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Flashcards in Female- Reproduction Deck (52):
1

What is PID?

What areas might be affected?

Pelvic Inflammatory Disease

Inflm of reproductive tract beyond the cervix (excludes vagina)
• Uterus (endometritis)
• Tubes (salpingitis)
• Ovary (oophoritis)

2

Describe Etiology of PID?

• Polymicrobial

Examples: Chlamydia, gonococci, staphylococci, streptococci
• Often related to untreated infect (sexual transmission)
o 10% d/t untreated gonorrhea
o 20% d/t untreated chlamydia
o E. coli also sometimes implicated possible d/t proximity of anus

3

What is pyogenic?

Pyogenic- Pus producing bacteria

Relates to most microbes of PID

4

Basic Pathology of PID

• Microbes enter cervix -> endometrium -> tubes
• Rapid proliferation as endometrium sloughs
• Ascending infections
• Common complication: pelvic abscess (often (Often Leading to peritonitis)

5

When do PID infections often gain entry to body?

When cervix is dialated during menstruation

Flow impedes a bit, but all the slough of the endometrium provides nutrients for bacteria
• Rapid proliferation as endometrium sloughs
• Ascending infections
• Common complication: pelvic abscess (leading to peritonitis)

6

What is Parametritis?

Parametritis refers inflm of ligaments around uterus

7

MNFTS of PID

• Lower abd pain
• Heavy, purulent vaginal discharge
• Dyspareunia (pain during sexual intercourse)
• Adnexal tenderness (around uterus)
• Fever
• Occasional vaginal bleeding
• Infertility (common if PID goes untreated)
• Leukocytosis

8

Dx of PID

• Presentation (i.e the MNFTS above)
• Inc ESR (erythrocyte sedimentation rate)
o Indicates Inflm
• Inc CRP
• Laparoscopy

9

Tx of PID

• Multiple broad spectrum Abx (90% success)
• Evaluate and treat partner
• Occasionally may need Sx (laparotomy)

10

Describe the basics of Breast CA

Incidence, Location,

• Most common CA in Women (~1 in 8)
• Major cause of CA death
• Rarely in men

Locations: Upper outer quandrant (axillary region) most likely location, then nipple... region

11

Basics of Etiology of Breast CA?

• Mutated genes (as with all CA)
• Aging (but can occur in younger women
• Genetic predisposition
• Hereditary Type (5-10%)
• Hormonal factors

12

Describe the hereditary Type of Breast CA

Include Genes/Chr involved

Hereditary is a specific form of Breast CA
o Of these 75% have know defective gene
• BRCA 1 – Chr 17
• BRCA 2 gene on chr 13
o The rest are unknown genes

13

Describe the hormonal factors that influence Breast CA

o Estrogen admin post menopause
• This is E without progesterone (exogenous estrogen)
• Given to limit effects of menoapuse
o Early menarche (more estrogen exposure starting early)
o Late menopause (same longer E exposure)
o Nulliparity (without pregnancy)

14

What are the two major types of breast CA

(Other types in Text day 1577 take a look)

Ductal carcinoma in situ

Infiltrating ductal Carcinoma

(Other types in Text day 1577 take a look)

15

Ductal Carcinoma

• Ductal carcinoma in situ
o ~20% of all breast cancer
o Intraductal
• Non invasive
o Stage 0 (tumor is there, if not treated it will change inform to the next

16

Describe infiltrating ductal carcinoma

o Most common (~75%)
o Ductal in origin (solid irreg mass)
o Invasive
o Proximal metastasis (to axillary lymph node)
o Distal metastasis (eg liver, bone, brain)

17

MNFTS of Breast CA

• Unilateral
• Fixed, irregular, Painless mass
• Usually upper outer quadrant
• Late Presentation: discharge, retraction & edema in breast

18

Dx of Breast CA

• Mammography
• Biopsy (to determine benign or malignant)
• E & P receptors (In Biopsy, reveals hormone support)
•Tumor Markers CEA eg (Carcinoembryonic Antigen)
• Most detected by patient

NOTE:
CEA
o Proteins that marks for breast CA (though not exclusively- i.e colorectal CA)
o Protein present in breast tissue r/t to cell adhesion

19

Basic Tx of Breast CA

• SX, Radiation, Chemo (Triad) + hormones
• If E/P receptors High = Hormone therapy (hormones never used on their own)



20

Describe Hormone Tx in Breast CA

Hormone therapy
o Estrogen- Sometimes treat with high does of hormone
• Goal being “down regulating” the receptor
• Reducing the # of receptors
o Tamoxifen (antiE) non steroidal Tx
o Androgens- (caution- complications with male sex hormone)
o Progestins

21

What is an important factor relating to progression that impacts Breast CA prognosis

Lymph node involvement is most important

Tumour size may also have an impact

22

Describe the "ectomy's " of breast CA

Lumpectomy
• Mass and surrounding tissue
Quadrantectomy
• Quadrant removal
Mastectomy
• Breast

23

How are Radiation and Chemo used in breast CA

Radiation
• Limited to breast and axillary lymph nodes
Chemotherapy
• Pre or post Surgery

24

What is the prognosis of ovarian CA and what is this related to ?

• Most Lethal Female reproductive CA
• Differential Dx
o 75% metastasized at Dx

25

Describe Etiology and risk of Ovarian CA

• Aging 64-84 (cumulative exposure to potential carcinogens)
o r/t Ovulatory Aging (oocytes have been there from birth)

• Autosomal Dominant in some forms
• Family Hx in others
• Other Factors
o Nulliparity, infertility, dysmenorrhea (low risk)

26

What are three cells that may be become malignant in Ovarian CA

Epithelial (90%), Stromal (structural), Germ cell (give rise to Gametes)

27

Describe the spread of Ovarian CA

• Silent growth and spread
o Extension/invasion- tubes, uterus, and ligaments, other ovary
o Seeding- bowel surfaces, liver other organs
• (through body cavity- not always falling)
• Pressure on adj organs or abdm distension
o Metastasis- via blood and lymph
• Pressure on abd organs

28

Describe MNFTS and Dx of Ovarian CA

• Early non specific GI disturbances
o Difficult to detect
• Abdm distension
• Pain, Urinary and bowel obstruction
• Ascites with dyspnea (fluid shift relating to exudate from tumour spread)
• Pelvic mass usually 1rst finding (but late)
o US and Exploratory Sx (help stage the CA), but still a differential DX

29

Describe Tx for Ovarian CA

• Determined by exploratory Sx
• Aggressive Surgery
o Excise uterus, tubes, ovaries, omentum, etc
• Then Chemo (intermediate and Advanced disease)
• 6-24months later laparotomy to explore for growth
• Though poor prognosis... some recover fully

30

What is Uterine CA also known as?
Why does this make sense for CA?
What group is at risk?

Uterine (Endometrial) CA
• Most common pelvic CA in Women
• Usually between 55-65 yr
• (endometrium is regenerating constantly)

31

Describe the Etiology of Uterine CA

• Mostly related to Hyperestrogenism
• Some unrelated to E
• Family Hx (Risk inc)
• Risk Factor
o Obesity
• Adipose tissue can store & synthesize estrogen
leading to hyperestrogenism
o Age
o Pelvic Radiation
o Low risk
• Diabetes (metabolic derangements- inc synthesis of E)
• HTN

32

How hyperplasia affect endometrium in Uterine CA

TRICK QUESTION!!!!!

Hyperplasia is normal in the endometrium. But with high levels of Estrogen this can turn to dysplasia and finally anaplasia

33

Describe types of Uterine CA

• Adenocarcinoma (~85%)
• 2 types:
o Type 1 (90%) E sensitive endometrial hyperplasia
• Better prognosis
o Type 2 (10%) Non E dependent
• Linked to endometrial atrophy (don’t link atrophy and endometrial) = Poor prognosis

34

Describe spread of Uterine CA

• Slow progression (overall uterine CA has good prognosis)
• Spreads to uterus (i.e deeper muscle layers) and Vagina
• Late metastasis via lymph and blood
• No decent screen

35

MNFTS of Uterine CA

• Painless vaginal Bleeding (often post menopause, important sign)
• Others relate to invasion and Metastasis

36

Tx for Uterine CA

• Based on stage
• Sx with radiation

37

Describe the main Etiology of Cervical CA

o HPV infect (human papaloma Virus)
• (vaccine prevents the virus)
• ~ 100 strains
• ~ 40 Sexually transmitted
• 4 of interest
 strains 6 and 11 (cause Genital Warts ~90%)
 Strains 16 nd 18 (CA ~70)

38

What are the Risks of Cervical CA

What is the prognosis?

o Risk for virus is risk for CA
• Early age sex, multiple sex partners
• Smoking, Hx of STD’s

• 100% cure rate if it’s caught in situ

39

Describe the Patho (i.e Origin to Spread) of Cervical Ca

• Mostly squamous cell in origin
• Begins on inner lining of cervix and growth into deep muscle layers in a widening pattern (like forest fire driven by wind)
• Initial Dysplasia (pre cancerous lesion)
• Then Carcinoma in situ (epith layer) (Anaplasia)
• Later invasive CA (deeper layers)
• Several yrs betw PreCA and invasive stage
• Levels if cervical intraepithelial neoplasia CIN
• Metastasis via lymphatics

40

Describe the Pap Smear

How are result presented?

PAP Test-Is a cervical CA Screen.

Collecting shedding cells and staining them.
Observe for squamous appearance? If yes, then dysplasia. CIN is acronym of results. (Cervical intraepithelial neoplasia)

• CIN 1 = mild dysplasia
• CIN 2 = Moderate
• CIN 3 = Severa Dysplasia and carcinoma in situ

41

Dx of cervical CA

• PAP
• Visualize cervix (colposcopy)

42

MNFTS of Cervical CA

• Vaginal discharge and bleeding (outside of menses)
• Metrorrhagia
• Inc Freq of menses

• Pain (late Stage)

43

Tx of Cervical CA

• Early- Excision (Sx)
• Invasive- Radiation and Sx
• Cryosurgery (nitro with probe to induce necrosis)
• Conization- (Core out an area - biopsy or removal)
• Laser Sx (necrosis)
• Radical Hysterectomy

44

Define:
Amenorrhea
Hypomenorrhea
Oligomeorrhea
Polymenorrhea
Menorrhagia
Metrorrhagia
Menometrorrhagia
Dysmenorrhea:

Amenorrhea – An absence of menstruation.
Hypomenorrhea – scant menstruation.
Oligomeorrhea - Infrequent menstruation periods more than 35 days apart.
Polymenorrhea – Frequent menstruation periods less than 21 days apart.
Menorrhagia – excessive menstruation.
Metrorrhagia – bleeding between periods.
Menometrorrhagia – heavy bleeding during and between menstrual periods.

45

What often changes menstrual bleeding patterns?

• When basic pattern of bleeding is changed, it is most often due to lack of ovulation and hormone disturbances.

• When basic pattern of bleeding is undisturbed, but there are superimposed episodes of bleeding or spotting, the etiology is more likely to be related to organic lesions or hematologic disorders.

46

Likely cause and types of dysmenorrhea

It is believed that dysmenorrhea is result from excessive production of prostaglandins, causing painful contraction of the uterus and arteriolar vasospasm. There are two different form of dysmenorrhea.

Primary Dysmenorrhea
• Not associated with physical abnormality or pathologic process.
• Begins 6 month – 2 years after menarche

Secondary Dysmenorrhea:
• Menstrual pain caused by specific organic conditions. (e.g. lesion or IUD's in uterus)

47

What is the most significant bleeding concern for CA in menstruation

Metrorrhagia is vaginal bleeding between regular menstrual periods.

• It is the most significant form of menstrual dysfunction because it may signal cancer. May require further investigation or treatment

48

2 kinds of amenorrhea\

Etiology

Primary Amenorrhea
• The failure to menstruate by 15 years of age.
• Or: by age 13 if failure to menstruate is accompanied by absence of secondary sex characteristics

CAUSES: Absence of sex organs, unresponsiveness to hormones, loss of germ cell, Hypothalamus or pituitary disfunction

Secondary Amenorrhea
• The cessation of menses for at least 6 months in a woman who has established normal menstrual cycles.

• Causes: ovarian, pituitary, or hypothalamic dysfunction; intrauterine adhesions; infections (tuberculosis, syphilis); pituitary tumour; anorexia nervosa; strenuous physical exercise.

49

What hormone change might cause bleeding from previously built up endometrium?

Decrease in Estrogen

Bleeding irregular in amount and duration

50

If no follicles mature to ovulation what sort of hormone response would we likely see?

An absence of progesterone

In absence progesterone allows estrogen to produce a thicker endometrial layel

51

Causes of Metrorrhagia

• It is the most significant form of menstrual dysfunction because it may signal cancer, benign tumours of the uterus, or other gynaecologic problems.

• Bleeding between regular periods by women taking oral contraceptives is usually not serious, irregular bleeding by women taking hormone therapy should be evaluated.

52

Causes Menorrhagia

Menorrhagia:
Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow.
Etiology
• In young women – related to endocrine disturbances.
• In older women – results from inflammatory disturbances, tumours of the uterus, or hormonal imbalances.