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What is Cervicitis?
what's a typical symptom/sign?
Primary or secondary onset? which is more common?
how do you distinguish from carcinoma?
- Inflammation of the cervix. very common.
- Associated with purulent vaginal discharge.
- Usually primary, arising from nonspecific infections.
- Can be secondary: after candida, trichomonas, chlamydia, gonorrhea, syphilis, HPV or herpes infection.
- Biopsy is required for diagnosis.
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Squamous cell carcinoma of the Cervix:
Why has the incidence plummeted over the last 50 years?
- Once was most frequent cause of cancer deaths. Incidence has plummeted due to the intro of the Papanicolaou (Pap) smear.
- Today: 13th leading cause of cancer mortality
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Carcinoma of the cervix:
Colposcopy: What is it? How do you detect carcinomas?
Colposcopy: Medical diagnostic procedure to examine an illuminated, magnified view of the cervix. Abnormalities appear as white patches following application of acetic acid.
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Papanicolaou Smear (Pap smear)
What is it?
How is it prepared?
Can ID what?
Problems?
- A screening test that detects precancerous clls.
- Exfoliated cells collected from the cervix and prepared with a special stain (papanicolau stain)
- Allows Identification of precancerous (dysplastic) cytological features
- Inexpensive, false positives, false negatives.
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Squamouse Cell Carcinoma:
Nearly all cases of SCC arise from what?
What are the peak ages for CIN and SCC
Biopsy is necessary for what?
- Nearly all cases of SCC arise from precursor epithelial changes: Cervical Intraepithelial Neoplasia (CIN)
- Peak age fro CIN is 30 years and 45 years for SCC
- Biopsy necessary to confirm atypical pap smear.
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Squamous Cell Carcinoma of the Cervix
What is Dysplasia?
What are the three stages of Cervical Intraepithelial Neoplasia (CIN)?
Do all cases of CIN progress to invasive cancer?
- Dysplasia: Cytologic and maturational disturbances of epithelium seen microscopically.
- CIN I: MIld dysplasia.
- CIN II: Moderate dysplasia
- CIN III: Severe dysplasia and carcinoma in situ
- Not all cases of CIN progress to invasive cancer.
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Squamous Cell Carcinoma of Cervix/CIN
What is the most important agent in cervical neoplasia?
Transmitted how?
What are High-Risk types of HPV
Low Risk HPV?
- Human Papillomavirus (HPV) most important agent in cervical neoplasia.
- Transmitted by direct contact.
- HIgh Risk HPV types = 16,18, associated with cancer
- Low Risk HPV types = 6, 11 associated with condyloma (genital warts)
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What are four risk factors for Squamous cell Carcinoma of the Cervix/CIN?
- Early age at first intercourse
- Multiple sexual partners
- Male partner with multiple previous sexual partners
- Prolonged infection with high-risk HPV.
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Squamous cell Carcinoma of the Cervix/CIN
Treatment:
Prognosis:
Vaccine?
- Tx: Laser vaporization or excisional biopsy of CIN. Surgery with/without radiation and chemotherapy for invasive disease.
- Prognosis: Highly variable, depending on tumor extent. 5 year survival: 100% for stage 0 (pre-invasive) to 10% for stage 4 disease.
- Recent development of a vaccine (Gardasil) to prevent infection.
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What structure of the Uterus is responsible for the majority of female reproductive tract diseases?
The Uterine Corpus (Endometrium). Disorders are often chronic and recurrent.
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Define:
Menorrhagia
Metrorrhagia:
Dysmenorrhea:
- Menorrhagia: Abnormally heavy menstrual bleeding.
- Metrorrhagia: Bleeding between menstrual cycles.
- Dysmenorrhea: Unusually painful menstrual bleeding.
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What is Endometriosis?
What complications occur from Endometriosis?
What is a characteristic cyst?
- Endometriosis: Functional Endometrium (glands and stoma) located OUTSIDE the uterus which still undergoes cyclic bleeding.
- Complications: Intrapelvic bleeding and organization of blood leads to widespread fibrosis and periuterine adhesions. Results in severe dysmenorrhea and pelvic pain.
- Large blood filled cysts on the ovaries transform to "chocolate" cysts as the blood ages.
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Define Endometrial Hyperplasia:
caused by?
Risk factors?
May progress into?
Treatment?
- Endometrial Hyperplasia: Overgrowth of endometrial glands and stroma.
- Results from excess exposure to estrogen (endogenous or exogenous)
- Risk factors: Obesity, hormone intake, failure to ovulate, estrogen producing ovarian tumors.
- May progress to Adenocarcinoma
- Tx: D&C (dilation and curtage?)
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What are the most common tumors/neoplasms of the Uterus? (3)
What do they all produce?
- Endometrial polyps
- Smooth muscle tumors (Leimyoma aka Fibroids)
- Carcinoma
- (They all produce abnormal uterine bleeding.
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What is a Leiomyoma? (aka?)
Growth is stimulated by what?
Symptoms?
- Leiomyoma aka Fibroids
- Benign tumor arising from smooth muscle cells of the myometrium.
- Most common benign tumor in females, reproductive age (30-50%)
- Growth stimulated by Estrogens; regress after menopause.
- Usually asymptomatic; can cause menorrhagia, a a palpable pelvic mass or infertility.
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What is the most frequent female genital tract cancer?
Age groups?
- Endometrial Carcinoma
- Diagnosed between 55-65, rarely before 40.
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Endometrial Carcinoma:
Cause?
Symptoms:
Tx:
Prognosis:
- Endometrial Carcinoma is thought to be caused by excess estrogen, similar risk factors to endometrial hyperplasia.
- Leukorrhea and irregular bleeding (obvious red flag if women is postmenopausal).
- Treatment: surgery and radiation therapy +/- chemo
- Prognosis depends on tumor stage:
- 90% 5 year survival for stage 1
- 20% 5 survival for stage III and IV
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Ovarian Carcinoma:
origin?
risk factor?
familial?
Asymptomatic?
prognosis?
- Surface epithelial variant accounts for 70% (less commonly from germ cells or stroma)
- Risk factors: Nulliparity (no babies)/family history
- Familial: 5-10% of cases. Mutations of BRCA genes (BRCA1, BRCA2) = increase risk for breast and ovarian cancer.
- Asymptomatic until they become large
- Prognosis: depends on stage.
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Teratoma:
What is it?
when do they occur?
Malignant?
Microscopic path?
- Teratoma: Differentiation of totipotential germ cells into mature tissues representing all three germ layers.
- Occurs in first 2 decades of life, 90% benign mature cystic teratoma (Dermoid cyst).
- Malignancy may arise (1%)
- Microscopic path: Multiple mature elements, skin, teeth, hair - in wrong locations.
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Fibrocystic Change (Breast Pathology)
common?
When does it arise?
what is it?
Malignant?
- Very common, arise during reproductive years.
- Exaggeration and distortion of normal cyclic breast changes occuring with menstruation.
- Overgrowth of fibrous stroma and/or glandular elements.
- Generally innocuous (benign) but may cause breast "lumps" that must be differentiated from cancer.
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What is Fibroadenoma (Breast Pathology)
prevalance?
Results from what?
describe.
- Most common benign neoplasm of the breast.
- Presents in prepubertal girls; peak prevalence in 3rd decade.
- Results from increased estrogen.
- Discrete, solitary, freely movable nodule; 1-10cm
- Biopsy for diagnosis.
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Breast Carcinoma
Arises from what structures?
age of onset? risk?
Familial?
- Arise from glandular and ductal structures of the breast.
- Lifetime risk 1/8
- 2nd leading cause of cancer related death in women.
- 75% occurs after age 50.
- Only 5-10% familial: Mutations of BRCA genes (BRCA1, BRCA2) = increase risk for breast and ovarian cancer.
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Breast Carcinoma:
Detection: clinical exam looks for?
Mammography?
Diagnosis?
- Detection: Clinical exam: discrete non tender mass. Adherence to the overlying skin resulting in nipple retraction. Thickened overyling skin rsembles surface of orange (Peau d'orange)
- Mammography: calcifications or soft tissue density.
- Diagosis: biopsy.
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What genes are associated with Ovary and Breast Cancers?
Mutations of BRCA genes (BRCA1, BRCA2) = increase risk for breast and ovarian cancer.
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