| Question |
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| Answer |
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| 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.
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| 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. |
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