Week 13: Reproductive System Flashcards
1
Q
Epididymis—maturation of _________
A
sperm
2
Q
Vas deferens—transport of sperm to __________
A
urethra
3
Q
Seminal vesicles—secretion to nourish __________
A
sperm
4
Q
Prostate gland—secretions to _________________
A
balance pH
5
Q
Penis— _____________ of semen
A
ejaculation
6
Q
Cowper glands (bulbourethral)—secretes alkaline __________
A
mucus
7
Q
Male hormones
-Follicle-stimulating hormone (FSH)—initiates ____________
- Luteinizing hormone (LH)—stimulates ____________production
- Testosterone—maturation of ________, sex characteristics, protein metabolism, muscle development
A
-Follicle-stimulating hormone (FSH)—initiates spermatogenesis
- Luteinizing hormone (LH)—stimulates testosterone production
- Testosterone—maturation of sperm, sex characteristics, protein metabolism, muscle
development
8
Q
Congenital Abnormalities of the Penis
-Epispadias—urethral opening on _________________surface of the penis
- Hypospadias—urethral opening on _________ surface (underside) of the penis
- Either condition may result in incontinence/infection.
-Treatment—____________ reconstruction
A
-Epispadias—urethral opening on ventral or upper surface of the penis
- Hypospadias—urethral opening on dorsal surface (underside) of the penis
- Either condition may result in incontinence/infection.
-Treatment—surgical reconstruction
9
Q
-Cryptorchidism—testis fails to descend into _________ properly
- Ectopic testis—testis positioned outside of ___________
— Can cause degeneration of seminiferous tubules and spermatogenesis is impaired
— Risk of testicular cancer increased significantly if treatment not done by age 5 years
A
-Cryptorchidism—testis fails to descend into scrotum properly
- Ectopic testis—testis positioned outside of scrotum
— Can cause degeneration of seminiferous tubules and spermatogenesis is impaired
— Risk of testicular cancer increased significantly if treatment not done by age 5 years
10
Q
Hydrocele—occurs when excessive _______ collects in space between layers of the tunica
vaginalis of the scrotum
- May occur as congenital defect in newborn
-May be acquired as result of injury, infection, tumor - May compromise blood supply or lymph drainage in testes
A
Hydrocele—occurs when excessive fluid collects in space between layers of the tunica
vaginalis of the scrotum
- May occur as congenital defect in newborn
-May be acquired as result of injury, infection, tumor - May compromise blood supply or lymph drainage in testes
11
Q
Spermatocele— _____ containing _____ and sperm that develops between the testis and
the epididymis
- May be related to developmental abnormality
- Surgical removal
A
Spermatocele—cyst containing fluid and sperm that develops between the testis and
the epididymis
- May be related to developmental abnormality
- Surgical removal
12
Q
Varicocele—a ______________ in the spermatic cord
-Lack of valves allows backflow in veins; leads to increased pressure and dilation
-Causes impaired blood flow to testes and decreased spermatogenesis
- Requires surgery
A
Varicocele—a dilated vein in the spermatic cord
-Lack of valves allows backflow in veins; leads to increased pressure and dilation
-Causes impaired blood flow to testes and decreased spermatogenesis
- Requires surgery
13
Q
Torsion of the testes—testes _______ on spermatic cord, compressing arteries and veins
- Ischemia develops, scrotum swells
- Testis may be infarcted if torsion is not reduced
- Can occur spontaneously or following trauma
- Treated manually and surgically
A
Torsion of the testes—testes rotate on spermatic cord, compressing arteries and veins
- Ischemia develops, scrotum swells
- Testis may be infarcted if torsion is not reduced
- Can occur spontaneously or following trauma
- Treated manually and surgically
14
Q
Prostatitis—infection or inflammation of the ___________
Four recognized categories
1. Acute ________
2. Chronic __________
3. Nonbacterial
4. Asymptomatic _____________
A
Prostatitis—infection or inflammation of the prostate gland
Four recognized categories
1. Acute bacterial
2. Chronic bacterial
3. Nonbacterial
4. Asymptomatic inflammatory
15
Q
Prostatitis
- Acute bacterial—gland is tender and ________ , urine and secretions contain bacteria
- Nonbacterial—urine and secretions contain large numbers of ___________
- Chronic bacterial—gland only slightly _________ , dysuria, frequency, urgency
A
- Acute bacterial—gland is tender and swollen, urine and secretions contain bacteria
- Nonbacterial—urine and secretions contain large numbers of leukocytes
- Chronic bacterial—gland only slightly enlarged, dysuria, frequency, urgency
16
Q
Prostatitis (Cont.)
- Acute bacterial infection is caused primarily by ____________ and sometimes by Pseudomonas, Proteus, or Streptococcus faecalis.
- Chronic bacterial infection is related to repeated infection by ______
- These are opportunistic bacteria from the normal flora of the gut.
A
- Acute bacterial infection is caused primarily by Escherichia coli and sometimes by Pseudomonas, Proteus, or Streptococcus faecalis.
- Chronic bacterial infection is related to repeated infection by E. coli.
- These are opportunistic bacteria from the normal flora of the gut.
17
Q
Prostatitis occurs in
- Young men with _____
- Older men with prostatic hypertrophy
- In association with _____
- With instrumentation such as catheterization
- Through bacteremia
A
- Young men with UTIs
- Older men with prostatic hypertrophy
- In association with STDs
- With instrumentation such as catheterization
- Through bacteremia
18
Q
Prostatitis -Signs and symptoms
-dysuria, urinary frequency, and ________
- Decreased urinary ______
- Acute form includes fever and chills
- Lower ______ pain; Muscle aches
- Leukocytosis
-Abdominal discomfort
- Systemic signs include fever, malaise, anorexia
A
-dysuria, urinary frequency, and urgency
- Decreased urinary stream
- Acute form includes fever and chills
- Lower back pain; Muscle aches
- Leukocytosis
-Abdominal discomfort
- Systemic signs include fever, malaise, anorexia
19
Q
Prostatitis treatment for acute or chronic bacterial infection
- ____________ drugs such as ciprofloxacin
Treatment for nonbacterial infection
- ________________ drugs and prophylactic antibacterial agents
A
Prostatitis treatment for acute or chronic bacterial infection
- Antibacterial drugs such as ciprofloxacin
Treatment for nonbacterial infection
- Anti-inflammatory drugs and prophylactic antibacterial agents
20
Q
Balanitis
- ________ infection of the glans penis
- Sexually transmitted
- Caused by Candida albicans
- Vesicles develop into patches
- Severe burning and itching
- Treatment—topical _________ medication
A
- Fungal infection of the glans penis
- Sexually transmitted
- Caused by Candida albicans
- Vesicles develop into patches
- Severe burning and itching
- Treatment—topical antifungal medication
21
Q
Tumors: Benign Prostatic Hypertrophy
- Occurs in up to ____ of men > 65 years
- Hyperplasia of prostatic tissue
- Compression of urethra and urinary obstruction
- Related to estrogen–testosterone ___________
- Does not predispose to prostatic carcinoma
A
- Occurs in up to 50% of men > 65 years
- Hyperplasia of prostatic tissue
- Compression of urethra and urinary obstruction
- Related to estrogen–testosterone imbalance
- Does not predispose to prostatic carcinoma
22
Q
Tumors: Benign Prostatic Hypertrophy (Cont.)
- Enlarged ______ palpated on digital rectal examination
- Leads to frequent __________
- Continued obstruction causes distended bladder, dilated ureters, hydronephrosis, and
renal failure if untreated.
A
- Enlarged gland palpated on digital rectal examination
- Leads to frequent infections
- Continued obstruction causes distended bladder, dilated ureters, hydronephrosis, and
renal failure if untreated.
23
Q
Tumors: Benign Prostatic Hypertrophy - Signs and symptoms
- Obstructed urinary ______
- Hesitancy in starting flow
- Dribbling
- Decreased flow _________
- Increased frequency and urgency
- Nocturia
- Dysuria occurs if infection is present.
A
- Obstructed urinary flow
- Hesitancy in starting flow
- Dribbling
- Decreased flow strength
- Increased frequency and urgency
- Nocturia
- Dysuria occurs if infection is present.
24
Q
Tumors: Benign Prostatic Hypertrophy (Cont.)
Treatment
- Drugs such as dutasteride (Avodart) to slow ___________
- Smooth muscle ______ such as tamsulosin (Flomax)
- Combo of finasteride (Proscar) and doxazosin (Cardura) reduces progression of hypertrophy
- Surgery
A
Treatment
- Drugs such as dutasteride (Avodart) to slow enlargement
- Smooth muscle relaxers such as tamsulosin (Flomax)
- Combo of finasteride (Proscar) and doxazosin (Cardura) reduces progression of hypertrophy
- Surgery
25
Tumors: Cancer of the Prostate
- Most common cancer in men > ____ years
- Third leading cause of cancer death in men
- One in ____ men affected
- Most are adenocarcinomas arising near surface of gland
- The more undifferentiated the tumor, the more aggressive
- Many tumors are androgen-dependent.
- Most common cancer in men > 50 years
- Third leading cause of cancer death in men
- One in six men affected
- Most are adenocarcinomas arising near surface of gland
- The more undifferentiated the tumor, the more aggressive
- Many tumors are androgen-dependent.
26
Tumors: Cancer of the Prostate (Cont.)
- Both invasive and metastatic
- Some forms are highly aggressive but others are not.
- 5% to 10% caused by ___________ mutations
-Other causes—high androgen levels, increased insulin-like growth factor, history of recurrent prostatitis
- Both invasive and metastatic
- Some forms are highly aggressive but others are not.
- 5% to 10% caused by inherited mutations
-Other causes—high androgen levels, increased insulin-like growth factor, history of recurrent prostatitis
27
Tumors: Cancer of the Prostate - Signs and symptoms
- Hard _______ felt on periphery of gland
- Hesitancy in urination
- Decreased urine stream
- Frequent __________
- Recurrent UTI
- Hard nodule felt on periphery of gland
- Hesitancy in urination
- Decreased urine stream
- Frequent urination
- Recurrent UTI
28
Tumors: Cancer of the Prostate (Cont.)
Diagnosis
- Serum markers
* Prostate-specific antigen (PSA)
* Prostatic acid phosphatase
- Ultrasonography
- Biopsy
- Bone scans to detect metastases
Treatment
- ________ (radical prostatectomy)
- ___________ : external or implanted pellets
- If androgen-sensitive, then orchiectomy is effective, as well as antitestosterone drugs.
- New chemotherapies are in clinical trials.
Diagnosis
- Serum markers
* Prostate-specific antigen (PSA)
* Prostatic acid phosphatase
- Ultrasonography
- Biopsy
- Bone scans to detect metastases
Treatment
- Surgery (radical prostatectomy)
- Radiation: external or implanted pellets
- If androgen-sensitive, then orchiectomy is effective, as well as antitestosterone drugs.
- New chemotherapies are in clinical trials.
29
Cancer of the Testes
- Most testicular tumors are ___________.
- 1 in 300 affected; Most _________ solid tumor cancer in young men
- Number of cases increasing
- Testicular self-examination is essential for early detection.
- Most testicular tumors are malignant.
- 1 in 300 affected; Most common solid tumor cancer in young men
- Number of cases increasing
- Testicular self-examination is essential for early detection.
30
Cancer of the Testes (Cont.)
- May originate from one type of cell or mixed ______ from various sources
-Teratoma—tumor consisting of mixture of different _____ cells
- Some malignant tumors secrete hCG or AFP, which serve as useful markers for diagnosis.
- May originate from one type of cell or mixed cells from various sources
-Teratoma—tumor consisting of mixture of different germ cells
- Some malignant tumors secrete hCG or AFP, which serve as useful markers for diagnosis.
31
Cancer of the Testes (Cont.)
- Typical _______ pattern
- Appear in common iliac and para-aortic lymph nodes
-Then to the mediastinal and supraclavicular lymph nodes
- Then through the ______ to the lungs, liver, bone, and brain
- Typical spreading pattern
- Appear in common iliac and para-aortic lymph nodes
-Then to the mediastinal and supraclavicular lymph nodes
- Then through the blood to the lungs, liver, bone, and brain
32
Cancer of the Testes - Signs and symptoms
- Tumors are ____, painless, usually unilateral
- Testes may be _________ or feel heavy.
- Dull _______ scrotum and pelvis
- Hydrocele or epididymitis may develop.
- Gynecomastia occurs if the tumor is hormonesecreting.
- Tumors are hard, painless, usually unilateral
- Testes may be enlarged or feel heavy.
- Dull aching scrotum and pelvis
- Hydrocele or epididymitis may develop.
- Gynecomastia occurs if the tumor is hormonesecreting.
33
Cancer of the Testes - Diagnostic tests
- _______ is not usually done.
- ______ markers (hCG and AFP)
- Ultrasound
- Computed tomography
- Lymphangiography
- Biopsy is not usually done.
- Tumor markers (hCG and AFP)
- Ultrasound
- Computed tomography
- Lymphangiography
34
Cancer of the Testis - Treatment
-Combination of:
* _______ (orchiectomy)
* ________therapy
* Chemotherapy
- NOTE: the client may wish to donate sperm prior to treatment to ensure future fertility.
* Surgery (orchiectomy)
* Radiation therapy
* Chemotherapy
- NOTE: the client may wish to donate sperm prior to treatment to ensure future fertility.
35
Vulva
- Mons pubis—_______ tissue and hair covering the symphysis pubis
- Labia majora and minora—outer and inner __________ of skin extending back and down from the
mons pubis
- Mons pubis—adipose tissue and hair covering the symphysis pubis
- Labia majora and minora—outer and inner thin folds of skin extending back and down from the
mons pubis
36
Clitoris— _________ tissue anterior to urethra
erectile
37
Vagina—__________, distensible ________ extending upward from the vulva to the cervix
Vagina—muscular, distensible canal extending upward from the vulva to the cervix
38
Uterus—muscular organ within which fertilized ______ may implant and develop
ovum
39
Cervix—opening into uterus and neck of the uterus
External os
* ________ from vagina filled with thick mucus
* Prevents vaginal flora from ascending into the uterus
Internal os
External os
* Opening from vagina filled with thick mucus
* Prevents vaginal flora from ascending into the uterus
Internal os
40
Fallopian tubes (oviducts)—tubes from ovaries to _______
uterus
41
Ovaries—produce _____ and estrogen and progesterone hormones
ova
42
Breasts
- Glands produce colostrum and _____ for newborn
- ________ tissue
- Glands produce colostrum and milk for newborn
- Adipose tissue
43
Hormones and the menstrual cycle
-Cycle may be from 21 to 45 days
- Cycle consists of:
* ___________ (days 1 to 5)
* Endometrial proliferation and production of estrogen (days vary)
* Maturation of ovarian ________
* Release of _____ , causing ovulation
-Cycle may be from 21 to 45 days
- Cycle consists of:
* Menstruation (days 1 to 5)
* Endometrial proliferation and production of estrogen (days vary)
* Maturation of ovarian follicle
* Release of LH, causing ovulation
44
The Menstrual Cycle
- Follicle becomes the corpus luteum, produces __________
- Vascularization of ___________ in preparation for implantation (12 to 14 days prior to onset
of next menstruation)
If implantation does not occur:
- Corpus luteum atrophies
- Uterine muscle contracts → ischemia
- Endometrium degenerates
- Follicle becomes the corpus luteum, produces progesterone
- Vascularization of endometrium in preparation for implantation (12 to 14 days prior to onset
of next menstruation)
If implantation does not occur:
- Corpus luteum atrophies
- Uterine muscle contracts → ischemia
- Endometrium degenerates
45
Structural Abnormalities
Normal position of uterus
- Slightly anteverted and anteflexed
- Cervix downward and posterior
Retroflexion of uterus
- Uterus tipped posteriorly
- May be excessively ______ or bent
- Marked retroversion may cause back ______ dysmenorrhea, dyspareunia
- In some cases, ___________ may occur.
Normal position of uterus
- Slightly anteverted and anteflexed
- Cervix downward and posterior
Retroflexion of uterus
- Uterus tipped posteriorly
- May be excessively curved or bent
- Marked retroversion may cause back pain dysmenorrhea, dyspareunia
- In some cases, infertility may occur.
46
Structural Abnormalities (Cont.)
Uterine displacement or prolapse
- First-degree prolapse if cervix drops into the ___________
- Second-degree prolapse if cervix lies at opening to the vagina
* Body of uterus is in the vagina
- Third-degree prolapse if uterus and cervix protrude through the vaginal orifice
* Early stages of prolapse may be asymptomatic.
* Advanced stages cause discomfort, infection, and decreased _________.
Uterine displacement or prolapse
- First-degree prolapse if cervix drops into the vagina
- Second-degree prolapse if cervix lies at opening to the vagina
* Body of uterus is in the vagina
- Third-degree prolapse if uterus and cervix protrude through the vaginal orifice
* Early stages of prolapse may be asymptomatic.
* Advanced stages cause discomfort, infection, and decreased mobility.
47
Structural Abnormalities (Cont.)
Rectocele
- Protrusion of the rectum into the posterior _________
- May cause constipation and pain
Cystocele
- Protrusion of ________ into the anterior vagina
- May cause UTIs
If severe, conditions are treated surgically to increase the support of the pelvic ligaments.
Rectocele
- Protrusion of the rectum into the posterior vagina
- May cause constipation and pain
Cystocele
- Protrusion of bladder into the anterior vagina
- May cause UTIs
If severe, conditions are treated surgically to increase the support of the pelvic ligaments.
48
Menstrual abnormalities
Amenorrhea (__________ of menstruation)
* May be primary or secondary
- Primary form may be genetic.
- Secondary form usually hormonal imbalance
Dysmenorrhea
* _______ menstruation caused by excessive release of ___________ bc of endometrial ischemia
* Usually begins a few days prior to menses and lasts a few days after onset
* NSAIDs offer relief.
Amenorrhea (absence of menstruation)
* May be primary or secondary
- Primary form may be genetic.
- Secondary form usually hormonal imbalance
Dysmenorrhea
* Painful menstruation caused by excessive release of prostaglandins bc of endometrial ischemia
* Usually begins a few days prior to menses and lasts a
few days after onset
* NSAIDs offer relief.
49
Menstrual abnormalities - Premenstrual syndrome
* Begins approximately ________ before onset of menses
* Pathophysiology not completely known; may be several forms
* Breast tenderness, weight gain, abdominal distension or bloating, irritability, emotional liability, sleep disturbances, depression, headache, fatigue
* Treatment is individualized and may include exercise, limiting salt intake, use of oral
contraceptives, diuretics, or antidepressant drugs
* Begins approximately 1 week before onset of menses
* Pathophysiology not completely known; may be several forms
* Breast tenderness, weight gain, abdominal distension or bloating, irritability, emotional liability, sleep disturbances, depression, headache, fatigue
* Treatment is individualized and may include exercise, limiting salt intake, use of oral
contraceptives, diuretics, or antidepressant drugs
50
Abnormal Menstrual Bleeding- usual cause is lack of ovulation, but a hormonal imbalance in the pituitary-ovarian axis may be a factor.
- Menorrhagia
* Increased amount and duration of ____
- Metrorrhagia
* Bleeding between _______
- Polymenorrhea
* ______ cycles of less than 3 weeks
- Oligomenorrhea
* _____ cycles of more than 6 weeks
- Menorrhagia
* Increased amount and duration of flow
- Metrorrhagia
* Bleeding between cycles
- Polymenorrhea
* Short cycles of less than 3 weeks
- Oligomenorrhea
* Long cycles of more than 6 weeks
51
Menstrual Disorders - Endometriosis
- Endometrial tissue occurs outside the ________.
- Ectopic endometrium responds to cyclical hormone changes.
- Bleeding leads to inflammation and ______.
- Fibrous tissue may cause adhesions and obstructions of the involved structures.
- Cause has not been established but thought to be congenital in some cases
Treatment
* _________ suppression
* Surgical removal of ectopic tissue
- Endometrial tissue occurs outside the uterus.
- Ectopic endometrium responds to cyclical hormone changes.
- Bleeding leads to inflammation and pain.
- Fibrous tissue may cause adhesions and obstructions of the involved structures.
- Cause has not been established but thought to be congenital in some cases
Treatment
* Hormonal suppression
* Surgical removal of ectopic tissue
52
Infections: Candidiasis
-Form of vaginitis that is not _________ transmitted
- Caused by the fungus Candida albicans
- Opportunistic infection by normal flora of vagina
--- _______ therapy
---Pregnancy
--- Diabetes
--- Reduced host resistance
-Form of vaginitis that is not sexually transmitted
- Caused by the fungus Candida albicans
- Opportunistic infection by normal flora of vagina
--- Antibiotic therapy
---Pregnancy
--- Diabetes
--- Reduced host resistance
53
Candidiasis causes red and swollen, intensely pruritic mucous membranes and a thick, white, curdlike discharge.
-May extend to vulvar tissues
- __________ treatment
Candidiasis causes red and swollen, intensely pruritic mucous membranes and a thick, white, curdlike discharge.
-May extend to vulvar tissues
- Antifungal treatment
54
Infections: Pelvic Inflammatory Disease
- Infection of uterus, fallopian tubes, and/or ovaries
- May be acute or chronic
- Infection usually originates as an ascending infection from _______ reproductive tract.
- May occur because of bacteremia
- Most infections arise from ________ transmitted diseases, nonsterile abortions, or childbirth.
- Infection of uterus, fallopian tubes, and/or ovaries
- May be acute or chronic
- Infection usually originates as an ascending infection from lower reproductive tract.
- May occur because of bacteremia
- Most infections arise from sexually transmitted diseases, nonsterile abortions, or childbirth.
55
Pelvic Inflammatory Disease (Cont.)
- Scarring of tubes increases risk of infertility and ectopic pregnancy.
- Potential acute complications
- Peritonitis
- Pelvic abscesses
- Septic shock
- _________ is usually first sign
- Increased temperature
- Guarding
- Nausea and vomiting
- Leukocytosis
- _______ discharge may be present.
- Treatment usually requires aggressive ____________ therapy in hospital.
- Scarring of tubes increases risk of infertility and ectopic pregnancy.
- Potential acute complications
- Peritonitis
- Pelvic abscesses
- Septic shock
- Pelvic pain is usually first sign
- Increased temperature
- Guarding
- Nausea and vomiting
- Leukocytosis
- Purulent discharge may be present.
- Treatment usually requires aggressive antibiotic therapy in hospital.
56
Benign Tumors
Leiomyoma (fibroids)
- Benign tumor of the myometrium
- Common during the reproductive years
- Classified by location
- Usually multiple, well-defined, encapsulated masses
* Abnormal bleeding may occur.
* May interfere with __________
- Often asymptomatic until large growth
- Hormonal therapy or surgery
Leiomyoma (fibroids)
- Benign tumor of the myometrium
- Common during the reproductive years
- Classified by location
- Usually multiple, well-defined, encapsulated masses
* Abnormal bleeding may occur.
* May interfere with implantation
- Often asymptomatic until large growth
- Hormonal therapy or surgery
57
Benign Tumors (Cont.)
Ovarian cysts
- Variety of types occur
- Physiological type lasts about 8 to 12 weeks and disappear without complications
- Usually multiple, small, fluid-filled sacs
- If __________ occurs, more serious inflammation occurs.
* Requires surgical intervention
- Ultrasound or laparoscopy for identification
- Variety of types occur
- Physiological type lasts about 8 to 12 weeks and disappear without complications
- Usually multiple, small, fluid-filled sacs
- If bleeding occurs, more serious inflammation occurs.
* Requires surgical intervention
- Ultrasound or laparoscopy for identification
58
Benign Tumors (Cont.)
Polycystic ovarian disease
- Fibrous capsule thickens around follicles of ______
-May be hereditary
- Absence of ovulation and infertility
- Hormonal imbalance
- Amenorrhea
-Hirsutism
- Treatment may be surgical wedge resection or pharmacology.
Polycystic ovarian disease
- Fibrous capsule thickens around follicles of ovary
-May be hereditary
- Absence of ovulation and infertility
- Hormonal imbalance
- Amenorrhea
-Hirsutism
- Treatment may be surgical wedge resection or pharmacology.
59
Benign Tumors (Cont.)
Fibrocystic breast disease
- Includes a broad range of _______ changes and increased density of breast tissue
- Cyclic occurrence of nodules or ________ in breast tissue
-Increased risk of breast cancer if atypical cells are present.
- Increased density makes breast self-examination difficult
- Increased cystic masses with caffeine intake
Fibrocystic breast disease
- Includes a broad range of breast changes and increased density of breast tissue
- Cyclic occurrence of nodules or masses in breast tissue
-Increased risk of breast cancer if atypical cells are present.
- Increased density makes breast self-examination difficult
- Increased cystic masses with caffeine intake
60
Malignant Tumors
Carcinoma of the breast
- Incidence increases after age ___ years
* Most cases in women between ages _________ years
- Most tumors are unilateral
- Earlier onset associated with more aggressive growth
- Different types * Most arise from ductal epithelial cells
- Metastasis occurs via lymph nodes early in the course of the disease.
- Presence of estrogen or progesterone receptors on tumor cells influences treatment
- Incidence increases after age 20 years
* Most cases in women between ages 50 and 69 years
- Most tumors are unilateral
- Earlier onset associated with more aggressive growth
- Different types * Most arise from ductal epithelial cells
- Metastasis occurs via lymph nodes early in the course of the disease.
- Presence of estrogen or progesterone receptors on tumor cells influences treatment
61
Carcinoma of the Breast - Predisposing factors
- First-degree ________ with the disease
- Strong ______ predisposition (BRCA1 and BRCA2)
- Longer and higher exposure to estrogen
- Nulliparous or late first pregnancy
- Lack of exercise
- Smoking
-High _____ diet
- Radiation therapy to the chest
- Cancer of the uterus, ovaries, or pancreas
- First-degree relative with the disease
- Strong genetic predisposition (BRCA1 and BRCA2)
- Longer and higher exposure to estrogen
- Nulliparous or late first pregnancy
- Lack of exercise
- Smoking
-High-fat diet
- Radiation therapy to the chest
- Cancer of the uterus, ovaries, or pancreas
62
Carcinoma of the Breast - Signs and symptoms
- Change on __________
- Initial sign—single, small, hard, painless _______
- Later—distortion of breast tissue, dimpled skin, _______ from nipple
- Ultrasound or needle biopsy confirms diagnosis.
- Change on mammogram
- Initial sign—single, small, hard, painless nodule
- Later—distortion of breast tissue, dimpled skin, discharge from nipple
- Ultrasound or needle biopsy confirms diagnosis.
63
Course of breast cancer
- Metastasis occurs by the time the tumor is ______ cm in diameter.
- Axillary lymph node involvement
- Secondary tumors in:
* Bone
* Lung
* Brain
* Liver
- Metastasis occurs by the time the tumor is 1 to 2 cm in diameter.
- Axillary lymph node involvement
- Secondary tumors in:
* Bone
* Lung
* Brain
* Liver
64
Carcinoma of the Breast - Treatment
- Surgery may be a lumpectomy or removal of the ______.
- ___________ may be removed, depending on the stage of the disease.
- Tissue biopsy will determine the presence of specific growth factors to design drug treatment
and chemotherapy.
- Radiation therapy may be done before or after surgery.
- Surgery may be a lumpectomy or removal of the breast.
- Lymph nodes may be removed, depending on the stage of the disease.
- Tissue biopsy will determine the presence of specific growth factors to design drug treatment
and chemotherapy.
- Radiation therapy may be done before or after surgery.
65
Carcinoma of the Cervix
- Most cases of cervical cancer are caused by ___________ infection, a sexually transmitted virus.
- Vaccines now exist against the causative strains of HPV.
-Routine ___________ of cervical cells are important in identifying early, treatable stages of the disease:
- By age 20 years or in the year that sexual intercourse begins
- At intervals, as advised by health care worker
- Most cases of cervical cancer are caused by human papillomavirus (HPV) infection, a sexually transmitted virus.
- Vaccines now exist against the causative strains of HPV.
-Routine Pap smears of cervical cells are important in identifying early, treatable stages of the disease:
- By age 20 years or in the year that sexual intercourse begins
- At intervals, as advised by health care worker
66
Carcinoma of the Cervix - Risk factors
- Age < 40 years
- Strongly linked to _____ viral infection (STD)
- Multiple partners
- Sexual intercourse beginning _____________ years
- Smoking
- History of prior STDs
- Age < 40 years
- Strongly linked to HPV viral infection (STD)
- Multiple partners
- Sexual intercourse beginning in early teenage years
- Smoking
- History of prior STDs
67
Carcinoma of the Uterus
-Most common in _____________ women
- Early indicator is painless vaginal __________ or spotting
Risk factors
- Age > 50 years
- High-dose _________ hormone treatment without progesterone
- Obesity
- Diabetes
Carcinoma of the Uterus
-Most common in postmenopausal women
- Early indicator is painless vaginal bleeding or spotting
Risk factors
- Age > 50 years
- High-dose estrogen hormone treatment without progesterone
- Obesity
- Diabetes
68
Carcinoma of the Uterus (Cont.)
- ___________ does not detect this cancer
- Usually arises from glandular epithelium
- Relatively slow-growing but is invasive
- Staging of cancer based on degree of localization
- Treatment—surgery and radiation are commonly used.
- Pap smear does not detect this cancer
- Usually arises from glandular epithelium
- Relatively slow-growing but is invasive
- Staging of cancer based on degree of localization
- Treatment—surgery and radiation are commonly used.
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Ovarian cancer
- No reliable screening available
* Large ______ detected by pelvic examination
* Transvaginal ultrasound
- Considered a ______ tumor
* Few diagnosed in the early stage
* Research is ongoing to identify markers for serum diagnosis.
- Different types—vary in aggressiveness
- No reliable screening available
* Large mass detected by pelvic examination
* Transvaginal ultrasound
- Considered a silent tumor
* Few diagnosed in the early stage
* Research is ongoing to identify markers for serum diagnosis.
- Different types—vary in aggressiveness
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Ovarian Cancer (Cont.)
Risk factors
- Obesity
-BRCA1 _____
- ______ menarche
- Nulliparous or late first pregnancy
- Use of fertility drugs
-Oral contraceptives containing progesterone are somewhat protective.
- Surgery and chemotherapy are usual treatments.
Risk factors
- Obesity
-BRCA1 gene
- Early menarche
- Nulliparous or late first pregnancy
- Use of fertility drugs
-Oral contraceptives containing progesterone are somewhat protective.
- Surgery and chemotherapy are usual treatments.
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Infertility
- Cause may be a female condition, male condition, or a combination of both
- Associated with __________ imbalances
-Age of ___________
- Structural abnormalities
-Infections
- Chemotherapy
- Workplace toxins
- Other environmental factors
- Idiopathic
- Cause may be a female condition, male condition, or a combination of both
- Associated with hormonal imbalances
-Age of parents
- Structural abnormalities
-Infections
- Chemotherapy
- Workplace toxins
- Other environmental factors
- Idiopathic
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(STDs): Bacterial
Chlamydial infections
- Considered one of the most _____________
- Caused by Chlamydia trachomatis
Males—urethritis and epididymitis
* Symptoms include dysuria, itching, white discharge from penis (urethritis symptoms)
* Painful, swollen scrotum, usually unilateral, fever (epididymitis); inguinal lymph nodes swollen
Females
* Often __________ until PID or infertility develops
* Newborns may be infected during birth.
Chlamydial infections
- Considered one of the most common STDs
- Caused by Chlamydia trachomatis
Males—urethritis and epididymitis
* Symptoms include dysuria, itching, white discharge from penis (urethritis symptoms)
* Painful, swollen scrotum, usually unilateral, fever (epididymitis); inguinal lymph nodes swollen
Females
* Often asymptomatic until PID or infertility develops
* Newborns may be infected during birth.
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(STDs): Bacterial (Cont.)
Gonorrhea
- Caused by Neisseria gonorrheae
* Many strains have become resistant to penicillin and tetracycline.
Males
* Most common site is _______, which is inflamed
* Some males are asymptomatic.
Females
* Frequently ___________
* PID and infertility are serious complications.
- May infect the eyes of the newborn, causing irreversible damage and blindness
- May spread systemically to cause septic arthritis
Gonorrhea
- Caused by Neisseria gonorrheae
* Many strains have become resistant to penicillin and tetracycline.
Males
* Most common site is urethra, which is inflamed
* Some males are asymptomatic.
Females
* Frequently asymptomatic
* PID and infertility are serious complications.
- May infect the eyes of the newborn, causing irreversible damage and blindness
- May spread systemically to cause septic arthritis
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STDs: Syphilis is Caused by Treponema pallidum, a spirochete
Primary stage
-Presence of chancre at site of infection
* Genital region
* Anus
* Oral cavity
-Painless, firm, ulcerated _______
- Occurs about 3 weeks after exposure
- Lesion heals spontaneously but client is still contagious
-Presence of chancre at site of infection
* Genital region
* Anus
* Oral cavity
-Painless, firm, ulcerated nodule
- Occurs about 3 weeks after exposure
- Lesion heals spontaneously but client is still contagious
75
STDs: Syphilis (Cont.)
Secondary stage
-If untreated, a _______ illness occurs, with a widespread symmetrical rash—self-limited but client remains contagious
Latent stage
- May persist for ______
-Transmission may occur.
- Tertiary syphilis—irreversible changes
- Gummas in organs and major blood vessels
- Dementia, blindness, motor disabilities
Secondary stage
-If untreated, a flulike illness occurs, with a widespread symmetrical rash—self-limited but client remains contagious
Latent stage
- May persist for years
-Transmission may occur.
- Tertiary syphilis—irreversible changes
- Gummas in organs and major blood vessels
- Dementia, blindness, motor disabilities
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STDs: Syphilis (Cont.)
- Organism can be transmitted to fetus in _______
- Baby born with tertiary syphilis changes that are not reversible
- Treatment is usually ____________ drugs.
- Increase in antibiotic resistant strains causing an increase in prevalence
- Organism can be transmitted to fetus in utero
- Baby born with tertiary syphilis changes that are not reversible
- Treatment is usually antimicrobial drugs.
- Increase in antibiotic resistant strains causing an increase in prevalence
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STDs: Viral Infections
Genital herpes—herpes simplex
- Caused by HSV-2 or HSV-1
* HSV-1 possible with oral sex
- Lesions similar to HSV-1
- Recurrent outbreaks of blister-like ________ on the genitalia
* Preceded by tingling or ________ sensation
* _________ are extremely painful.
- After acute stage, virus migrates back to dorsal root ganglion
- Infectivity greater when symptoms are present
Genital herpes—herpes simplex
- Caused by HSV-2 or HSV-1
* HSV-1 possible with oral sex
- Lesions similar to HSV-1
- Recurrent outbreaks of blister-like vesicles on the genitalia
* Preceded by tingling or itching sensation
* Lesions are extremely painful.
- After acute stage, virus migrates back to dorsal root ganglion
- Infectivity greater when symptoms are present
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STDs: Genital Herpes (Cont.)
___________ is common and may be associated with:
- Stress
- Illness
- Menstruation
- Antiviral drugs are used for treatment and prevention of transmission.
- Infection is considered lifelong.
Reactivation is common and may be associated with:
- Stress
- Illness
- Menstruation
- Antiviral drugs are used for treatment and prevention of transmission.
- Infection is considered lifelong.
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STDs: Viral Infections (Cont.)
Condylomata acuminata—genital warts
- Caused by _____
- Incubation period may be up to 6 months
- Disease may be asymptomatic
- Warts vary in appearance.
- Warts can appear wherever contact with _______ has occurred.
- Warts can be removed by different methods.
- May predispose to cervical or vulvar cancer
- Caused by HPV
- Incubation period may be up to 6 months
- Disease may be asymptomatic
- Warts vary in appearance.
- Warts can appear wherever contact with virus has occurred.
- Warts can be removed by different methods.
- May predispose to cervical or vulvar cancer
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STDs: Viral Infections (Cont.)
Trichomoniasis
-Caused by Trichomonas vaginalis, a protozoan _________
-Localized infection
Men
* Usually asymptomatic
Women
* May be subclinical
* Flares up when _______ balance in vagina shifts
* Causes intense itching
-Systemic treatment necessary for both partners
Trichomoniasis
-Caused by Trichomonas vaginalis, a protozoan parasite
-Localized infection
Men
* Usually asymptomatic
Women
* May be subclinical
* Flares up when microbial balance in vagina shifts
* Causes intense itching
-Systemic treatment necessary for both partners
