Intro To Female Reproductive System/cervical Cancer

Front 1

Meds to reduce diarrhea

Back 1

Lomotil

Front 2

outermost layer of the uterus

Back 2

perimetrium

Front 3

abnormal cells, not yet cancerous

Back 3

dysplasia

Front 4

burning off of dysplasia cells

Back 4

electrocautery

Front 5

fallopian duct

Back 5

oviduct

Front 6

tandum and ovoids after loading device for brachytherapy of uterus/cervix

Back 6

Flecter Apparatus

Front 7

removal of usterus

Back 7

hysterectomy

Front 8

reduction division of sex cells

Back 8

meiosis

Front 9

placing radioactive materials in after patient is in restricted room. (not OR)

Back 9

after loading

Front 10

removal of uterus of ovaries

Back 10

complete hysterectomy

Front 11

3 categories of organs in the female reproductive systems

Back 11

primary, internal accessory, and external parts

Front 12

examples of primary

Back 12

ovaries

Front 13

examples of internal accessory

Back 13

uterine tubes (fallopian tubes or oviducts), infundibulum, uterus, vagina, vainal oriface

Front 14

examples of external parts

Back 14

labia majora, labia minora, clitoris, vestibule and vestibular glands (Bartholin's glands) -This group surrounds the openings of the urethra and vagina compose the vulva

Front 15

description of ovaries, location, lymph drainage from ovaries?

Back 15

solid, ovoid structures, unshelled almond, located on the lateral walls of the pelvic cavity on either side. Lymphatic drainage to periaortic lymph nodes (lumber chain of nodes)

Front 16

what and where is broad ligament

Back 16

largest formed fold in the peritoneum, attached to the fallopian (or uterine) tubes and uterus.

Front 17

what and where is suspensory ligament

Back 17

at the upper end, the ovary is held by a small fold of peritoneum that contains the ovarian blood vessels and nerves

Front 18

define oocyte

Back 18

eggs that go under meiosis (reduction from 46 to 23). At time of birth 600,000 primary oocytes in each ovary.

Front 19

define ovarian follicles

Back 19

Each ovary contains these follicles that contain primary oocytes.

Front 20

State the function of the uterine tubes (4) and give 2 other names for them

Back 20

Aka fallopian tube or oviducts, 1. convey egg cells toward uterus by cilia 2. suspended by broad ligament 3. expands to form funnel shaped infundibulum 4. is 10 cm (4 in.) and opends medially into uterus

Front 21

Describe the infundibulum and the fimbriae of the uterine tube

Back 21

-infundibulum is near the ovary
-funnel shaped
-encircles the ovary
-has irregular- branched extentions- fimbriae
-does not touch ovary but is connected directly to it

Front 22

Describe how movement of the egg from the ovary to the uterus is accomplished

Back 22

egg goes from ovary to uterus by uterine tube where cilia sweeps egg forward with muscular peristalisis too.

Front 23

Describe the uterus and state its function

Back 23

-Function is to recieve the embryo and sustain its life during development.
-It is hollow, muscular shaped organ, like an inverted pear.
-located medially within the ant. pelvic cavity, above vagina and bent forward over the urinary bladder
-normal size is 7cm (2.8 in.) long and 5 cm (2in) wide.

Front 24

State the significance of the rectouterine pouch

Back 24

posterior to the uterus and between it and rectum, is a ligament that forms deep pouch which prevents the spread of uterine ca to rectum

Front 25

Describe and locate the parts of the uterus, including the: fundus, body corpus, cervix, internal os, external os

Back 25

Fundus- rounded portion above the level of the entrance of the uterine tubes
Body/Corpus- upper 2/3 of uterus, is dome shaped and joined by uterine tubes that enter its wall
Tubular Cervix- lower 1/3 uterus, tubular, extends downward into the upper portion of the vagina,
Internal os- junction of the uterine cavity with the cervical canal
External os- lower end of the cervical canal which opens into the vagina
Cervix- surrounds the opening where uterus communicates with vagina

Front 26

Describe the location of the vagina and identify the following parts; vault, fornices

Back 26

-fibromuscular tube 9cm (3.6 in) in length, extending from the uterus to the vestibule.
-post. to urinary bladder and urethra and ant. to rectum and is attached by connective tissue
Vault- part of vagina which surrounds the cervix
Fornices- the recesses that occur between the vaginal wall and the cervix, thin walled and allow the internal abd organs to palpated during physical exam

Front 27

List the structures which make make up the vulva

Back 27

labia majora, labia minora, clitoris, vestibule, and vestibular glands (Bartholin's glands)

Front 28

Discuss the importance of early screening methods for gynecologic cancers

Back 28

almost all gyn cancers are curable if treated in precancerous stage.

Front 29

State what took is most effective in screening for gynecologic cancers

Back 29

Papanicolaou (Pap) smear developed in 1941

Front 30

State the most common histologic type of cancer of the cervix and state where they are most likely to arise

Back 30

Most ca of cervix are squamous cell ca...some are adenocarcinomas. Arise freq in posterior lip of cervix

Front 31

State the chemical to which clear cell ca is most closely linked

Back 31

diethylstilbestrol when exposed in utero, occurs in 1-2% of cases
-clear cell is a variant of adenoca

Front 32

List risk factors for ca of the cervix and give the peak age of incidence

Back 32

-sexual history, intercourse before 20 and multiple partners, or larger number of pregnancies
-low socioeconomic classes
-arises and peaks between 45-55, and 48 for average age

Front 33

State the most common method of spread for ca of the cervix

Back 33

sexually transmitted

Front 34

Describe the pattern of lymphatic spread usually followed by cancers of the cervix

Back 34

spreads principally by direct (blood) or local extention as well as lymphatically- but related to stage of disease.

Front 35

List some common metastatic sites for cervical cancers

Back 35

-lungs
-mediastinal and supra clavicular nodes
-bones
-liver

Front 36

Discuss and describe pap smear classification, class I -class IV

Back 36

Class I- normal
Class II- atypical
Class III- dysplasia
Class IV- carcinoma in situ
Class V- invasive carcinoma

Front 37

List the most common symptom of ca of the cervix

Back 37

-vaginal bleeding/discharge, generally caused by ulceration but is not always present.
-also pain or blood after sex

Front 38

Describe a complete diagnostic workup for cervical ca

Back 38

-history
-physical exam- including detailed pelvic and rectal exams
-IVP
-Chest Xray
-cystoscopy
-sigmoidscopy
-BE

Front 39

List the 2 primary treatments for cervical cancer

Back 39

surgery and XRT

Front 40

Discuss the treatment of precancerous lesions of the cervix

Back 40

hysterectomy, especially is past child bearing age

Front 41

Discuss internal vs. external radiation of cervical cancers

Back 41

-External beam RT is used to shrink the tumor and to treat the surrounding lymph node areas prior to brachytherapy
- Brachytherapy is then used to treat the central disease

Front 42

Describe external RT ports used for cervical cancer

Back 42

-parallel opposed fields
-4 field box
-modified rotational arcs (partially spare the bladder and rectum)
-paraortic field extentions is lymph node mets

Front 43

Describe an afterloading system

Back 43

Brachytherapy that allows te applicators to be inserted unloaded and verifiction films are taken with dummy metal sources and active sources inserted once the pt is in a private room
-radium and cesium 137 most common
-Most common is Fletcher apparatus (tandum and 2 ovoids)

Front 44

Define tandum, ovoids, copostats, give the purpose and positioning for each. Also give the 3 sizes of ovoids.

Back 44

-tandum- hollow metal tube applicator inserted up to the fundus of uterus
-ovoids- aka colpostats- should be as large as the vault size permits and lie in the lateral fornices on each side of cervix
-Size........ask tracey???????

Front 45

Describe the Manchester System, locate point A and B and state what each point represents

Back 45

System to report radiation doses in cervical cancer.
-point A- is located 2cm lateral and 2cm above external os.- is dose that reaches uterus
-point B- located 3cm lat to point A (5cm total lateral) is dose to nodal areas

Front 46

Describe the side effects of XRT treatment for cervical ca

Back 46

-diarrhea- by irratating SML bowel
-dysuria
-freq urination
-ocassional pyelonephritis or cystitis
-10% develope superficial vault necrosis
-ocassional sigmoiditis, vaginal stenosis, enteritist, vaginal/cervical fibrosis, fistula, uretral strictures and other bowel complications

Front 47

Discuss the overall prognosis for ca of cervix

Back 47

-5 yr is 67%.
-5 yr for early stages is 90%
-Patients whose cervical ca recurs, tumors tend to appear at distant sites- poor prognosis (most die within 3 yrs)

Front 48

Ovaries produce

Back 48

-female sex cell or egg cell
-hormones estrogen and progesterone

Front 49

Lymphatic drainage of the ovaries goes almost exclusively to

Back 49

periaortic lymph nodes (lumbar chain of nodes

Front 50

When do oocytes begin to produce eggs?

Back 50

During puberty, 1 per month from puberty to menapause

Front 51

Flattened band within the broad ligament connects the upper end of the uterus to the pelvic wall

Back 51

round ligament

Front 52

The tissues of the uterus are arranged in 3 distinct layers.

Back 52

perimetrium-outer
myometrium-middle
endometrium-inner

Front 53

Orifice that allows uterine and vaginal secretions to pass to the outside and opens into the vestibule

Back 53

vaginal oriface

Front 54

The most common sites of cancer in women and accounts for _____ new cases and ____ deaths in the US each year

Back 54

genital organs
94,000
27,000

Front 55

Almost all gyn ca are curable if treated in precancer stage except

Back 55

ovarian cancer

Front 56

Cervical ca is diagnosed as ____ 2/3 of the time

Back 56

in-situ

Front 57

Unfortunately only ___% of women in the US get a pap each year

Back 57

20%

Front 58

Other rare cervical ca, (besides clear cell ca), include

Back 58

-adenosquamous ca
-verrucous ca
-basal cell ca
-primary sarcomas
-serous ca
-malignant lymphomas in cervix are also possible

Front 59

Cervical ca is the __ most common gyn ca and the ___ most common leading to death

Back 59

3rd most common gyn
2nd leading death

Front 60

Ca of the cervix more common in ___ and __. Less freq in

Back 60

Latin America and Africa- common
Jewish and european -less

Front 61

Hormonal or chemical agents such as __(3)_____ play roles in cervical ca

Back 61

-Cigarettes
-oral controceptives- maybe
-diet and lack of folic acid

Front 62

Viral agents too such as ___ may be a factor to cervical ca

Back 62

-herpes simplex virus type II
-HPV

Front 63

Pap smear should start at age ___ or earlier if ____

Back 63

18 or if she is sexually active

Front 64

At the onset of the disease, growth of cervical ca is ___ and may take __-__ years to progress.

Back 64

slow growth and may take 10-20 years to progress

Front 65

As the cervical ca progresses it breaks through the basement membrane of the ____ and invades the ___ ___. But once invasion begins the disease rapidly and can cause death in __-__ years.

Back 65

breaks thru the basement of the epithium and invades the cervical stroma.
can cause death in 2-3 yrs

Front 66

Extention of the lesion into the cervix may eventually be manifested by (4)

Back 66

-superficial ulceration
-exophytic tumor
-extensive infiltration
-spread to vaginal fornices or paracervical tissues with eventual direct invasion of the bladder, rectum or both

Front 67

Cervical ca can spread by direct extention downward into the ____ ___ for considerable distance beyond the palpable or visible disease. It can also spread upward into the ___ or ___ of the ___.

Back 67

-downward to vaginal mucosa
-upward to corpus/body of uterus

Front 68

Dissemination does not always follow an orderly pattern. The cervix is a rich lymphatic network and more abundant in ___ layers with high probability of spread to ___ ___ ____

Back 68

more abundant in muscular layers that spread to regional lymph nodes

Front 69

Ca of cervix may spread to

Back 69

-paracervical and parametrial lymphatics
-mets to obturator
-external iliac and hypogastric (internal iliac) lymph nodes
-then mets to common iliac or periaortic lymph nodes

Front 70

Physical signs of disease beyond pelvis convey poor prognosis. The ___ ___ __ may be the most noticable site of extrapelvic spread and should be bx if palpable

Back 70

left supraclavicular node

Front 71

It is reccomended that patients with documented paraaortic node metastasis have a rountine ___ ___ bx.

Back 71

supraclavicular node

Front 72

T1

Back 72

confined to cervix

Front 73

T1a

Back 73

microinvasive- depth 3mm or less

Front 74

T1b

Back 74

invasive- depth greater that 3mm

Front 75

T2

Back 75

extention into vagina (upper 2/3 -parametrium)

Front 76

T2a

Back 76

extention to vagina

Front 77

T2b

Back 77

extention to parametrium (not pelvic wall

Front 78

T3

Back 78

extention to lower third vagina/ parametrium/ pelvic wall

Front 79

T3a

Back 79

extention to lower third of vagina

Front 80

T3b

Back 80

extention into parametrium and pelvic wall

Front 81

T4

Back 81

extention to bladder/ rectum /beyond true pelvis

Front 82

met pelvic lymph node

Back 82

I- 15%
II- 25%
III- 35-45%
IV- 50%

Front 83

Surgery for cervical ca cancer is for pt

Back 83

insitu to stage 2a

Front 84

XRT for cervical ca is for pt

Back 84

Stage 2b to stage 3

Front 85

Stage IV cancer is managed by

Back 85

combo of surgery, RT, and chemo

Front 86

Conservation therapy as an outpatient and is accomplished by

Back 86

-cryosurgery (freezing)
-electrocautery (burning)
-laser vaporation

Front 87

In stage I disease RT and surgery acheive similar rates however surgeryy is generally preferred in order to avoid

Back 87

the delayed side effects of RT -sexually dysfunction

Front 88

External RT- AP/PA and LAT fields are

Back 88

15x15 AP/PA
9x15 Lat
to ischial tuberosity

Front 89

Doses for external RT is approx

Back 89

4500-5500 cGy

Front 90

bracytherapy is ideally suited for cervix ca because

Back 90

high doses delivered to central tumor and its rapid dose fall off. But is inadequate to treat lymph nodes

Front 91

Doses for ca cervix is limited by

Back 91

tolerance of surrounding organs such as rectum, bladder and small intestine
-sigmoid most susceptible

Front 92

In general brachytherapy _____ application gives best results

Back 92

short, high

Front 93

In brachy ____ ___ may be used between sources to produce better geometry of dose

Back 93

plastic spacers