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Gynecologic Disease Flashcards

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1
Q

Disorders of the Vulva and Vagina

A

mostly inflammatory
uncomfortable; not serious
malignancies uncommon

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2
Q

vulvitis

A

inflammation of the vulva (external female genitalia)

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3
Q

cause of vulvitis

A
  1. infection
  2. contact irritant
  3. allergic rxn
  4. trauma
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4
Q

what pathogens are associated w/ vulvitis

A

many different pathogens; often sexually transmitted

Candida albicans–>fungal infection
–the moist environment supports candida

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5
Q

what can cause a contact irritation/allergic rxn of the vulva

A
  1. soaps
  2. perfumes
  3. deodarants
  4. clothing textiles
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6
Q

what is pruritus

A

itching

scratching a primary condition can exacerbate it and cause a scratching induced trauma

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7
Q

Vaginitis

A

inflammation of the vaginal canal

relatively common

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8
Q

what is the main sign of vaginits

A

production of vaginal discharge (leukorrhea)

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9
Q

what is leukorrhea

A

vaginal discharge produced as a result of vaginitis

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10
Q

what organisms are associated with vaginitis

what can happen with normal vaginal flora under certain circumstances

what are two frequent microorganisms found in vaginitis

A

bacteria, fungi, parasites

normal commensal organisms can become pathogenic when a person has diabetes, systemic antibiotic therapy, immunodeficiency

Candida albicans
Trichomonas vaginitis

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11
Q

what is the physiological purpose of the cervix

A

to act as a barrier to prevent entrance of air and bacteria into the uterus

to allow menstrual flow and expand to accommodate child birth

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12
Q

cervicitis

A

inflammation of the cervix
common
purulent vaginal discharge

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13
Q

cervicitis can be secondary to which infections

A 
candida
trichomonas
chlamydia
gonorrhea
syphilis
HPV
herpes
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14
Q

very commonly seen in what type of women

A

women that have had multiple children (multiparous)

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15
Q

two types of cervicitis

A

acute

chronic

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16
Q

what used to be the leading cause of cancer deaths in women but now is ranked 13th

A

carcinoma of the cervix

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17
Q

what happened after the usage of Papanicolaou Cytologic Test began

A

the mortality rate from cancer of the cervix decreased

but the discovery of preinvasive intraepithelial cervical neoplasia increased

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18
Q

several factors that tend to increase prevalence of cancer of the cervix

A
  1. early age of first intercourse
  2. multiple sex partners
  3. being with a male partner that has had several partners
  4. persistent infection with “high risk” HPV
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19
Q

what is present in 85-90% of cervical neoplasia

A

HPV

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20
Q

how do 75-95% of cervical cancers present

A

as squamous cell carcinoma

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21
Q

what is the precursor lesion that most invasive cervical carcinomas arise from

A

cervical intraepithelial neoplasia (CIN)

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22
Q

what are the stages of CIN

A

CIN I: mild epithelial dysplasia
CIN II: | | |
CIN III: carcinoma in situ

higher the grade the greater the likelihood will rogress to carcinoma
but not all CINs progress to invasive cancer

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23
Q

what is a pap smear

A

Papanicolaou Smear

screening test that detects precancerous cells
exfoliated cells are collected and prepared w/ special stain

inexpensive
but get false positives and negatives

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24
Q

colposcopy

what do abnormalities look like?

A

medical diagnostic procedure to examine an illuminated, magnified crevix

abnormalities look like white patches following application of acetic acid

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25
what is the peak age for CIN
35 yrs
26
what is the peak age for squamous cell carcinoma
45 yrs
27
if you get an atypical pap smear; whats next?
need to confirm w/ biopsy
28
CIN symptoms
typically asymptomatic
29
what are the symptoms of cervical cancer once it becomes invasive
1. irregular vaginal bleeding 2. leukorrhea 3. painful coitus (sexual intercourse) 3. dysuria
30
how is human papilomavirus transmitted
direct contact
31
what is high risk HPV and low risk HPV strains
high risk: 16 and 18; associated with cancer | low risk: 6 and 11; associated with condyloma
32
tx of SCC of cervix
laser vaporization or excisional biopsy of CIN surgery and/or radiation chemotherapy for invasive disease
33
prognosis of cancer of cervix
in situ lesions have 5 yr survival rate at 100% | stage 4 diesease has 5 yr survival rate at 10%
34
HPV vaccines
type 6, 11, 16, 18 | expected to greatly lower frequency of genital warts and cervical cancers
35
disorders of the uterus common complaints | chronic or acute?
common complaints: pelvic pain and abnormal menstrual function - ->menorrhagia - ->metrorrhagia - ->dysmenorrhea chronic and recurrent mostly
36
menorrhagia
profuse or prolonged bleeding
37
metrorrhagia
irregular bleeding betwen periods
38
dysmenorrhea
unusually painful menstrual bleeding
39
structure of the uterus
myometrium: muscular wall of uterus - ->composed of interlacing bundles of smooth muscle endometrium: glandular lining of uterus - ->changes under hormonal influence
40
most endometrial disease will present with what?
abnormal bleeding
41
common causes of abnormal bleeding are but not limited to
endometriosis endometrial hyperplasia leiomyomas endometrial carcinoma
42
endometriosis
presence of endometrial glands and/or stroma (functional endometrium) in locations other than the uterine lining -->outside the uterus-->causes cyclic bleeding
43
most common site of abnormal location for function endometrium less common sites
pelvis peritoneal cavity, umbilicus, lymph nodes, lungs, heart, bone
44
"regurgitation" theory of endometriosis
backflow of menstrual endometrium through the fallopian tubes and enters the local venous and lymphatic systems
45
what happens with long standing disease (endometriosis)
intrapelvic bleeding and organization of blood leads to widespread fibrosis and periuterine adhesions also get - severe dysmenorrhea - dyspareunia (painful intercourse) - dysuria - pain upon defecation - general pelvic pain
46
involvement of the ovaries w/ endometriosis
cause sterility large blood filled cysts on the ovaries transform to "chocolate cysts" as the blood ages
47
what is endometrial hyperplasia
overgrowth of endometrium (epithelial lining of uterus)
48
what is thought to cause endometrial hyperplasia
excess exposure to estrogen
49
risk factors for endometrial hyperplasia
1. postmenopausal women that are obese - ->fat deposits synthesize estrogen 2. failure of ovulation 3. administration of estrogen 4. estrogen-secreting tumors
50
endometrial hyperplasia complications
produce abnormal bleeding | increase risk for endometrial carcinoma (adenocarcinoma)
51
stages of hyperplasia
mild moderate atypical
52
tumors of the uterus arise from.....and produce
endometrium and myometrium | produce abnormal uterine bleeding
53
most common uterine neoplasms:
1. endometrial polyps 2. smooth muscle tumors 3. carcinoma
54
leiomyoma another name? arises from? benign or malignant?
aka Fibroids benign tumor arising from smooth muscle cells of myometrium
55
when do leiomyoma present in women
30-50% during active reproductive life
56
what is the most common benign tumor in females
leiomyoma
57
what seems to be the cause of leiomyoma
associated w/ estrogen | grow with excess estrogen (pregnancy) and regresses in menopausal women
58
leiomyoma symptoms and detection
may be asymptomatic | detected by routine pelvic exam
59
leiomyoma causes what type of bleeding abnormallity? and pathologically presents as? complications?
causes menorrhagia presents as a palpable pelvic mass causes infertility
60
what is the most frequent genital tract cancer in the US
endometrial carcinoma
61
endometrial carcinoma incidence
diagnosed 55-65 yrs | uncommon before the age of 40
62
endometrial carcinoma tends to present in two different clinical settings
1. perimenopausal women w/ evidence of strong estrogen excess - ->endometrioid carcinoma 2. older women w/ endometrial atrophy - ->serous carcinoma
63
most common early symptoms of endometrial carcinoma
- leukorrhea - irregular bleeding **red flag to postmenopausal women
64
tx of endometrial carcinoma
- surgery - radiotherapy - antiestrogen chemotherapy
65
prognosis of endometrial carcinoma
if localized to body of uterus-->5 yr survival rate is 90% | if spread to outside uterus-->5 yr survival rate is 20%
66
non neoplastic cysts of the ovaries
common but not serious
67
what is the most significant disease of the ovary
neoplasia
68
polycystic ovarian disease
hormonal disorder affecting 5-10% females of reproductive age
69
when is polycystic ovarian disease diagnosed
after menarch in teenage girls or young adults
70
etiology of polycystic ovarian disease
unknown may be genetic
71
polycystic ovarian disease presentation
multiple cystic follicles that result in enlargement of the ovaries and excess production of androgens and estrogens
72
person with polycycsitc ovarian disease may have
delayed or absent maturation, oligomenorrhea, hirsuitism (increased body hair), acne, fertlity prolems, and obeity
73
women with polycistic ovarian disease are at increased risk for...
type II diabetes | cardiovascular disease
74
what is the fifth leading cause of cancer deaths in women
neoplasia of the ovaries
75
risk factors for ovarian carcinoma | what appears to help
``` nulliparity family history (5-10% familial cases) ``` use of oral contraceptives appears to reduce risk somewhat
76
clinical presentations of these ovarian tumors
asymptomatic until they become large enough to cause local pressure symptoms
77
prognosis of ovarian cancer
those that have penetrated the capsule | -->10 yr survival rate is less than 15%
78
histology of ovarian cancer
wide variety of histogenic types | epithelial variant accounts for 90% of ovarian cancers
79
teratoma
develop from differentiation of totipotentail germ cells into mature tissues which represent all three germ layers - ->endoderm - ->mesoderm - ->ectoderm
80
when do teratomas present
first 2 decades of life; earlier the onset the greater chance for malignancy
81
90% of germ cell neoplasms are termed
benign mature cystic teratomas
82
pathology of teratoma
cysts that contain epidermal appearing cyst lining w/ adnexal skin appendages (dermoid cysts)
83
what do these teratomas contain inside?
hair, bone, cartilage, bronchial or gastrointestinal epithlium, and teeth
84
what gene is thought to be mutated in ovarian cancer
BRCA gene
85
breast disorders prevalence
extremely common breast carcinoma used to be number 1 cause of cancer deaths until lung cancer surpassed it
86
three most frequent abnormalities of the breast
1. fibrocystic changes 2. fibroadenoma 3. carcinoma of the breast
87
what is fibrocystic change of the breast
exaggeration or distortion of normal changes that occur during the menstrual cycle overgrowths of fibrous stroma, epithelial elements, or both
88
prevalence of fibrocystic changes and when does it arise
very common arise during reproductive years but can still persist after menopause
89
presentation of fibrocystic change
often bilateral and/or multiple
90
fibrocystic change complications
generally innocuous or harmless but "lumps" that form must be differentiated from cancer most lesions do not predispose to cancer but w/ florid ductal hyperplasia-->slight increase in risk
91
fibroadenoma incidence and prevelance
usually presents in females that are prepubertal or young woman (peak prevalence in 3rd decade) MOST COMMON BENIGN TUMOR OF THE BREAST
92
fibroadenoma pathology
encapsulated tumors involving both glandular epithelium and fibrous tissue
93
fibroadenoma presentation
solitary, freely moveable nodules (1-10 cm)
94
fibroadenoma etiology
increase in estrogen
95
fibroadenoma tx
must be biopsied to confirm that it is benign
96
carcinoma of the breast arise from
glandular and ductal structures many histologic varients seen
97
what is the number 2 cause of cancer deaths in women
breast cancer used to be number 1 before lung cancer surpassed it
98
those that have breast cancer; how many will result in death
1 in 4 women
99
what is the lifetime risk of developing breast cancer
1 in 8 women
100
after what age are 75% of carcinomas of the breast detected
after age 50
101
what percent of breast cancers are related to genetics and what genes are involved when does this type of cancer develop
10% BRCA1 and BRCA2 usually affects females under the age of 40
102
what are the three major risks involved in developing carcinoma of the breast
1. genetics 2. hormones 3. environmental factors
103
how do hormones affect development of breast cancer
higher risk if exposed to exogenous estrogens for a prolonged period of time
104
what 4 environmental variables pose risk to development of carcinoma of the breast
1. ionizing radiation 2. diet 3. reproductive pattern 4. nursing habits
105
carcinoma of the breast presentation
- freely moveable - non tender mass - adherence to the overlying skin-->nipple retraction - thickened overlying skin-->peau d'orange
106
what are the two classifications of breast cancer
1. ductal carcinoma-->arises from ductal epithelium | 2. lobular carcinoma-->arises from glandular acini
107
ductal carcinoma in situ (DCIS) | lobular carcinoma in situ (LCIS)
non invasive precursor stages to carcinoma of the breast have not penetrated basement membrane or underlying connective tissue
108
how are most breast cancers detected
self examination also mammography-->finds calcification of soft tissue
109
tx of carcinoma of the breast
simple mastectomy segmental resection of mass-->lumpectomy postoperative irradiation chemotherapy
110
prognosis of breast cancer
10 yr survival rate is 50% variable dependent on tumor stage every year free of disease passed therapeutic success improves prognosis
111
diagnosis of carcinoma of the breast
biopsy

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