PID, Breast + Ovarian + Uterine CA Flashcards
PID - what is it?
• Infl of repod tract beyond the cervix (has moved past vagina into urterus + beyond)
o Uterus = endometritis
o Tubes = salpingitis
o Ovary = oophoritis
Et of PID?
• Polymicrobial eg
- Chlamydia, gonococci, staphylococci, streptococci –> Said to be “pyogenic” microbes – are pus producing
• Untreated bacterial infection → leads to PID
- 10% gonorrhea
- 20% Chlamydia
Patho of PID?
Common complication?
Fig 46-6 p. 1097
• Microbes enter cervix (dilated at menstruation) → endometrium → tubes
• Endocervix is where this infection manifests, then transitions up toward tubes (?)
• Rapid prolif as endometrium sloughs (as provides nutrition for bacteria)
• Ascending infection up toward infundibulum, ovaries, entering abdominal cavity
• Common complication: pelvic abscess (pockets of pus?) → followed by peritonitis….possible massive fluid shifts, ascites, etc.
Parametritis = ?
inflm of mesenteries that attach reproductive structures to abdominal wall (ligaments that support uterus = parametrium)
Manifestations of PID?
1) Lower abdominal pain (d/t extensive inflm) often first symptom
- Acute onset (as infection develops rapidly), often described as sharp, aching
2) heavy, purulent vaginal discharge (this is one of main defining manifestations of PID)
3) Dyspareunia (pain during sexual intercourse d/t inflm)
4) Adnexal tenderness: ad = toward; nexal = uterus…areas in vicinity of uterus present with pain upon palpation
5) Fever
6) Leukocytosis
7) Occasional vaginal bleeding
WHy do you see lots of purulent discharge in PID?
• In early stages otherwise asymptomatic (besides pain)..but shortly after bacteria are setting in defenses set in…producing lots of exudate
Long term complication of PID?
infertility – tissue damage + scarring d/t inflm… implantation, ovulation etc affected
Dx of PID?
- Presentation
- Inc CRP + ESR (erythrocyte sedimentation rate) – both nonspecific markers for inflm
- Laproscopy – see internal structures, scoping body cavity and determining which parts of reprod system have been affected
What is ESR?
erythrocyte sedimentation rate
ESR: if leave RBC’s with anticoag in vessel, will eventually settle at bottom and fluids rise to top. When add proteins involved in inflm process, are inc level of protein content in the blood, which tends to cluster the RBC’s in the blood (NOT clotting) and they tend to settle to the bottom faster
CRP more often used than ESR now – is specific to inflm
Tx of PID?
- Multiple broad spectrum Abx (90% success – if no significant damage, prognosis is very good)
- Eval and treat partner
- Sx? (May need to repair/remove abscesses, repair oviduct)
Why broad spectrum abx in PID?
Often multiple microorganisms involved…
What is the most common female CA?
Breast
- Major cause of CA death
- Rarely in men
Et + risks for breast CA?
• Basic CA et: Mutation of genes that control cell proliferation
• Inc age - cumulative exposure
• Genetic predisposition (no specific gene identified but are most susceptible to risk factors if have genetic makeup)
• Hereditary (5-10%) – is true etiology (next slide has details)
• Hormonal factors (these are risks…not true etiology)
1) Excessive exposure to estrogen for menopause
2) Early menarche
3) Late menopause
4) Nulliparity
Outline the hereditary kind of breast CA
Which specific genes are involved?
o Only 5-10% of these CAs are inherited (defective gene tranmitted from mom to child)…this is contrary to what the media wants to make us believe
o Over this 5-10%, 70-80% will have one of two genetic defects:
o BRCA1 gene on chr 17 + BRCA2 gene on Chr 13 (Breast Cancer Gene 1 and 2) – these are tumour suppressor “stop” genes
• Are autosomal dominant – 50% change of getting
Why are hormonal factors expected to be implicated in develop of breast CA?
o Have tissue that is highly hormone dependent (for both structure and fx)…as such, excessive exposure to the hormones (mainly estrogen), then likely that will bring about more proliferation = possible malignancy
outline excessive exposure to estrogen after menopause - why is this a used in women?
(exogenous estrogens) – ovary ceases exposure to sex hormones as menstrual cycle ceases – almost overnight, estrogen is withdrawn, which causes hot flashes, etc. → HR tx is providing estrogens here in absence of progesterone (this is important)
Why is early menarche factor in breast CA development? Late menopause?
Both inc breast exposure to E over lifetime
Nullparity as risk factor for breast CA?
no offspring; breaking menstrual cycle seems to dec risk; contrceptive pill also breaks up this cycle
Most common area for tumour in breast CA?
Most occurs at upper outer quadrant (near axilla) incl Tail of Spence; next highest around areola and then upper inner quadrant
What are the names of the kinds of breast CA?
Various forms (day pg 1577) - Look at the names of the other types + pick up ones that are most prevalent (don’t need to know all details!)
In notes:
1) Ductal carcinoma in situ
2) Infiltrating ductal carcinoma
What does “in situ” mean and what does it say about cancer prognosis?
“in situation” suggests is restricted to site of origin (good in terms of prognosis) – arises and remains in ductal epithelium
Ductal carcinoma in situ
- How common?
- Origin?
- Invasive?
- How is this staged?
- ~20%
- Intraductal – site of origin in ducts
- Non-invasive
- Stage 0 (sometimes categorized in this way….this is problematic because suggests that there is no tumour in place ) – cancer is in place but is very early stage of CA (but will progress if not dealt with)
Infiltrating Ductal Carcinoma
- Does this always go through in situ stage?
- How common?
- Origin?
- Invasive?
- Mets?
- What do you see deposited in breast?
• Doesn’t’ have to go through earlier stage
• Most common (~75% of breast CA)
• Ductal origin (therefore epithelial cells) (solid, irreg mass)
• Invasive
• 2 types of mets: proximal + distal
o Metastases means spread through lymph or blood
o Proximal mets spread into axillary lymph nodes
o Distal mets (eg: liver, bone, brain)
• See deposition of collagen fibres in the breast
Manifestations of breast CA?
- Usually woman is one to detect it…which means mass is large enough to palpate, and is therefore in later stage
- Fixed, irreg, painless mass – usually UOQ
- Late: discharge (from nipple) retraction (of nipple) edema(in breast)??? → occurs in SOME types