Reproductive/Breast Pathology Flashcards
common symptoms of brest disesases
pain, palpable masses, nipple discharge
Are the common symptoms of breast diseases specific for cancer?
No, they can also represent fibrotic growths or cysts; however, the older the patient, the greater the chance it is malignant.
At what age should women start screening and why?
Age 40; younger than 40 the breast tissue is too dense.
Characteristics and uses of mammography
- 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
Causes of acute mastitis
- infectious or non-infectious (bacterial = staph or strep)
- plugged breast ducts
- typically associated with women who are breast feeding (1st month, postpartum)
consequences of acute mastitis
- breast abscesses
- necrosis
What is the usual cause of fat necrosis?
trauma (esp. from a seat belt during a car accident)
examples of fibrocystic changes
- fibrosis
- cysts
- palpable changes (can make detection of breast cancer difficult)
which type of fibrocystic changes has the higher risk of cancer?
aggressively proliferative type with atypia
characteristics of breast cysts/fibrocystic changes
- 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
characteristics of benign neoplasms of the breast
- most common = fibroadenomas
- mostly connective tissue, well circumscribed
- don’t remove unless uncomfortable
- usually occurs in patients < 30 yrs.
incidence of breast carcinoma
- 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
breast carcinoma and genetics
- 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
causative factors of breast carcinoma
- diet high in animal fats
- obesity
- delayed first pregnancy
symptoms of breast carcinoma
- pain
- masses (assessed by palpation, mammography, ultrasound, MRI, or tissue biopsy)
- swollen, pitted surface (“peau d’orange” - orange peel)
- enlarged axillary lymph nodes
Prognosis of breast carcinoma
- 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
Invasive carcinomas make up _____% of cases of breast cancer.
75-85
characteristics of breast carcinomas
- 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
characteristics/risk factors for cervical cancer
- 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
what are the most common causes of excessive uterine bleeding?
- polyps
- endometritis
- endometrial hyperplasia
- cancers
- anovulatory cycles (associated with malformation of hypothalamus/pituitary)
Causes of endometrial polyps
- hypertension
- obesity
- late menopause
- < 2% progress to cancer
characteristics of leiomyoma
- benign smooth muscle neoplasm
- estrogen dependent
- bleeding and pain
- may cause infertility
- very frequent (about 10-15%)
risk factors and treatment of endometrial cancer
- risk factors: obesity, diabetes, hypertension
- treatment: hysterectomy (treatment of choice) with radiation and chemotherapy as adjuncts
cause of endometritis
- infections (chlamydia and neisseria)
- often associated with IUDs
cause and treatment of endometrial hyperplasia
- exaggerated responses due to excessive estrogen/excessive ovarian activity (lacks opposition from progesterone)
- treatment: progesterone; hysterectomy
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
what are the two types of ovarian masses
- non-neoplastic cysts (follicular cysts)
- neoplastic (ex. endometrioid)
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
symptoms of ovarian masses
- pelvic pain
- pelvic mass (go figure)
- abdominal bleeding
- ** no effective screening method for ovarian cancer (unlike cervical cancer)
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
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”)
Synthetic estrogens
- steroidal = ethinyl estradiol
- non-steroidal = diethylstilbesterol
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
clinical uses of estrogens
- primary hypogonadism
- postmenopasual problems
- treatment of acne
- reduce some repro organ neoplasms
guidelines for use of estrogen
- use smallest does for the shortest period of time possible
- local creams preferred to minimize systemic exposure
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
contraindications for use of estrogen
- liver diseases (slowed metabolism)
- breast/endometrial cancers
- thrombolytic disorders
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
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
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)
risks/contraindications for progestins
- breast cancer risk
- severe hypertension or heart disease is a risk
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
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
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)
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)
uses of contraceptives/hormone replacements
- oral contraception
- menstrual disorders, irregularity, heavy discharge
- acne
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”
