Quiz 5 Study Guide: Reproductive and Breast Flashcards by Dane Goodwin

What are the common symptoms of Breast Disease?

Pain
Palpable Masses
Nipple Discharge

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When do you start screenings with Mammography?

40 Years of age

*younger women have more dense breast tissue making discovering a mass more difficult.

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What Does a Mammography Show?

Density
Architectural Distortions
Calcification
Changes over time
Can help guide biopsy needle
85-90% predictive

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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

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What is characteristic of Fat necrosis?

Trauma

*seat belt during an accident

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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

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What are the 3 Fibrocystic changes seen with Breast Cysts?

Fibrosis
Cysts
Palpable changes making detection of cancer difficult

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What are characteristics of a benign neoplasm of the breast?

Fibroadenomas (most common)
Mostly Connective Tissue
Well Circumscribed
Don’t typically remove unless uncomfortable

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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 &amp; 2)
Family tendency = 20-30% risk
Sporadic = 70-80%
250,000 new cancers /year in US

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What are the symptoms of Breast Carcinomas?

Pain

- Masses (Assessed by, palpitation, mammography, ultrasound, MRI, or biopsy)

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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

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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

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What is characteristic of Benign Epithelial Lesions of the Breast?

Fibrocytic changes

e.g. 60% of women have microscopic cysts associated with epithelial tissues

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What is usual cause for Cervical Cancers?

HPV - associated squamous cell neoplasm

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What is used to detect Cervical Cancers early?

Pap Smear

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What are the risk factors of Cervical Cancers?

Multiple Partners
Immunosuppression
Early age of first sexual contact
Oral Contraception for >5 Years
Nicotine Use

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What are the causes of endometrial polyps?

Hypertension
Obesity
Late Menopause

*Progresses to Cancer in 2%

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What are characteristics of Leiomyoma of the endometrium?

Benign Smooth Muscle Neoplasm
Estrogen-Dependent
Bleeding and Painful
May Cause Infertility

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What are the risks of endometrial Cancer (adenocarcinoma)?

Obesity
Diabetes
Hypertension

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What are the Treatments for endometrial cancer?

Hysterectomy- Treatment of choice

Radiation/Chemotherapy adjunctive

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What is the cause of endometritis? (Infections)

Intrauterine Devices (IUD’s)

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What can endometrial hyperplasia progress to?

Cancer

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What is characteristic of endometrial hyperplasia?

Exaggerated responses due to excessive estrogen

-Excessive ovarian activity

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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?

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