Pathology - female reproductive 2nd half

taylormaloney's version from 2017-01-26 23:36

Section 1

Question Answer
Carcinoma of Vulva, how common? What is it?Relatively rare carcinoma usually found in older women.
How may this be diagnosed?Gross inspection of the external genitalia, wart-like mucosal lesion/ulceration.
What are the clinical symptoms?Itching, Discomfort, Pain, Bleeding. 1 in 5 = asymptomatic. Grows slowly!
What is the prognosis?If caught before metastases to lymph nodes, survival rate is 70% for five years.
Carcinoma of the Cervix, how common? What is it?Fairly common, making up 20% of all malignant tumors of female reproductive system. Cancer of cervix, squamous cell carcinoma.
What causes cervical cancer?Ultimate cause is unknown, but thought to have a relation to HPV
What is the prognosis?Dependant on stage of tumor.
What are risk factors to cervical cancer?Exposure to HPV, sexual activity with multiple partners at early age, partner has history of multiple partners, Evidence of HPV infection. STI's, Smoking.
What subtypes of HPV are most relevant to cervical cancer?6,11,16,18.
What other factors may have a contribution to cervical cancer?Being overweight, diet lacking fruit and vegetables, DES (synthetic estrogen), Immunosuppression, Coinfection w/ chlamydia, low socioeconomic standing.
What are the early signs and symptoms?None.
What S + S may be present when tumor has developed?Bleeding, spotting between periods or after menopause, vaginal discharge, abdominal pain (only when spread beyond cervix).
How is it diagnosed?Pap smear. - Colopscopy, Biopsy, Tests for staging. More tests becoming available.
Prevention/Treatment?HPV Vaccine- Tx depends on stage, most found in stage 0-1. Surgery/Laser Ablation/Kryotherapy. LEEP- loop electrosurgical excision procedure(Most popular for removal of preinvasive cancers) Radiation and Chemotherapy if needed.

Section 2

Question Answer
Tumors of the Uterus, develop from what tissue?Endometrium and/or Myometrium, most from myometrium (SMT).
What are the myometrial tumors?Fibroid Tumors- Leimyoma (benign, common). Leiomyosarcoma (malignant, rare).
What are the endometrial tumors, and what is specific about them?All are malignant. Endometrial adenocarinomas (most common). Endometrial Sarcomas. Carcinosarcomas (mixed).

Section 3

Question Answer
What are fibroid tumors?Benign uterine tumors, originating from myometrium and also called leiomyoma.
What is unique about them?Most common, vary greatly in size, stimulated by estrogen and shrink after menopause.
Etiology?Likely a combination of genetics, environment, and hormones.
How are they classified?By location- submucosal, intramural, and subserosal.
What are the signs and symptoms of fibroid tumors?Vary depending on tumor size and location. Small = asymptomatic. Large= mass effect, compression of rectum and bladder. May also interfere with pregnancy.
How are fibroid tumors treated?May not need to be, hormone therapy may temporarily shrink them, others- cryomyolysis/artery embolization/laser ablation/myomectomy/full hysterectomy.

Section 4

Question Answer
What are endometrial adenocarcinoma?The most common uterine malignant tumor.
Etiology?Sex hormone induced malignancy, triggered by exposure to estrogen.
What are the risk factors for Endometrial Adenocarcinoma?Taking estrogen, obesity, Nulliparous, Early menarche or late menopause.
What is the pros/cons to estrogen ?Prevents postmenopausal osteoporosis but increases risk of endometrial cancer.
What is Exophytic Tumor?Endometrial Adenocarcinoma that grows into the endometrial cavity.
What is Endophytic Tumor?Endometrial Adenocarinoma that invades into the myometrium.
Endometrial carcinoma is likely to penetrate...Into myometrium, serosa or cervical canal into vagina.
Likely early metastasis to where?Pelvic lymph nodes.
Likely distant metastasis to where?Hematogenously- potentially anywhere.
Define Stage ILocal- endometrium.
Define Stage IIExtending into cervix and invading myometrium.
Define Stage IIIExtending through wall of uterus, but not outside pelvis.
Define Stage IVCarcinoma infiltrating the bladder and/or rectum, or extending outside pelvis.
What are the clinical signs of AdenocarcinomaVaginal Bleeding, Spotting between menstruation/post menopause.
How is it diagnosed?Endometrial biopsy, D + C, Hysterectomy.

Section 5

Question Answer
Uterine Cancer- makes up _________% of diagnoses5%
Uterine Sarcoma- hystological typesStromal Sarcoma- CT. Leiomyosarcoma- Muscle Cells. Malignant mixed mesodermal tumors- Combine features of adenocarcinomas + sarcomas.
S + S'sVaginal spotting/bleeding post menopause. Spotting between periods. Vaginal Discharge, pelvic pain, pelvic mass, pain during sex, change in bladder/bowel habits, unintended weight loss.
Diagnosed byEndometrial biopsy, transvaginal ultrasound, chest radiography to look for metastases.

Section 6

Question Answer
Ovarian Cancer- _____ Most common form of cancer in females.6th MC cancer,
_______ cause of gynecological deaths excluding...Most common cause of death excluding breast cancer.
Early ovarian cancer S + S ?Usually no symptoms, or only mild.
Late stage symptoms?Enlarged abdomen, abd/pelvic pain, persistent GI disturbances, urinary complications, menstrual irregularities, heavy menstrual bleeding.
Risk Factors for Ovarian CancerAge over 50, family history, race (caucasian = highest risk), never having children or children after age 30, high fat/low fibre/vit A deficient diet.
How is ovarian cancer categorized?By the origin.
Tumors of Surface epithelium - ____%70%, from epithelial lining of ovary. Oral contraceptives reduce risk.
Tumors of Germ Cells- ____%20%- originate from oocytes.
Tumors of sex cord stromal cell ___%, nonspecific tumors of ovarian stroma + Metastases from other organs.10%

Section 7

Question Answer
What is a teratoma?Most common form of germ cell tumor- benign.
What is a teratocarcinoma?Malignant tumor- may secrete hCG
What is a granulosa cell tumor?Derived from stromal component of ovary and testis- differentiate toward female characteristics.
What is a thecoma?Derived from stromal component of ovary and testis - differentiate toward male characteristics.
What is Sertoli-Leydig Cell tumor?Derived from stromal component of the ovary and testis, differentiate toward male characteristics.
What are the most common cancers that metastasize to the ovaries?1) Krukenberg Tumor. 2) Breast Carcinoma.

Section 8

Question Answer
What are the potential treatments for ovarian cancer?Surgery- standard treatment. Chemotherapy- may prolong survival and/or cure. Radiation therapy.
What is sexual dysfunction?Altered sexual function and sexuality, affecting both men and women.
What factors may affect sexual function?Medical Treatments, Medications, Surgery etc. Medical conditions such as- diabetes, arthritis, pelvic floor disorders, menopause,CV diseases, depression, etc. ( Most can be managed with medications/lifestyle changes) Sexual abuse, marital rape, assault, etc may require psychiatric support.