Gynecology Flashcards
- Breast diseases
Mastitis
Fibrocytic changes
Hyperplasia
Galactocele
Fibroadenoma
- Breast cancer types
Types:
Mainly epithelial tumors, from cells lining ducts and lobules
Carcinoma in situ:
* ductal (85%)
* lobular
Invasive carcinoma (adeno)
* infiltrative ductal type (75%)
* inflitrating lobular
* mucinus, tubulur, papillary
Inflammatory breast cancer
Paget disease of the nipple
- breast cancer
Risk factors, clinical presentation, screening, diagnosis, treatment
Risks: Age > 50, fam. history, BRCA1-2, early menarche/late menopause/late 1st preg., hormone replacement ther., OCP, radiation, lifestyle
Clinical: Mass discovered by pt., thickening in skin, rarely pain. Advanced stage fixation of the mass to chest wall: mixed axillary, supra- or infraclavicular l.n suggests tumor spread.
Screening: Mammography, MRI, CBE (clinical breast examination), BSE (breast self examination)
Diagnosis: take biopsy of every suspicious lesions (core biopsy), repeated mammography (6-12w after), senital l.n. biopsy
Treatment:
* lumpectomy + axillary l.n. dissection (if sentinel l.n is +) if tumor is found early, unilateral and <4cm
* Mastectomy: simple for DCIS and LCIS, modified for larger
* Radiation: ALWAYS
* Chemo: doxorubicin + cyclophosphamide + paclitaxel
* Targeted: tamoxifen etc. (remember it incr. the risk of cancer in uterus
- Sexually transmitted diseases in female
List bacterial and viral
Bacterial: Syphilis, gonorrhea, chlamydia, mycoplasma, ureaplasma, lymphgranuloma venerum
Viral: genital/anorectal warts, herpes, HIV, molloscum contagiosum
- Sexually transmitted diseases in female
Treatment
Chlamydia trachomatis: azithromycin + doxycycline (swap for erythromycin or amoxicillin in pregnancy
Neisseria gonorrhea: azithromycin + doxyxycline
HPV 6, 11: cryotherapy, imiquimoid cream, podophyllotoxin. HPV vaccine prevention
Genital herpes HSV-2: Acyclovir cream, systemic acyclovir
Syphilis: Penicillin G for all stages
HIV/AIDS: ART (antiretroviral treatment)
Lymphgranuloma venerum: erythromycin/doxycycline
- Staging of corporal cancer
FIGO staging
Stage I
1A < 50% myometrium
1B > 50% myometrium
Stage II
Invades cervical serosa, not beyond uterus
Stage III
IIIA: invades corporal serosa and/or adnexa
IIIB: vaginal and/or parametrial involvement
IIIC: met. to pelvic/paraaortic l.n.
Stage IV
IVA: bladder and/or bowel mucosa
IVB: distant metastasis intraabd. and inguinal l.n.
- Therapy of corporal cancer
Stage I+II: total abdominal hysterectomy and bilateral salpingoophorectomy. To preserve fertility, surgery can be postponed and metroxyprogesterone acetate is given for 3-6 months.
Stage III-IV: TAH + BSO + radiation + chemo
- Functional ovarian cysts
Follicular cysts
Corpus luteum cysts
Theca-lutein cysts
*Ovarian masses can be functional, inflammatory, metaplastic and neoplastic. During childbearing age, 70% of non-inflammatory benign ovarian tumors are functional. *
- Benign neoplasms of ovaries
Epithelial ovarian neoplasm:
* Serous cystadenoma
* Mucinous cystadenoma
Sex-cord stromal ovarian neoplasm
* Granulosa-theca cell tumors
* Sertoli-leydig cell tumors
* Fibromas
Germ-cell tumors
* Dermatoid cyst
* Gonadoblastoma
- Ovarian tumors
Etiology, clinical, screening
Etiology/risks: BRCA gene, nulliparity, ealry menarche/late menopause, fam. history. Decreased risk: oral contraceptives.
Clinical: Based on stage.
* early: asymp., vague abd. pain, bloating
* advanced: non-spec. symp. (dyspepsia, bloating, bacache). Later pelvic pain, anemia, abd. selling, ascites.
Screening: Tumor markers lack specificity and sensitivity for early disease, and population screening therefore not effective.
* CA-125 more useful in postmenopausal women, high false pos. rate in premenopausal.
* Asymp high risk pt. should have pelvic ex. screening
* BRCA gene screening for high risk pt.
* Prophylactic salpingoophorectomy for high risk pt. once childbearing has been completed.
- Ovarian tumors
Etiology, clinical, screening
- Staging of ovarian neoplasms
Stage I:
* IA: one ovary, intact capsule, - cyt
* IB: both ovaries, intact capsule, - cyt
* IC: one/both ovaries and/or ruptured capsule, + cyt
Stage II:
* IIA: one/both ovaries + ext. to uterus/foll.t.
* IIB: one/both ovaries + ext. other pelvic intraper. organs
Stage III: one/both ovaries + met. to peritoneum outside pelvis and/or met. to retroper. l.n.
Stage IV:
* IVA: pleural effusion with + cyt
* IVB: met to extraabd. organs (inguinal l.n.)
- Therapy of oavrian neoplasms
Surgical exploration of abd. and pelvis.
* IA: childbearing age: USO then TSH-BSO
* IB: TAH-BSO
* IC: TAH-BSO + peeritoneal radioacive phosphorus
* II-IV: TAH-BSO + omentectomy + debulking + chemo
- Pathology of ovarian neoplasms
Epithelial: serous, mucinous, endometroid, clear cell
**Germ cell: **dysgerminomas, immature teratomas, endodermal sinus tumor
Gonadal stromal tumors: granulosa cell, thecomas, sertoli-leydig cell
- Normal and abnormal position of the vagina and uterus (genital prolapse) and their treatment
Vaginal prolapse (cystocele, rectocele, enterocele)
Uterine prlapse (1st-4th degree)
Treatment:
* Non-surgical: pelvic floor muscle excercises, pessaries
* Surgical: Hysterectomy, suspension of the top of the vagina, colporrhapy (repair of pelvic support structures)
