGN neoplasma of breast tissue and accounts for 7% of breast lumps.

A

fibroadenoma

67
Q

When is the peak prevalence of fibroadenoma?

A

3rd decade

68
Q

What does a fibroadenoma feel like, clinically? How does it look microscopically?

A

clinically: freely movable, 1-10cm nodule, solitary
biopsy: proliferation of stromal (fibro) and glandular (adenoma) tissue

69
Q

Breast carcinoma (10% of lumps) will arise from _____ elements of the breast.

A

glandular

there are lobular and ductal forms

70
Q

What is the lifetime risk of breast cancer?

A

1 in 8

71
Q

Breast cancer is the _____ leading cause of cancer death in women.

A

2nd

lung is number one

72
Q

When do the majority (75%) of breast cancers occur?

A

after age 50

73
Q

What are three important risk factors for breast carcinoma?

A
  1. genetics (BRCA1/BRCA2)
  2. hormones (prolonged estrogen use)
  3. environmental (radiation, diet, nursing)
74
Q

True or False: Breast carcinoma presents clinically as a discrete, tender mass.

A

False: non-tender

75
Q

What does “peau d’orange” have to do with breast cancer?

A

“surface of an orange” appearance of surface epithelium that occurs due to thickened skin overlying the cancer

76
Q

True or False: A mammogram is diagnostic for breast cancer.

A

False, need a biopsy!

Mammograms are great but they don’t show conclusive evidence of cancer (they detect calcification of soft tissue)

77
Q

Breast carcinoma can be _____ or _____. Both types have a pre-invasive stage.

A

ductal

lobular

78
Q

What does DCIS and LCIS stand for?

A

DCIS: ductal carcinoma in-situ
LCIS: lobular carcinoma in-situ

note: at this stage, the cancer is still has defined borders; when the cancer becomes invasive, the borders are no longer well-circumscribed

79
Q

______ is an anti-estrogen therapy drug used to treat breast cancer.

A

tamoxifen

80
Q

What is the overall 10-year survival rate for breast carcinoma?

A

50%

metastases may occur many years after apparent control of primary lesion

SP16- Gen Path Exam 3 (12 decks)

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