Quiz 5 Study Guide: Reproductive and Breast Flashcards
What are the common symptoms of Breast Disease?
Pain
Palpable Masses
Nipple Discharge
When do you start screenings with Mammography?
40 Years of age
*younger women have more dense breast tissue making discovering a mass more difficult.
What Does a Mammography Show?
Density Architectural Distortions Calcification Changes over time Can help guide biopsy needle 85-90% predictive
What is characteristic of Acute Mastitis?
Breast accesses and necrosis
Usually associated with breast feeding
Can be from plugged ducts
Can be infectious or non-infectious
What is characteristic of Fat necrosis?
Trauma
*seat belt during an accident
What is characteristic of Breast Cysts?
Fibrocystic changes Higher breast cancer risk in aggressive proliferative type Occurs in 20-40 year olds usually not in post menopause women Can calcify Can look like cancer on a Mammogram
What are the 3 Fibrocystic changes seen with Breast Cysts?
Fibrosis
Cysts
Palpable changes making detection of cancer difficult
What are characteristics of a benign neoplasm of the breast?
Fibroadenomas (most common)
Mostly Connective Tissue
Well Circumscribed
Don’t typically remove unless uncomfortable
What are characteristics of Breast Carcinomas?
Rarely occurs <25 years of age Mostly in more affluent societies 30% incidence by 70 Years old (1 in 9 die) Inherited = 5-10% (BRCA 1 & 2) Family tendency = 20-30% risk Sporadic = 70-80% 250,000 new cancers /year in US
What are the symptoms of Breast Carcinomas?
- Pain
- Masses (Assessed by, palpitation, mammography, ultrasound, MRI, or biopsy)
What are the factors relating to Prognosis of Breast Carcinomas?
- Based on size, axillary node status, and far metastasis
- 5 year survival @ stage 0 = 92%; stage IV = 13%
- Tumor expressing estrogen/progesterone often responds to hormonal treatment
Characteristics of types of breast cancer…
- Invasive Carcinomas = 75-85%
- Generally all are adenocarcinomas from epi cells in terminal ducts.
- Most are ductal and incidence increases with age
- Lumpectomies can treat smaller masses
What is characteristic of Benign Epithelial Lesions of the Breast?
Fibrocytic changes
e.g. 60% of women have microscopic cysts associated with epithelial tissues
What is usual cause for Cervical Cancers?
HPV - associated squamous cell neoplasm
What is used to detect Cervical Cancers early?
Pap Smear
What are the risk factors of Cervical Cancers?
Multiple Partners Immunosuppression Early age of first sexual contact Oral Contraception for >5 Years Nicotine Use
What are the causes of endometrial polyps?
Hypertension
Obesity
Late Menopause
*Progresses to Cancer in 2%
What are characteristics of Leiomyoma of the endometrium?
Benign Smooth Muscle Neoplasm
Estrogen-Dependent
Bleeding and Painful
May Cause Infertility
What are the risks of endometrial Cancer (adenocarcinoma)?
Obesity
Diabetes
Hypertension
What are the Treatments for endometrial cancer?
Hysterectomy- Treatment of choice
Radiation/Chemotherapy adjunctive
What is the cause of endometritis? (Infections)
Intrauterine Devices (IUD’s)
What can endometrial hyperplasia progress to?
Cancer
What is characteristic of endometrial hyperplasia?
Exaggerated responses due to excessive estrogen
-Excessive ovarian activity
What is the treatment of endometrial hyperplasia?
Progesterone
Hysterectomy
What are the two types of Ovarian Masses?
Non-neoplastic cysts (e.g. follicular)
Neoplastic (e.g. endometroioid)
What are characteristics of Neoplastic Ovarian Masses?
Most are sporadic (90%)
Contraceptives can decrease risk
10% are Hereditary (BRCA 1&2)
What is treatment for Neoplastic Ovarian Masses?
Total Hysterectomy + removal of surrounding tissue + chemotherapy
What are the symptoms of Ovarian Masses?
Pelvic Pain
Pelvic Mass
Abdominal Bleeding
Is there an effective screening for ovarian cancer?
NO
Characteristics of Estrogens and Progestins…
- Natural estrogens are Steroid hormones (Not Synthetic)
- They cross cell membranes and activate estrogen receptors inside cell (modulate gene expression)
What are the 3 stages of the Menstrual Cycle?
Menstrual Stage - Menses
Follicular Stage - Proliferative
Luteal Stage - Secretory
What are the 3 natural Estrogens?
Estrone (E1) - Menopause
Estradiol (E2) - Productive Years
Estratriol (E3) - Pregnancy
What are the 2 Synthetic Estrogens?
Ethinyl Estradiol - Steroidal
diethylstilbesterol - Non-steroidal
What are the physiological functions of Estrogens?
Sexual Maturity Increased CNS excitability (Seizures???) Increased Endometrial and Uterine Growth Maintain Skin Elasticity Reduce bone adsorption Increase Blood Coagulability
What are the clinical uses of Estrogens?
Primary Hypogonadism
Post-menopausal problems
- always used smallest dose for shortest time possible
- Local creams can be preferred to minimize exposure
What are the adverse effects of Estrogen use?
Postmenopausal Bleeding
Nausea
Breast Tenderness
Migraines
Hypertension
Hyperpigmentation (especially around eyes)
Increases some cancers (breast & endometrial)
What are the contraindications for Estrogen use?
Liver Disease (Slows Metabolism) Breast and Endometrial Cancers Thrombolytic Disorders
What are characteristics of Progestins?
Made from Cholesterol
Present in males/less in females
What is the natural Progestin?
Progesterone
What are characteristics of Progesterone?
- Precursor to estrogen, androgen, and adrenal cortical steroids. (e.g. Cortisol)
- Also precursor to testosterone and estradiol.
What is the half life of Progestins?
Very Short Acting (5 min)
What are the effects of Progestins?
Increase Fat Deposition
Decrease CNS Excitability (Anti seizure - opposite estrogen)
Increase Aldosterone
Increase Na+ retention
Increase BP
Increase water retention and blood volume
Increase Body Temperature
What are the clinical uses of Progestins?
- Replacement Therapy
- Oral Contraception
- Long term ovarian suppression
- No problem with bleeding or clotting (contrast to estrogens
What are the contraindications for the clinical use of Progestins?
Breast Cancer Risk
Severe hypertension/heart disease
What makes up the combination of drugs used as a contraceptive?
Progesterone + Estrogen
What are characteristics of Combo contraceptives?
Decreases Ovulation near (100%)
Decreases conception and Implantation
What are characteristics of Progestin only contraceptives?
Less effective (80-90%)
Decreases ovulation 50-80%
Thickens mucus and reduces sperm penetration
Impairs implantation
What are the delivery forms of Contraceptives?
Combinations Progestin only Implantable Injections Intravaginal rings IUDs with or without estrogen/progestin Transdermal Combinations
What are the three phases of Combinations?
Monophasics -constant doses of estrogen/progestin
Biphasics- dosage of one or both change one time / cycle
Triphasics- dosages change two times
What are side effects of Combination contraceptives?
Reduced Ovarian Functions and Size
Increased Breast Size and Tenderness
Increased Thrombolytic Events
Increased HR and BP
Hyperpigmentation (especially around the eye)
Mild Nausea
Breakthrough Bleeding
Headaches
*May interact with antibiotics (wide-spectrum)
- Absorption of contraceptive depends on normal GI flora.
What are uses for Contraceptives?
Oral Contraception Menstrual Disorders Irregularity Heavy Discharge Acne
What are three hormone antagonists?
Tamoxifen
Mifepristone
Danazol
What is the Mechanism of action of Tamoxifen?
Blocks actions of estrogen in breasts
- Used to treat breast cancers
What is the Mechanism of action of Mifepristone?
Morning after contraceptive: Blocks progesterone and glucocorticoid receptors (99% effective if used within 3 days)
What is the Mechanism of action of Danazol?
Surpasses ovarian function
*masculinizing effect
What drug is Ovulation inducing or promotes fertilization and pregnancy?
Clomiphene (Clomid)
*increased risk of multiple births (twins)
What is an example of an androgen?
Testosterone
*Causes male puberty
What are characteristics/uses of Testosterone?
Converts to estradiol
Replacement therapy for males
Gynecological Disorders-reduces breast size
Has protein anabolic effects - replace muscle loss
Growth Stimulation- premature close growth plates
Counter some age-related loss of muscle mass
Adverse effects in women especially-masculinization
Testosterone analogs abused for muscle and strength building
- Can cause acne, aggressiveness and roid rage
