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Week 11
Diseases of the male and female genital tract
| Question | Answer |
|---|---|
| The transitional zone is known as the...? | T-Zone |
| What hapens at the T-Zone? | Mucosa undergoes metaplastic formation |
| Why is the T zone important/Significant? | They are susceptible to mutogenic oncologic stiumly and are easily infected by the human papilloma virus (HPV) |
| What are pap-smears used for? | identifying pre-cancerous changes |
| What are most cervical dysplasias a result of? | infection of the HPV virus |
| What kind of HPV are the cause of genital warts? | HPV 6 and 11 |
| ____ to ____ percent of patients with gential warts have associated HPV infection of the vagina/cervix. | 30% to 50% |
| What subtypes of HPV promote pre-cancerous changes? | HPV 16, 18, 31, 33, 35 |
| What are the risk factors for HPV infection? | 1. Young age at first intercourse 2. multiple sexual partners 3. smoking 4. oral contraception use 5. Pregnancy 6. Diabetes 7. Immunosuppression 8. Poor hygene |
| What kind of women should have pap smears on a regular basis? For how long | Women have had sexual intercourse, and on a regular basis till the age of 69. |
| What percent of cervical cancers are squamous cell carcinomas? | 90% |
| What is a co-factor for cervical cancer? | HIV +ve |
| What are some symptoms of invasive cervical cnacer? | Typically, abnormal vaginal bleeding. |
| What is the survival rate for cervical cancer? | ~90% for stage 1, and less than 20% for stage 4. |
| Why, with the availability of pap smear test, are there over 500 new cases of cervical cancer in Canada? | 1.) pap smear not performed, 2.) abnormal pap smear result was not followed up or was managed inappropriately, 3.) False negative smears |
| What stimuates the endometrial glands to proliferate? | Estrogen |
| What happens when ovulation occurs? | Estroen production subsides, and progesterone production increases |
| What does the balance of estrogen and progesterone mean? | Balances the proliferative phase and the secretory phase in preparation to receive and nourish a fertilized egg. |
| What happens to menstral cycle as a woman approaches menopause? | Mestural cycle becomes unbalanced and more sporadic. |
| What is the role of estrogen wrt proliferation and secretion? | Estrogen elicits proliferative phase |
| What is the main issue when estrogen is unopposed by progesterone? What is this condition termed? What can it result in? | Excessive proliferation, terme endometrial hyperplasia and can result in edometrial carcinoma |
| Estrogen unopposed by progesterone may be associated with what? | 1.) Perimenopausal failure to ovulate - ovary produces estrogen but no progesterone 2.) Polycystic ovarian disorder - young women who fail to ovulate b/c of disturbances in the hormonal control of ovulation. |
| Estrogen unopposed by progesterone may be associated with what? (pt 2) | 3.) Hormonal replacement therapy control for menopausal symptoms 4.) Obesity - increased amounts of estrogen are produced in fat cells 5.) Functional tumors - rare ovarian tumors that produce estrogens |
| What age group is endometrial hyperplasia predominant in? | Women ages 45-55 |
| What sequence are the changes in endometrial hyperplasia in? | 1. Disorderly proliferation; 2. simple hyperplasia; 3. complex hyperplasia; 4. atypical hyperplasia |
| Hyperplasia without atypia has a _____ risk of devoloping cancer. | Low |
| What is the most common malignancy of the female genital tract? | Endometrial adenocarcinoma |
| What age group does the most common malignancy of the female genital tract occur in? | Around the age of 60 years old. |
| ____% of endometrial carcinomas are associated with unopposed estrogen stimulation. | 85% |
| What is the most common symptom for endometrial cancer? | Post-menopausal vaginal bleeding. |
| How is endometrial cancer treated? | Usually treated hormonally. |
| How is how are endometrial atypical hyperplasia and carcinoma treated? | By hysterectomy and bilateral salpingo-oophorectomy (removal of uterus, fallopian tubes, and overies). |
| When does endometriosis occur? | When benign endometrial tissue is present outside of the normal location in the uterus. |
| Where are the most common sites for endometriosis to occur? | 1. Ovaries, 2. fallopian tubes, 3. peritoneum and bowel |
| What are the typical symptoms of endometriosis? | Pelvic pain, dysmenorrhea & infertility |
| What organ is most frequenly involved in endometriosis? | The ovaries are, 80% of the time. |
| What suggested theories cause endometriosis? | 1. Retrograde menstruation through the tube, with implantation in the endometrial tissue; 2. Metaplastic transformations in the peritoneum and connective tissue; 3. Vascular or lymphatic dissemination |
| What is the most common tumor of the female genital tract? Where are they usually situated? | Leiomyomas, situated in the myometrium. |
| What female population are leiomas usually found in? | 25% of women over the age of 30 |
| What are the clinical symptoms of leiomyomas? | bleeding pelvic pain dysmenorrhoea infertility |
| What is the treatment for leiomyomas and under what circumstances? | Nothing if asymptotic; hysterectomy if symptoms are troublesome; myomectomy (sometimes) |
| What is an ectopic pregnancy? | A pregnancy that implants in a site other than in the endometrial cavity. |
| What is the incidence ectopic pregnancies? | 0.7% or 1 in 150 births. |
| Where else can implantation occur to cause an ectopic pregnancy? Which is most common? | Fallopian tube (most common), cervix, ovary, or peritoneal cavity (rare) |
| How is an ectopic pregnancy treated and when? | Treated with chemo, only if detected early enough. Can be done surgically as well. |
| What is PID? | Pelvic inflammatory disease. A generic term used for an inflammatory process in which infection of the fallopian tube usually plays a central role |
| In PID, infection of what is most common? And termed what. | Infection of the tubes of the fallopians. Termed salpingitis. |
| When does PID occur? | Either throw sexual transmission or via after a IUD insertion or curettage. |
| When is antibiotic therapy needed to treat PID? | When there is an abscess. |
| What is the most common cause of an ovarian mass in a young woman? | Functional cysts |
| Where is a functional cyst derived from? | A ripening follicle (follicle cyst) or a corpus luteum (luteal cyst) |
| How long do functional cysts last for? | They disappear spontaneously over 4-6 weeks |
| What is the leading cause of death from a gynecologic malignancy? | Carcinoma of the ovary. |
| What is the most frequent ovarian malignancy | Serous adenocarcinoma |
| What is the treatment for serous adenocarcinoma? | Standard surgery treatment (hysterectomy, salpingo-oophrectomy & "debulking" or "staging" |
| Where is a mature cystic teratoma derived from? | The ovarian germ cells |
| Who does mature cystic teratoma affect? | Young women |
| What 3 germ layers do germ cell tumours have the capacity to differentiate in? | 1.) Ectoderm (skin & skin appendages); 2.) endoderm (respiratory and intestinal epithelium); 3.) mesoderm (cartilage, bone, fat) |
| When skin, hair and other skin appendages predominate in mature cystic teratoma, what is it termed? | Dermoid cyst |
| What is the most common ovarian neoplasm in young women? | Mature cystic teratomas |
| Where do granulosa cell tumors originate from? | Stroma of the ovary |
| What age does granulosa cell tumors range? | 45-55 y/o women |
| What is 'metastatic carcinoma'? | Malignant tumours that arise in the GI tract, breast, endometrium. |
| Metastatic carcinoma is usually ________ (bilateral or unilateral?) | bi-lateral. |
| Where is the prostate located? | At the base of the bladder |
| Where does it encircle? | The urethra |
| This organ in the male genital system is walnut shaped... | What is a prostate. |
| What does the prostate do? | They make up a lot of the 'ejaculate'. |
| Who is prone to an enlarged prostate? | Oldermen |
| With respect to egg fertalization, what is the roll of the prostate? | To make the vaginal conditions more ideal for sperm transport (making sperm able to deal with vagina acidity) |
| Why is the urethra susceptible to compression? | Because of the location of teh postate. |
| What is prostatic hyperplasia? | Prostatic enlargement |
| What is the most common urological diseas of oldermen and the major cause of urinary obstruction? | Prostatic hyperplasia |
| How does prostatic hyperplasia cause urinary obstruction? | Enlargement compress the urethra, causing partial or complete urinary blockage. |
| What age group does prostatic hyperplasia affect? | generally men > 40. 50% of men 50-60y have PH; 90% of men in their 80s |
| What are the early symptoms of prostatic hyperplasia? | dicrease in the calibre and force of urinary stream, hesitancy in initiating urination and a sense of an incomplete bladder after peeing. |
| Late symptoms of hyperplasia are: | frequency, nocturia, urgency and incontenance |
| What are the symptoms of prostatic hyperplasia due to? | Flow obstruction & pressure effects on the bladder musculature. |
| What is the most common form of malignancy in men? | Prostatic adenocarcinoma. |
| What age groups does prostatic adenocarcinoma occur? | Older men. 10-20% of cases are of men 50y and up to 70% in males aged 80. |
| What are the risk factors of prostatic adenocarcinoma? | 1. Familial association is the main risk factor (genetic factors) 2. Race (common in negros), dietary fat (complex). 3. Prostatic intraepithelial neoplasia (PIN) |
| What age groups are usually screened for prostatic adenocarcinoma? Why? | Men age > 50, because the cancer is clinically silent till then. |
| What is the most common site for metastasis of prostatic adenocarcinoma? | Bone |
| What is the role of prostate specific antigen wrt prostatic adenocarcinoma? | Elevated blood levels of PSA occur in association with malignancy and can be detected in a routine blood test. |
| What is the downfall of prostate specific antigen with respect to prostatic adenocarcinoma? | PSA elevation usually indicates malignancy, but elevated PSA isn't exactly specific for PA. Benign conditions like nodular hyperplasia or prostatitis also can elevate PSA. |
| __% of prostatic adenocarcinomas are located in the peripheral regions of the prostate. This makes it _____ to detect. | 70%; difficult. |
| Treatment of prostatic adenocarcinoma | 1.) surgical resection; 2.) Radiation; 3.) Hormonal therapy (suppression of androgen production) |
| What is the outcome of prostatic adenocarcinoma? | IT's really dependent on the stage of the tumor (how advanced it is) and the grade (level of differentiation). Localized carcinomas (confined within prostate) have excellent outcome. Best defence = early detection. |
Created by:
mex200m
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