Flashcards in Quiz 5 Study Guide: Reproductive and Breast Deck (58)
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1
What are the common symptoms of Breast Disease?
Pain
Palpable Masses
Nipple Discharge
2
When do you start screenings with Mammography?
40 Years of age
*younger women have more dense breast tissue making discovering a mass more difficult.
3
What Does a Mammography Show?
Density
Architectural Distortions
Calcification
Changes over time
Can help guide biopsy needle
85-90% predictive
4
What is characteristic of Acute Mastitis?
Breast accesses and necrosis
Usually associated with breast feeding
Can be from plugged ducts
Can be infectious or non-infectious
5
What is characteristic of Fat necrosis?
Trauma
*seat belt during an accident
6
What is characteristic of Breast Cysts?
Fibrocystic changes
Higher breast cancer risk in aggressive proliferative type
Occurs in 20-40 year olds
usually not in post menopause women
Can calcify
Can look like cancer on a Mammogram
7
What are the 3 Fibrocystic changes seen with Breast Cysts?
Fibrosis
Cysts
Palpable changes making detection of cancer difficult
8
What are characteristics of a benign neoplasm of the breast?
Fibroadenomas (most common)
Mostly Connective Tissue
Well Circumscribed
Don't typically remove unless uncomfortable
9
What are characteristics of Breast Carcinomas?
Rarely occurs <25 years of age
Mostly in more affluent societies
30% incidence by 70 Years old (1 in 9 die)
Inherited = 5-10% (BRCA 1 & 2)
Family tendency = 20-30% risk
Sporadic = 70-80%
250,000 new cancers /year in US
10
What are the symptoms of Breast Carcinomas?
-Pain
-Masses (Assessed by, palpitation, mammography, ultrasound, MRI, or biopsy)
11
What are the factors relating to Prognosis of Breast Carcinomas?
-Based on size, axillary node status, and far metastasis
-5 year survival @ stage 0 = 92%; stage IV = 13%
-Tumor expressing estrogen/progesterone often responds to hormonal treatment
12
Characteristics of types of breast cancer...
-Invasive Carcinomas = 75-85%
-Generally all are adenocarcinomas from epi cells in terminal ducts.
-Most are ductal and incidence increases with age
-Lumpectomies can treat smaller masses
13
What is characteristic of Benign Epithelial Lesions of the Breast?
Fibrocytic changes
e.g. 60% of women have microscopic cysts associated with epithelial tissues
14
What is usual cause for Cervical Cancers?
HPV - associated squamous cell neoplasm
15
What is used to detect Cervical Cancers early?
Pap Smear
16
What are the risk factors of Cervical Cancers?
Multiple Partners
Immunosuppression
Early age of first sexual contact
Oral Contraception for >5 Years
Nicotine Use
17
What are the causes of endometrial polyps?
Hypertension
Obesity
Late Menopause
*Progresses to Cancer in 2%
18
What are characteristics of Leiomyoma of the endometrium?
Benign Smooth Muscle Neoplasm
Estrogen-Dependent
Bleeding and Painful
May Cause Infertility
19
What are the risks of endometrial Cancer (adenocarcinoma)?
Obesity
Diabetes
Hypertension
20
What are the Treatments for endometrial cancer?
Hysterectomy- Treatment of choice
Radiation/Chemotherapy adjunctive
21
What is the cause of endometritis? (Infections)
Intrauterine Devices (IUD's)
22
What can endometrial hyperplasia progress to?
Cancer
23
What is characteristic of endometrial hyperplasia?
Exaggerated responses due to excessive estrogen
-Excessive ovarian activity
24
What is the treatment of endometrial hyperplasia?
Progesterone
Hysterectomy
25
What are the two types of Ovarian Masses?
Non-neoplastic cysts (e.g. follicular)
Neoplastic (e.g. endometroioid)
26
What are characteristics of Neoplastic Ovarian Masses?
Most are sporadic (90%)
Contraceptives can decrease risk
10% are Hereditary (BRCA 1&2)
27
What is treatment for Neoplastic Ovarian Masses?
Total Hysterectomy + removal of surrounding tissue + chemotherapy
28
What are the symptoms of Ovarian Masses?
Pelvic Pain
Pelvic Mass
Abdominal Bleeding
29
Is there an effective screening for ovarian cancer?
NO
30
Characteristics of Estrogens and Progestins...
-Natural estrogens are Steroid hormones (Not Synthetic)
-They cross cell membranes and activate estrogen receptors inside cell (modulate gene expression)
31
What are the 3 stages of the Menstrual Cycle?
Menstrual Stage - Menses
Follicular Stage - Proliferative
Luteal Stage - Secretory
32
What are the 3 natural Estrogens?
Estrone (E1) - Menopause
Estradiol (E2) - Productive Years
Estratriol (E3) - Pregnancy
33
What are the 2 Synthetic Estrogens?
Ethinyl Estradiol - Steroidal
diethylstilbesterol - Non-steroidal
34
What are the physiological functions of Estrogens?
Sexual Maturity
Increased CNS excitability (Seizures???)
Increased Endometrial and Uterine Growth
Maintain Skin Elasticity
Reduce bone adsorption
Increase Blood Coagulability
35
What are the clinical uses of Estrogens?
Primary Hypogonadism
Post-menopausal problems
*always used smallest dose for shortest time possible
*Local creams can be preferred to minimize exposure
36
What are the adverse effects of Estrogen use?
Postmenopausal Bleeding
Nausea
Breast Tenderness
Migraines
Hypertension
Hyperpigmentation (especially around eyes)
Increases some cancers (breast & endometrial)
37
What are the contraindications for Estrogen use?
Liver Disease (Slows Metabolism)
Breast and Endometrial Cancers
Thrombolytic Disorders
38
What are characteristics of Progestins?
Made from Cholesterol
Present in males/less in females
39
What is the natural Progestin?
Progesterone
40
What are characteristics of Progesterone?
-Precursor to estrogen, androgen, and adrenal cortical steroids. (e.g. Cortisol)
-Also precursor to testosterone and estradiol.
41
What is the half life of Progestins?
Very Short Acting (5 min)
42
What are the effects of Progestins?
Increase Fat Deposition
Decrease CNS Excitability (Anti seizure - opposite estrogen)
Increase Aldosterone
Increase Na+ retention
Increase BP
Increase water retention and blood volume
Increase Body Temperature
43
What are the clinical uses of Progestins?
-Replacement Therapy
-Oral Contraception
-Long term ovarian suppression
-No problem with bleeding or clotting (contrast to estrogens
44
What are the contraindications for the clinical use of Progestins?
Breast Cancer Risk
Severe hypertension/heart disease
45
What makes up the combination of drugs used as a contraceptive?
Progesterone + Estrogen
46
What are characteristics of Combo contraceptives?
Decreases Ovulation near (100%)
Decreases conception and Implantation
47
What are characteristics of Progestin only contraceptives?
Less effective (80-90%)
Decreases ovulation 50-80%
Thickens mucus and reduces sperm penetration
Impairs implantation
48
What are the delivery forms of Contraceptives?
Combinations
Progestin only
Implantable
Injections
Intravaginal rings
IUDs with or without estrogen/progestin
Transdermal Combinations
49
What are the three phases of Combinations?
Monophasics -constant doses of estrogen/progestin
Biphasics- dosage of one or both change one time / cycle
Triphasics- dosages change two times
50
What are side effects of Combination contraceptives?
Reduced Ovarian Functions and Size
Increased Breast Size and Tenderness
Increased Thrombolytic Events
Increased HR and BP
Hyperpigmentation (especially around the eye)
Mild Nausea
Breakthrough Bleeding
Headaches
*May interact with antibiotics (wide-spectrum)
- Absorption of contraceptive depends on normal GI flora.
51
What are uses for Contraceptives?
Oral Contraception
Menstrual Disorders
Irregularity
Heavy Discharge
Acne
52
What are three hormone antagonists?
Tamoxifen
Mifepristone
Danazol
53
What is the Mechanism of action of Tamoxifen?
Blocks actions of estrogen in breasts
- Used to treat breast cancers
54
What is the Mechanism of action of Mifepristone?
Morning after contraceptive: Blocks progesterone and glucocorticoid receptors (99% effective if used within 3 days)
55
What is the Mechanism of action of Danazol?
Surpasses ovarian function
*masculinizing effect
56
What drug is Ovulation inducing or promotes fertilization and pregnancy?
Clomiphene (Clomid)
*increased risk of multiple births (twins)
57
What is an example of an androgen?
Testosterone
*Causes male puberty
58
