lecture 2 part 2- female Flashcards
-benign smooth muscle neoplasm
-fibroids
-may cause irregular bleeding(metrorrhagia)
-painful intercource (dyspareunia)
uterine leiomyoma
-glandular epithelium
-bleeding
proliferative lesions: endometrial hyperplasia and polyps
2 major diseases of the endometrium
endometriosis
adenocarcinoma
-endometrial tissue outside the uterine cavity
-Ectopic endometrial tissue influenced by hormonal change
-Recurring pelvic pain
-Symptoms depend on the site involved and worsen with the
menstrual cycle
endometriosis
“chocolate cyst”
endometriosis- ovary
risk factors for endometrial carcinoma
- age- most common in the 55 to 65 age group
- obesity- greater synthesis of estrogen in body fat
- infertility- women who are nulliparous are at increased risk of endometrial carcinoma
-Exfoliative cytologic screening for early detection (Papanicolau smear)
-squamo-columnar junction
-vaccination
cervical squamous cell carcinoma
cervical squamous cell carcinoma are mostly caused by
HPV sub types 16 and 18
sequence of events that may follow HPV infection
- sex
- HPV exposure
- low risk HPV[condyloma]
or high risk HPV 16 and 18 [CIN->higher grade CIN-> invasive cancer->metastasis]
Cervical Intraepithelial Neoplasia (grades I, II, III)
LSIL- low-grade squamous intraepithelial lesion
HSIL- high-grade squamous intraepithelial lesion
A tumor containing tissues from all three germ layers
teratoma
Most tumors are derived from one
cell layer
(ectoderm, endoderm, mesoderm)
-Generally arise in gonadal tissues
-Most commonly seen in the ovary
teratoma
may contain a variety of tissues including hair, teeth, bone, cartillage,
thyroid, etc.
“Dermoid cyst” of the ovary – a benign cystic teratoma
-Pelvic inflammatory disease
-Tubal scarring
-Ectopic pregnancy
gonerrhea
(neisseria gonorrhea)
5 parts of breast
Glandular epithelium
Ducts
Lobules
Interstitial tissue
Lymphatics
-Enlargement of male breast may occur in response to estrogen
-Hyperestrinism in male
gynecomastia
gynecomastia
bilateral:
unilateral:
bilateral: rule out hormonal
unilateral: rule out tumor
Cirrhosis of liver – inability to metabolize estrogens
Klinefelter syndrome
Estrogen-secreting tumors
Estrogen therapy
factors of gynecomastia
-Most common benign neoplasm of breast
-Discrete, usually solitary, moveable nodule
-Young women (third decade)
fibroadenoma
Invasive lobular carcinoma
lobules
Invasive ductal carcinoma
ducts
-Genetic changes
-Hormonal influences
-Environmental variables
pathogenesis of breast cancer
well-established risk factors in breast cancer (6)
- Age – uncommon < 30 y
- Genetics and family history - p53, BRCA1/2
genes - Menstrual history – early menarche (<12y),
late menopause (>55y) - Length of reproductive life
- Nulliparous – having children is protective
- Geographic variation
other breast cancer risk factors
- Exogenous estrogens – postmenopausal hormone
replacement therapy - Oral contraceptives – newer formulations of balanced,
low doses of estrogen and progestin safe - Ionizing radiation during breast development
Less well-established risk factors for breast cancer
alcohol
high fat diet
obesity
cigarette smoking
Familial syndromes with breast cancer
- Li-Fraumeni Syndrome – germ-line mutations in p53
- Cowden Syndrome – germ-line mutations in PTEN
- Ataxia-telangiectasia gene –
DNA repair genes - BRCA1/BRCA2 – germ-line
mutations
-Epidermal growth factor
receptor
-Amplified in 30% of breast
cancers
-Overexpression associated with
poor prognosis
-Therapeutic intervention –
Herceptin (trastuzumab)
HER2/NEU proto-oncogene
with breast cancer
Genetic changes continued:
Amplification of ____ and ____
(proto-oncogenes)
mutations on ___and ___(tumor suppressor genes)
estrogen receptor positivity-> therapeutic intervention:
progesterone receptor positive
RAS and MYC
Rb and p53
tamoxifen
increased exposure to estrogen is a
risk factor for breast cancer
-long duration of reproductive life (more estrogen)
-nulliparity- having children is protective
-late age at birth of first child
The more ______ the breasts are exposed to over a lifetime, the higher the risk of
breast cancer. During each monthly menstrual cycle, the breasts are exposed to
increased ______ levels, especially at the time of ovulation.
estrogen
estrogen
Both early age at the start of menstrual cycles (menarche) and late menopause
increase breast cancer risk through increased exposure to estrogen during more
menstrual cycles.
T/F
true
Late age for menarche and early age for menopause decrease breast cancer risk through
fewer menstrual cycles.
increase breast cancer risk through
increased exposure to estrogen.
birth control pills and hormone replacement therapy
The more alcohol consumed, the more impaired the liver becomes in its
ability to metabolize estrogen. Therefore, alcohol consumption
increases breast cancer.
This is because adipose tissue produces small amounts of
estrogen.
obesity is risk for breast cancer
most common breast cancer location
upper outer quadrant-50%
central portion- 20% next
- have not penetrated the basement membrane
-Ductal carcinoma in situ (DCIS, intraductal carcinoma)
-Lobular carcinoma in situ (LCIS)
noninvasive classification of breast cancers
- have penetrated the basement membrane (infiltrating)
-Invasive ductal carcinoma – most common (scirrhous carcinoma)
-Invasive lobular carcinoma
invasive classification of breast cancers
-Precursor lesion to invasive carcinoma
-When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same
breast.
-treatment is surgery and radiation
ductal carinoma in situ
antiestrogenic if estrogen receptor + (blocks estrogen receptor)
tamoxifen
post-menopausal women (blocks estrogen formation)
aromatase inhibitors
-Clinical variant of DCIS
-Extension of DCIS up to the lactiferous ducts and into the
contiguous skin of the nipple
-Crusting exudate over the nipple and areolar skin
-Underlying invasive carcinoma in 50%
paget’s disease of nipple
-One-third of women with _____ develop invasive carcinoma
-The invasive carcinoma may arise in either breast
-_____ is a marker of increased risk for developing breast cancer
in either breast
LCIS
lobular carcinoma in situ
Most breast carcinomas (70-80%)
Term used for all carcinomas that cannot be sub-classified into a specific
type (not discussed)
invasive ductal carcinoma
(Carcinoma of “no special type” or “not otherwise specified” (NOS) are
synonyms for invasive ductal carcinoma)
3 clinical features common to all invasive carincomas
- Fixation secondary to adherence to pectoral muscles or deep
fascia of chest wall - Adherence to overlying skin with retraction or dimpling of the skin
or nipple - Lymphatic involvement may cause localized lymphedema with
the skin thickened around exaggerated hair follicles (peau
d’orange – orange peel appearance)
TNM staging of breast cancer
Stage 1
tumor <2cm, without nodal involvement, no metastases
TNM staging of breast cancer
Stage 2
tumor <5 cm with <3 nodes and no distant metastases (or
more than 5 cm without nodes)
TNM staging of breast cancer
Stage 3
- many categories, any cancer infiltration into skin and chest
wall, with nodes, without disseminated metastases
TNM staging of breast cancer
Stage 4
any cancer with disseminated metastases
prognostic factors
- Size of primary carcinoma
- Lymph node involvement and number of
nodes - Distant metastases
- Histologic grade
- Histologic type
- Estrogen or progesterone receptor expression - Tamoxifen
- Proliferative rate
- Aneuploidy
- HER2/NEU overexpression - Herceptin
