Class 6 chapter 40

Question 1

Cervical Cancer risk factors

Answer 1

Linked to Human Papilloma Virus (HPV) infection
Smoking
Dietary/nutritional
Early age of first sexual intercourse/contact
Family history
Immunodeficiency
Multiparity
Oral contraceptives
H/o chlamydial or herpes virus infection

Question 2

Cervical Cancer pathogenesis

Answer 2

Cell dysplasia can be pre-cancerous (Pap smear)
Long latent period but rapid once starting
Squamous cell carcinoma most common

Question 3

Cervical Cancer manifestations

Answer 3

Abnormal vaginal bleeding, spotting, discharge (intercreased after intercourse)
Pain (pelvic, back, leg)
Hematuria, fistulas

Question 4

Cervical Cancer treatment

Answer 4

Removal of lesion
Surgical removal of organs
Radiation
Chemo-radiation
Chemotherapy
Brachytherapy

Question 5

Pelvic Inflammatory Disease

Answer 5

Involves upper reproductive tract (Uterus to fallopian tubes to ovaries)
Caused by polymycrobial sexually transmitted organisms (more rarely, endogenous organisms)

Question 6

Pelvic Inflammatory Disease risk factors

Answer 6

16-24 years old
Multiparity
Multiple sexual partners
H/o PID, IUD use (predisposes to endometritis)
Enhanced during menstruation

Question 7

Pelvic Inflammatory Disease manifestations

Answer 7

Lower abdominal pain (just after menstruation)
Cervical pain on manipulation
Purulent discharge
Bleeding (especially if on oral contraceptives)
Fever
Elevated WBC, ESR, CRP

Question 8

Endometriosis

Answer 8

Cells from the lining of the uterus flourish elsewhere
Ectopic
10-15% of premenopausal women have this
Common sites – ovary, rectum, uterus, bladder
Cyst development interferes with blood flow

Question 9

Endometriosis risk factors

Answer 9

Early/altered menarche
Postponed childbearing
Familial
Dysmenorrhea (painful menstruation)

Question 10

Endometriosis manifestations

Answer 10

Pain (pelvic, back, micturition and defecation)
D/t bleeding during menstruation
Infertility
Ovarian cysts

Question 11

Endometriosis treatment

Answer 11

Symptomatic (pain)
Endometrial suppression
Surgical removal
- Tissue
- Hysterectomy
- Hysterectomy and BSO

Question 12

Endometrial Cancer

Answer 12

Most common Ca of female reproductive tract (adenocarcinoma type)

Question 13

Endometrial Cancer risk factors

Answer 13

Post-menopause (seldom seen under 40)
Estrogen excess
Nulparity (no pregnancies)
Endometrial hyperplasia

Question 14

Endometrial Cancer manifestations

Answer 14

Post-menopausal painless bleeding

Question 15

Disorders of Uterine Support

Answer 15

1. Cystocele
Herniation of bladder into vagina
Difficulty emptying bladder, frequency
2. Rectocele
Herniation of rectum into vagina
Discomfort, difficulty defecating 
3. Uterine prolapse
Bulging of uterus into vagina
Discomfort, irritation of exposed membranes of cervix/vagina

Question 16

Ovarian Cysts

Answer 16

Common, but often benign

Question 17

Ovarian Cysts manifestations

Answer 17

Discomfort, aching

Occasionally can rupture or become infected

Question 18

Ovarian Cysts types

Answer 18

1. Follicle doesn’t burst and release ovum
2. Luteal cyst (from corpus luteum not dissolving)
3. Dermoid cyst
   - Benign “termatoma”
   - Skin, hair, bone, nails, teeth, eyes, thyroid tissues etc
4. Chocolate cyst
   - Caused by endometriosis

Question 19

Polycystic Ovary Syndrome risk factors

Answer 19

Hormonal changes
Chronic anovulation causing amenorrhea
Obesity

Question 20

Polycystic Ovary Syndrome pathophysiology

Answer 20

Follicles develop but don’t ovulate

LH levels remain, stimulating androgen production, which stimulates cycle to continue

Question 21

Polycystic Ovary Syndrome pathophysiology

Answer 21

Follicles develop but don’t ovulate

LH levels remain, stimulating androgen production, which stimulates cycle to continue

Question 22

Polycystic Ovary Syndrome manifestations

Answer 22

Menstrual irregularity
Hyperandrogenism (male hormone)
Infertility
Hyperinsulinemia/insulin resistance
Hypertension

Question 23

Polycystic Ovary Syndrome treatment

Answer 23

Symptom relief
Weight loss
Oral contraceptives
Spironolactone (inhibits androgen production by adrenal gland)

Question 24

Ovarian Tumors

Answer 24

1. Benign tumours (80% of all)

2. Functioning tumours (secrete hormones)

Question 25

Benign tumours

Answer 25

``` More common in younger women Epithelial cell Endometriomas or “chocolate cysts” Fibromas Teratomas/dermoid cyst - Serous/sebaceous/hair/teeth ```

Question 26

Functioning tumors

Answer 26

Estrogens: alter menstrual cycle Androgens: cause masculine characteristics

Question 27

Ovarian Cancer

Answer 27

2nd to endometrial cancer

Question 28

Ovarian Cancer risk factors

Answer 28

Nullparity Older women (usually) Family history of breast or ovarian cancer - High mortality rate as vague symptoms are not recognized early - Up to 75% have metastasized when diagnosed

Question 29

Ovarian Cancer manifestations

Answer 29

Often asymptomatic Increased abdominal size (ascites) Dyspepsia (indigestion) Bloating, early satiety

Question 30

Ovarian Cancer treatment

Answer 30

Total hysterectomy and BSO - Possible omentum removal Chemotherapy

Question 31

Menorrhea

Answer 31

A = Absence Hypo = Scanty Oligo = Infrequent Poly = Frequent (less than 21 days apart) Dys = painful - Primary (prostaglandin excess) - Secondary (from another disease condition causing this)

Question 32

...rrhagia

Answer 32

``` Metro = bleeding between periods Meno = Excessive bleeding Menometro = Heavy bleeding between and during periods ```

Question 33

Breast Cancer

Answer 33

Most common female cancer (1 in 9) Normally, BRCA1 or BRCA2 genes suppress tumour growth by repairing DNA that has mutated (Mutation of these genes leads to cancer growth) Breast cells supplied with estrogen or growth factor receptors prone to cancer

Question 34

Breast Cancer risk factors

Answer 34

``` Many diagnosed have none Increased age Family history/genetic mutation h/o benign breast disease Hormonal changes that influence breast maturation (early menarche, late pregnancy or menopause) ```

Question 35

Breast Cancer modifiable risk factors

Answer 35

Obesity Physical inactivity Postmenopausal hormone therapy Alcohol use (2 drinks/day increases risk by 8.5%, 5-10% of those diagnosed can be linked to alcohol use)

Question 36

Breast Cancer detection

Answer 36

Solitary, painless lesion with poorly defined borders Upper outer quadrant most common 1. Mamography 2. Self-examination 3. MRI 4. Biopsy Look for lump, pulled in nipple, dimpling, dripping, redness/rash, skin changes

Question 37

Breast Cancer classification

Answer 37

Size/nodal involvement/metastasis

Question 38

Breast Cancer treatment

Answer 38

Surgery (radical, modified) Chemotherapy Radiation therapy Hormonal manipulation

Question 39

Breast Cancer surgery

Answer 39

1. Lumpectomy (wide local excision) 2. Partial or segmental mastectomy or quadrantectomy 3. Total mastectomy 4. Modified radical mastectomy (leave some muscle, take as many lymph nodes out as they need to) 5. Radical mastectomy (take breast, muscle below, lymph nodes)