Structural Disorders and Neoplasms of the Reproductive System

Question 1

Alterations in pelvic support

Answer 1

Uterine displacement and prolapse
Cystocele and rectocele
    -Vaginal pessary
     -Surgical repair
Urinary incontinence
Genital fistulas

Question 2

Ovarian Cysts

Answer 2

Follicular cysts
Corpus luteum cysts
Theca-lutein cysts
Polycystic ovary syndrome (PCOS)
Other benign ovarian cysts and neoplasms - Dermoid cysts, Ovarian fibromas
(women prone to cysts can be on birth control pills)

Question 3

–> Polycystic ovary syndrome (PCOS)

Answer 3

cysts on ovary
increase levels of estrogen, testosterone
increase hair on face, irregular cycles, harder to get pregnant

Question 4

persary

Answer 4

helps to hold uterus where its supposed to be

Question 5

Uterine polyps

Answer 5

Endometrial or cervical in origin
Tumors on pedicles (stalks) arising from the mucosa
Polyps rarely recur after removal
Most common in multiparous women older than age 40

Question 6

Leiomyomas

Answer 6

Also called fibroid tumors, fibromas, myomas, or fibromyomas
Slow-growing benign tumors arising from the muscle tissue of the uterus
Rarely become malignant
Growth influenced by ovarian hormones
Spontaneously shrink after menopause
Most women are asymptomatic
(cause dysfunctional uterus bleeding)

Question 7

Leiomyomas management

Answer 7

Medical management - Medications, Uterine artery embolization (UAE)
Surgical management - Laser surgery, Myomectomy, Hysterectomy

Question 8

Bartholin cysts

Answer 8

Most common benign lesions of the vulva
Caused by obstruction of the Bartholin duct, causing it to enlarge
Recurrence in women is common; permanent opening for drainage may be recommended - Marsupialization**

Question 9

Vulvodynia

Answer 9

Vulvar pain

Question 10

Cancer of the endometrium

Answer 10

Most common malignancy of reproductive system
Hormone imbalance most significant risk factor
Metastasis through lymphatic system in pelvis and through blood to liver, lungs, and brain
- CA-125 antigen
- Transvaginal ultrasound

Question 11

Cancer of the ovary

Answer 11

Second most frequently occurring reproductive cancer
Symptoms vague
Definitive screening tests do not exist
Often diagnosed in advanced stage
(diagnosised in late staged)

Question 12

ovary cancer tx

Answer 12

dictated by stage of disease at time of initial diagnosis
Surgical removal
Cytoreductive surgery
Antineoplastic surgery
Chemotherapy

Question 13

Cancer of the Cervix

Answer 13

Third most common reproductive cancer
Incidence of invasive cancer has decreased 50% over past 30 years
Incidence of preinvasive cancer has increased
Most reliable method to detect preinvasive cancer is the Pap test
Diagnosis identified by use of: Colposcopy, Biopsy, Conization
(caused by HPV 70-80%)
(pap smear to test: guidelines: sexually active 3 years later or 21)

Question 14

Cancer of the Cervix management

Answer 14

Cryosurgery
Laser ablation
Electrosurgical excision

Question 15

invasive cancer of the cervix

Answer 15

Radical hysterectomy
External radiation therapy
Internal radiation therapy
Pelvic exenteration
Chemotherapy

Question 16

cancer of the vulva

Answer 16

Fourth most commonly occurring gynecologic cancer—5% of female genital malignancies
Grows slowly, extends slowly, and metastasizes fairly late
Survival rates are greater than 90% for all stages if nodes are negative
Most common site for vulvar lesions is on the labia majora

Question 17

cancer of the vulva

Answer 17

Laser surgery
Cryosurgery
Electrosurgical excision
Vulvectomy

Question 18

cancer of the vagina

Answer 18

Vaginal carcinomas account for less than 2% of gynecologic malignancy
Peak incidence from 50 to 70 years of age
Most lesions are squamous cell carcinomas
May be caused by chronic vaginal irritation, vaginal trauma, and genital viruses

Question 19

cancer of the uterine tubes

Answer 19

Primary carcinoma of the uterine tube is rare
Peak incidence between ages 50 and 60 years
Cause unknown

Question 20

cancer and pregnancy

Answer 20

Occurs with relative infrequency during the reproductive years
Therapeutic issues are complex
-Continue or terminate pregnancy
-Timing of therapies such as chemotherapy, radiation, and surgery are affected

Question 21

Most frequent types of cancer that occur during pregnancy

Answer 21

Breast cancer
Cervical cancer
Leukemia and lymphomas
Melanomas
Thyroid cancer
Colon cancer

Question 22

Other gynecologic cancers

Answer 22

Cancer of the vulva
Cancer of the vagina
Cancer of the uterus
Cancer of the uterine tube
Cancer of the ovary

Question 23

cancer therapy and pregnancy

Answer 23

Timing of therapy
Chemotherapy
Radiation therapy

Question 24

pregnancy after cancer treatment

Answer 24

Increase in the number of childhood and adolescent cancer survivors
Delay of 2 years from end of therapy to conception is advised

Question 25

Gestational Trophoblastic Disease (GTD)

Answer 25

Encompasses spectrum of disorders arising from the placental trophoblast Gestational trophoblastic neoplasia refers to persistent trophoblastic tissue presumed to be malignant Recognized as most curable gynecologic malignancy

Question 26

Key Points

Answer 26

Gynecologic disorders diminish quality of life for women and their families Structural disorders of the uterus and vagina related to pelvic relaxation and urinary incontinence may be a result of delayed childbearing, but they are also seen in young or childless women

Question 27

Key Points

Answer 27

Bladder training and pelvic muscle exercises significantly decrease or relieve mild to moderate urinary incontinence Development of neoplasms can have significant physical and emotional effect on woman/family Abnormal uterine bleeding is most common symptom of leiomyomas or fibroid tumors

Question 28

Key Points

Answer 28

Various alternatives to hysterectomy exist for structural and benign disorders of the uterus - Women need to be informed about the risks and benefits Endometrial cancer is the most common reproductive system malignancy Hysterectomy is the usual treatment for early-stage endometrial cancer

Question 29

Key Points

Answer 29

HPV is primary cause of cervical cancer and is linked to vulvar cancer in women younger than 40 Squamocolumnar junction is important landmark identified with neoplastic changes of the cervix Preinvasive cancer of the cervix may be treated with electrosurgical excision, cryotherapy, and laser therapy to save the structure of the cervix

Question 30

Key Points

Answer 30

Combination external and internal radiation therapy is successful in treating early stages of cancer of the cervix Pap test detects about 90% of early cervical dysplasias Cancer of the ovary causes more deaths than any other female genital tract cancer

Question 31

Key Points

Answer 31

Control exposure to radiation in three ways Increase distance from radiation source- Limit time of exposure, Use lead shielding, Cancer is relatively infrequent during pregnancy: 1:1000

Question 32

Key Points

Answer 32

Radiation or chemotherapy treatment of the pregnant woman with cancer places fetus at risk for death, miscarriage, teratogenesis, growth and development alterations Gestational trophoblastic neoplasms highly curable but require close monitoring of hCG levels