lecture 2 part 2- female

Question 1

-benign smooth muscle neoplasm
-fibroids
-may cause irregular bleeding(metrorrhagia)
-painful intercource (dyspareunia)

Answer 1

uterine leiomyoma

Question 2

-glandular epithelium
-bleeding

Answer 2

proliferative lesions: endometrial hyperplasia and polyps

Question 3

2 major diseases of the endometrium

Answer 3

endometriosis
adenocarcinoma

Question 4

-endometrial tissue outside the uterine cavity
-Ectopic endometrial tissue influenced by hormonal change
-Recurring pelvic pain
-Symptoms depend on the site involved and worsen with the
menstrual cycle

Answer 4

endometriosis

Question 5

“chocolate cyst”

Answer 5

endometriosis- ovary

Question 6

risk factors for endometrial carcinoma

Answer 6

1. age- most common in the 55 to 65 age group
2. obesity- greater synthesis of estrogen in body fat
3. infertility- women who are nulliparous are at increased risk of endometrial carcinoma

Question 7

-Exfoliative cytologic screening for early detection (Papanicolau smear)
-squamo-columnar junction
-vaccination

Answer 7

cervical squamous cell carcinoma

Question 8

cervical squamous cell carcinoma are mostly caused by

Answer 8

HPV sub types 16 and 18

Question 9

sequence of events that may follow HPV infection

Answer 9

1. sex
2. HPV exposure
3. low risk HPV[condyloma]
   or high risk HPV 16 and 18 [CIN->higher grade CIN-> invasive cancer->metastasis]

Question 10

Cervical Intraepithelial Neoplasia (grades I, II, III)

Answer 10

LSIL- low-grade squamous intraepithelial lesion
HSIL- high-grade squamous intraepithelial lesion

Question 11

A tumor containing tissues from all three germ layers

Answer 11

teratoma

Question 12

Most tumors are derived from one

Answer 12

cell layer
(ectoderm, endoderm, mesoderm)

Question 13

-Generally arise in gonadal tissues
-Most commonly seen in the ovary

Answer 13

teratoma

Question 14

may contain a variety of tissues including hair, teeth, bone, cartillage,
thyroid, etc.

Answer 14

“Dermoid cyst” of the ovary – a benign cystic teratoma

Question 15

-Pelvic inflammatory disease
-Tubal scarring
-Ectopic pregnancy

Answer 15

gonerrhea
(neisseria gonorrhea)

Question 16

5 parts of breast

Answer 16

Glandular epithelium
Ducts
Lobules
Interstitial tissue
Lymphatics

Question 17

-Enlargement of male breast may occur in response to estrogen
-Hyperestrinism in male

Answer 17

gynecomastia

Question 18

gynecomastia
bilateral:
unilateral:

Answer 18

bilateral: rule out hormonal
unilateral: rule out tumor

Question 19

Cirrhosis of liver – inability to metabolize estrogens
Klinefelter syndrome
Estrogen-secreting tumors
Estrogen therapy

Answer 19

factors of gynecomastia

Question 20

-Most common benign neoplasm of breast
-Discrete, usually solitary, moveable nodule
-Young women (third decade)

Answer 20

fibroadenoma

Question 21

Invasive lobular carcinoma

Answer 21

lobules

Question 22

Invasive ductal carcinoma

Answer 22

ducts

Question 23

-Genetic changes
-Hormonal influences
-Environmental variables

Answer 23

pathogenesis of breast cancer

Question 24

well-established risk factors in breast cancer (6)

Answer 24

1. Age – uncommon < 30 y
2. Genetics and family history - p53, BRCA1/2
   genes
3. Menstrual history – early menarche (<12y),
   late menopause (>55y)
4. Length of reproductive life
5. Nulliparous – having children is protective
6. Geographic variation

Question 25

other breast cancer risk factors

Answer 25

1. Exogenous estrogens – postmenopausal hormone replacement therapy 2. Oral contraceptives – newer formulations of balanced, low doses of estrogen and progestin safe 3. Ionizing radiation during breast development

Question 26

Less well-established risk factors for breast cancer

Answer 26

alcohol high fat diet obesity cigarette smoking

Question 27

Familial syndromes with breast cancer

Answer 27

1. Li-Fraumeni Syndrome – germ-line mutations in p53 2. Cowden Syndrome – germ-line mutations in PTEN 3. Ataxia-telangiectasia gene – DNA repair genes 4. BRCA1/BRCA2 – germ-line mutations

Question 28

-Epidermal growth factor receptor -Amplified in 30% of breast cancers -Overexpression associated with poor prognosis -Therapeutic intervention – Herceptin (trastuzumab)

Answer 28

HER2/NEU proto-oncogene with breast cancer

Question 29

Genetic changes continued: Amplification of ____ and ____ (proto-oncogenes) mutations on ___and ___(tumor suppressor genes) estrogen receptor positivity-> therapeutic intervention: progesterone receptor positive

Answer 29

RAS and MYC Rb and p53 tamoxifen

Question 30

increased exposure to estrogen is a

Answer 30

risk factor for breast cancer -long duration of reproductive life (more estrogen) -nulliparity- having children is protective -late age at birth of first child

Question 31

The more ______ the breasts are exposed to over a lifetime, the higher the risk of breast cancer. During each monthly menstrual cycle, the breasts are exposed to increased ______ levels, especially at the time of ovulation.

Answer 31

estrogen estrogen

Question 32

Both early age at the start of menstrual cycles (menarche) and late menopause increase breast cancer risk through increased exposure to estrogen during more menstrual cycles. T/F

Answer 32

true

Question 33

Late age for menarche and early age for menopause decrease breast cancer risk through

Answer 33

fewer menstrual cycles.

Question 34

increase breast cancer risk through increased exposure to estrogen.

Answer 34

birth control pills and hormone replacement therapy

Question 35

The more alcohol consumed, the more impaired the liver becomes in its ability to metabolize estrogen. Therefore, alcohol consumption

Answer 35

increases breast cancer.

Question 36

This is because adipose tissue produces small amounts of estrogen.

Answer 36

obesity is risk for breast cancer

Question 37

most common breast cancer location

Answer 37

upper outer quadrant-50% central portion- 20% next

Question 38

1. have not penetrated the basement membrane -Ductal carcinoma in situ (DCIS, intraductal carcinoma) -Lobular carcinoma in situ (LCIS)

Answer 38

noninvasive classification of breast cancers

Question 39

1. have penetrated the basement membrane (infiltrating) -Invasive ductal carcinoma – most common (scirrhous carcinoma) -Invasive lobular carcinoma

Answer 39

invasive classification of breast cancers

Question 40

-Precursor lesion to invasive carcinoma -When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same breast. -treatment is surgery and radiation

Answer 40

ductal carinoma in situ

Question 41

antiestrogenic if estrogen receptor + (blocks estrogen receptor)

Answer 41

tamoxifen

Question 42

post-menopausal women (blocks estrogen formation)

Answer 42

aromatase inhibitors

Question 43

-Clinical variant of DCIS -Extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple -Crusting exudate over the nipple and areolar skin -Underlying invasive carcinoma in 50%

Answer 43

paget's disease of nipple

Question 44

-One-third of women with _____ develop invasive carcinoma -The invasive carcinoma may arise in either breast -_____ is a marker of increased risk for developing breast cancer in either breast

Answer 44

LCIS lobular carcinoma in situ

Question 45

Most breast carcinomas (70-80%) Term used for all carcinomas that cannot be sub-classified into a specific type (not discussed)

Answer 45

invasive ductal carcinoma (Carcinoma of “no special type” or “not otherwise specified” (NOS) are synonyms for invasive ductal carcinoma)

Question 46

3 clinical features common to all invasive carincomas

Answer 46

1. Fixation secondary to adherence to pectoral muscles or deep fascia of chest wall 2. Adherence to overlying skin with retraction or dimpling of the skin or nipple 3. Lymphatic involvement may cause localized lymphedema with the skin thickened around exaggerated hair follicles (peau d’orange – orange peel appearance)

Question 47

TNM staging of breast cancer Stage 1

Answer 47

tumor <2cm, without nodal involvement, no metastases

Question 48

TNM staging of breast cancer Stage 2

Answer 48

tumor <5 cm with <3 nodes and no distant metastases (or more than 5 cm without nodes)

Question 49

TNM staging of breast cancer Stage 3

Answer 49

* many categories, any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases

Question 50

TNM staging of breast cancer Stage 4

Answer 50

any cancer with disseminated metastases

Question 51

prognostic factors

Answer 51

1. Size of primary carcinoma 2. Lymph node involvement and number of nodes 3. Distant metastases 4. Histologic grade 5. Histologic type 6. Estrogen or progesterone receptor expression - Tamoxifen 7. Proliferative rate 8. Aneuploidy 9. HER2/NEU overexpression - Herceptin