Reproductive/Breast Pathology Flashcards
1
Q
common symptoms of brest disesases
A
pain, palpable masses, nipple discharge
2
Q
Are the common symptoms of breast diseases specific for cancer?
A
No, they can also represent fibrotic growths or cysts; however, the older the patient, the greater the chance it is malignant.
3
Q
At what age should women start screening and why?
A
Age 40; younger than 40 the breast tissue is too dense.
4
Q
Characteristics and uses of mammography
A
- detects density
- shows architectural distortions
- identifies calcifications
- can show changes over time (which can be indicative of certain pathologies)
- does not detect all breast cancers (~10% of breast cancers not detected by mammography, can be detected by palpation)
- can be used to guide a biopsy needle
- 85-90% predicative
5
Q
Causes of acute mastitis
A
- infectious or non-infectious (bacterial = staph or strep)
- plugged breast ducts
- typically associated with women who are breast feeding (1st month, postpartum)
6
Q
consequences of acute mastitis
A
- breast abscesses
- necrosis
7
Q
What is the usual cause of fat necrosis?
A
trauma (esp. from a seat belt during a car accident)
8
Q
examples of fibrocystic changes
A
- fibrosis
- cysts
- palpable changes (can make detection of breast cancer difficult)
9
Q
which type of fibrocystic changes has the higher risk of cancer?
A
aggressively proliferative type with atypia
10
Q
characteristics of breast cysts/fibrocystic changes
A
- 20-40 yrs old
- doesn’t typically occur after menopause
- can calcify
- can look like cancer on a mammogram
- 60% of women have microscopic cysts associated with epithelial tissue
11
Q
characteristics of benign neoplasms of the breast
A
- most common = fibroadenomas
- mostly connective tissue, well circumscribed
- don’t remove unless uncomfortable
- usually occurs in patients < 30 yrs.
12
Q
incidence of breast carcinoma
A
- rarely occurs in patients < 25 yrs
- affluent societies with highest incidence regardless of race –> environmental causes
- about 30% incidence by 70 yrs old, 30% of cases are fatal
- about 250,000 new cases of breast cancer/yr in the US
13
Q
breast carcinoma and genetics
A
- 5-10% of cases = inherited (single strong gene factor; BRCA 1 and 2 are the most common inherited genes)
- 20-30% of cases = family tendency (not a single strong gene, but a pattern of occurrence in families)
- 70-80% of cases = no familial pattern, just chance
14
Q
causative factors of breast carcinoma
A
- diet high in animal fats
- obesity
- delayed first pregnancy
15
Q
symptoms of breast carcinoma
A
- pain
- masses (assessed by palpation, mammography, ultrasound, MRI, or tissue biopsy)
- swollen, pitted surface (“peau d’orange” - orange peel)
- enlarged axillary lymph nodes
16
Q
Prognosis of breast carcinoma
A
- based on size, axillary node status, and distant metastasis
- 5 year survival: stage 0 = 92%, stage IV = 13%
- if the tumor expresses estrogen/progesterone receptors if often responds to hormone therapy; higher estrogen receptors in postmenopausal
17
Q
Invasive carcinomas make up _____% of cases of breast cancer.
A
75-85
18
Q
characteristics of breast carcinomas
A
- generally all are adenocarcinomas, originating from epithelial cells in the terminal ducts
- most are ductal and the incidence increases with age (there are invasive and non-invasive types)
- lumpectomies to remove smaller masses
19
Q
characteristics/risk factors for cervical cancer
A
- HPV-associated squamous cell neoplasms most common
- risk factors: multiple sex partners, immunosuppression, early age of first sexual contact, oral contraception for more than 5 yrs, nicotine use
20
Q
what are the most common causes of excessive uterine bleeding?
A
- polyps
- endometritis
- endometrial hyperplasia
- cancers
- anovulatory cycles (associated with malformation of hypothalamus/pituitary)
21
Q
Causes of endometrial polyps
A
- hypertension
- obesity
- late menopause
- < 2% progress to cancer
22
Q
characteristics of leiomyoma
A
- benign smooth muscle neoplasm
- estrogen dependent
- bleeding and pain
- may cause infertility
- very frequent (about 10-15%)
23
Q
risk factors and treatment of endometrial cancer
A
- risk factors: obesity, diabetes, hypertension
- treatment: hysterectomy (treatment of choice) with radiation and chemotherapy as adjuncts
24
Q
cause of endometritis
A
- infections (chlamydia and neisseria)
- often associated with IUDs
25
cause and treatment of endometrial hyperplasia
- exaggerated responses due to excessive estrogen/excessive ovarian activity (lacks opposition from progesterone)
- treatment: progesterone; hysterectomy
26
what is preeclampsia?
- secondary hypertension in pregnant women of at least 20 weeks gestation
- often associated with diabetes
- exact cause is unknown, but appears to be associated with abnormal circulation in the placenta
27
what are the two types of ovarian masses
- non-neoplastic cysts (follicular cysts)
| - neoplastic (ex. endometrioid)
28
characteristics of neoplastic ovarian masses
- most are sporadic (90%)
- contraceptives can decrease risk
- treatment: total hysterectomy with removal of surrounding tissue and chemotherapy
- 10% hereditary (BRCA 1 and 2)
- most present at an advanced stage
29
symptoms of ovarian masses
- pelvic pain
- pelvic mass (go figure)
- abdominal bleeding
* ** no effective screening method for ovarian cancer (unlike cervical cancer)
30
what are the stages of the menstrual cycle?
- menstrual stage: menses
- follicular stage: proliferative, estrogen the predominant hormone
- luteal stage: secretory
- fertile window: last 5 days of follicular stage + ovulation
- as populations age they spend more time in menopause of andropause
31
characteristics of natural estrogens
- steroid hormones derived from cholesterol (synthetic estrogens may not be steroids)
- cross cell membranes and activate receptors inside the cell to modulate the expression of genes
- different forms:
> EstrONE (predominant during menopause, "E1")
> EstraDIol (predominant during repro years, most
active form of estrogen, "E2")
> EstraTRIol (predominant during pregnancy and
produced by the placenta, "E3")
32
Synthetic estrogens
- steroidal = ethinyl estradiol
| - non-steroidal = diethylstilbesterol
33
physiological functions of estrogen
- sexual maturity
- increased CNS excitability (seizure inducing?)
- increased endometrial and uterine growth
- maintains skin elasticity
- reduces bone absorption
- alters plasma lipids - increases HDLs and triglycerides, reduces LDLs
- increases blood coagulabiltiy
34
clinical uses of estrogens
- primary hypogonadism
- postmenopasual problems
- treatment of acne
- reduce some repro organ neoplasms
35
guidelines for use of estrogen
- use smallest does for the shortest period of time possible
| - local creams preferred to minimize systemic exposure
36
adverse effects of estrogen use
- postmenopausal bleeding
- nausea
- breast tenderness
- migraines
- hypertension
- hyperpigmentation (especially around the eyes)
- increased risk for some cancers (breast and endometrial)
- smoking dramatically increases the risk of cardiovascular disease
37
contraindications for use of estrogen
- liver diseases (slowed metabolism)
- breast/endometrial cancers
- thrombolytic disorders
38
characteristics of progestins
- made from cholesterol
- present in males, but less than females
- progesterone is the most important progestin in humans
- precursor to many steroid hormones: estrogen, androgen, adrenocortical steroids (cortisol), testosterone, estradiol
39
effects of synthetic progestins
- half life = 5 min (short acting)
- increase fat deposition
- decrease CNS excitability (antiseizure?)
- increase aldosterone (increased Na+ retention, increased BP, increased water retention and blood volume)
- increased body temperature
- increases insulin and insulin response to glucose
40
clinical uses of progestins
- replacement therapy
- oral contraception
- long-term ovarian suppression (for cases of dysmenorrhea or endometriosis; no issue of bleeding or clotting like with estrogens)
41
risks/contraindications for progestins
- breast cancer risk
| - severe hypertension or heart disease is a risk
42
2 main categories of hormonal contraception
- combination (estrogen and progesterone) - decreases ovulation (approaching 100%) and decreases conception/implantation
- progestin only (less effective, about 80-90%) - decreases ovulation (50-80%), thicken mucus and reduces sperm penetration, impairs implantation, less side effects
43
methods of delivery for hormonal contraceptives
- combinations: monophasics (constant doses of both estrogen and progesterone), biphasics (dosage of one or both change once during the cycle), and triphasics (dosages change 2 times during the cycle)
- progestin only: "minipill", fewer side effects but less effective
- implantable: efficacy 2-4 yrs (ex. Norplant)
- injections: IM, sustained effects
- intravaginal rings
- IUDs with and without estrogen/progestin
- Transdermal combinations
44
side effects of combinations
- typically reverse when contraceptive is discontinued
- reduced ovarian function and size
- increased breast size and tenderness
- increased thrombolytic events
- increased heart rate and BP
- hyperpigmentation, especially around the eye
- mild nausea, breakthrough bleeding, headaches
- interactions with antibiotics that disrupt GI normal flora (ex. amoxicillin) because absorption of the contraceptives is dependent on these bacteria
- reduced sebum production in the skin (can cause dry skin and help treat acne)
45
side effects of estrogen only replacement
- increased risk of ovarian, endometrial, and breast cancer after 10 yrs of use
- nausea, breast tenderness, migraines, hypertension (these effects are dose dependent)
46
uses of contraceptives/hormone replacements
- oral contraception
- menstrual disorders, irregularity, heavy discharge
- acne
47
clinical uses/effects of testosterone
- can be converted to estradiol via aromatase enzyme --> adverse effects in men that have too much testosterone
- hormone replacement therapy in males
- treatment of gynecological disorders in females (engorged breasts after child birth, uterine bleeding in postmenopausal women, etc.)
- protein anabolic effects (replace muscle loss)
- growth stimulation (can prematurely close growth plates in adolescents)
- counter age-related muscle loss
- masculinization in women
- when abused for muscle strength/building, can cause acne, aggressiveness, and "roid rage"
