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Week 11

Diseases of the male and female genital tract

QuestionAnswer
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