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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.
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
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.
Papanicolaou Smear (Pap smear)
What is it?
How is it prepared?
Can ID what?
- 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.
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.
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.
Squamous Cell Carcinoma of Cervix/CIN
What is the most important agent in cervical neoplasia?
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)
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.
Squamous cell Carcinoma of the Cervix/CIN
- 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.
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.
- Menorrhagia: Abnormally heavy menstrual bleeding.
- Metrorrhagia: Bleeding between menstrual cycles.
- Dysmenorrhea: Unusually painful menstrual bleeding.
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.
Define Endometrial Hyperplasia:
May progress into?
- 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?)
What are the most common tumors/neoplasms of the Uterus? (3)
What do they all produce?
- Endometrial polyps
- Smooth muscle tumors (Leimyoma aka Fibroids)
- (They all produce abnormal uterine bleeding.
What is a Leiomyoma? (aka?)
Growth is stimulated by what?
- 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.
What is the most frequent female genital tract cancer?
- Endometrial Carcinoma
- Diagnosed between 55-65, rarely before 40.
- 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
- 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.
What is it?
when do they occur?
- 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.
Fibrocystic Change (Breast Pathology)
When does it arise?
what is it?
- 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.
What is Fibroadenoma (Breast Pathology)
Results from what?
- 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.
Arises from what structures?
age of onset? risk?
- 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.
Detection: clinical exam looks for?
- 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.
What genes are associated with Ovary and Breast Cancers?
Mutations of BRCA genes (BRCA1, BRCA2) = increase risk for breast and ovarian cancer.