Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
73 Cards in this Set
- Front
- Back
|
Menstrual hx
|
menstrual hx
1. age at menarche 2. LMP and previous menstrual period 3. length of cycle 4. regularity of cycle 5. duration of bleeding 6. amount of bleeding 7. character of bleeding a. color, clots 8. cramping or pain and its timing to menses 9. premenstrual sx 10. menopause a. age at menopause b. menopausal sx c. postmenopausal bleeding |
|
|
Obstetric hx
|
1. number of pg (gravidity) 2. number of births (parity)
a. birth complications b. type of delivery c. postpartum complications 3. abortions - spontaneous and induced 4. infertility a. frequency and timing of intercourse b. previous testing c. partner’ s status |
|
|
sexual hx
|
1. contraceptives
2. libido 3. difficulties 4. STI |
|
|
bleeding hx
|
1. character and amount
2. relation to periods 3. frequency, duration, onset 4. associated pain |
|
|
discharge hx
|
1. amount, color, odor, consistency
2. associated sx - itching, burning, pain 3. relation to menses |
|
|
pain hx
|
1. OPQRST
2. relation to menses 3. associated sx 1. GI, urinary 4. radiation patterns 1. low back or gluteal region a. endometriosis, PID, fibroids, CA 2. lower abdomen a. uterine, ovarian, vaginal, bladder 3. lower abdominal quadrants, often radiating down medial thigh a. fallopian tubes, ovaries |
|
|
testing, breasts, past hx, family hx for gyne
|
G. testing
1. last PAP smear and results H. breasts 1. BSE 2. lumps, pain, nipple discharge I. past hx 1. abdominal or pelvic illnesses 2. abdominal or pelvic surgeries J. family 1. ovarian, uterine, breast CA |
|
|
physical general for gyne
|
A. empty bladder
B. appropriate draping C. breast exam D. lithotomy position E. inspection 1. external genitalia 2. color, vulvar lesions, swellings, discharge F. palpation 1. external genitalia G. speculum 1. view cervix 2. P AP smear a. samples of vaginal pool, cervix, endocervix 3. inspect vagina as withdrawing speculum a. color, discharge, masses H. bi-manual exam 1. index and middle finger of one hand in vagina, other hand on surface of lower abdomen 2. press in all directions in vagina 3. palpate uterus, adnexa with both hands a. size, consistency, contour, mobility, tenderness, masses |
|
|
laboratory for gyne, imaging:
|
Laboratory
A. CBC, CMP, thyroid function tests B. serum HCG - human chorionic gonadotropin 1. qualitative and quantitative C. hormonal assays 1. GnRH, LH, FSH, E, P, androgens, adrenal steroids 2. serum, urine, saliva D. cultures 1. vaginal a. bacteria, candida, herpes Imaging A. x-rays 1. plain film of abdomen (KUB) 2. hysterosalpingogram 3. gynecography a. carbon dioxide insufflation 4. mammography B. ultrasound |
|
|
special studies, gyne:
|
A. cytology
1. PAP smear (Papanicolaou) 2. endometrial biopsy B. wet prep 1. trichomonas, candida, gardnerella C. colposcopy 1. magnification of cervix D. Schiller’ s test 1. staining of cervix - abN does not stain E. cervical biopsy 1. conization 2. LEEP – loop electrosurgical excision procedure F. D&C - dilatation and curettage 1. scraping of endometrium G. culdocentesis 1. aspiration of peritoneal sac posterior to cervix through vagina 2. to determine the presence of free blood or pus in abdomen H. laparoscopy 1. small incision inferior to umbilicus 2. direct visualization of pelvis/lower abdomen with magnifying lens I. laparotomy 1. surgery to visualize pelvis |
|
|
emergencies gyne
|
A. pelvic pain
1. difficult to differentiate pain in abdomen, pelvis a. gynecological, GI, musculoskeletal, urinary, psychogenic 2. most common gynecological causes a. dysmenorrheal, ovulation, endometriosis 2. surgical emergencies include: twisted ovarian cyst, ectopic pg, ruptured tubal or ovarian abscess, appendicitis, bowel obstruction or perforation 3. sudden onset from ischemia or perforation 4. insidious onset from inflammation or obstruction 5. tender adnexal mass from ectopic pg, ovarian cyst 6. with fever from pelvic infection a. salpingitis |
|
|
ermergencies... questions
|
questions
a. discharge b. bleeding c. duration of sx d. relationship to movement, defecation, urination, menstrual cycle, sleep, eating, sexual activity i. LMP e. multiple sex partners i. contraceptives and their use f. hx of trauma, rape, illegal abortion 8. often ER referral or sometimes for primary evaluation |
|
|
ectopic pg (emergency)
|
a. pg outside the endometrial cavity
b. in tubes most commonly c. increased likelihood if previous tubal disease or ectopic pg d. any unilateral, progressive lower abdominal quadrant pain in a heterosexually active woman of reproductive age in the presence of a missed or strange period must be sent for immediate gynecological evaluation e. cramping pain soon after missed period f. spotting common g. hemorrhage causes pain and pressure h. possible hypotension and shock i. tender adnexal mass j. possible rupture of tube with fainting and shock k. dx i. HCG – urine, serum (pregnancy test: hcg) ii. ultrasound l. tx i. refer immediately if suspected to gynecologist or ER ii. surgery |
|
|
vaginal bleeding emergencies
|
1. menorraghia
a. excess menstrual flow i. soaking more than 4 pads in an hour iii. refer to gynecologist for evaluation immediately b. with dizziness, refer to ER 2. postmenopausal bleeding a. refer to gynecologist (endometrial carcinoma big risk) |
|
|
Vulvovaginitis definition
|
A. inflammatory condition affecting the vaginal mucosa
B. often secondarily involves vulva |
|
|
Vulvovaginitis etiology
|
C. etiology
1. bacteria - most common cause a. Gardnerella vaginalis b. Chlamydia trachomatis (scariest/ vie for top 1 w gardnerella) Infertility, scarring, abscesses c. Neisseria gonorrhoeae d. E. coli 2. protozoa: Trichomonas vaginalis 7 (hard shell. Doesn't die easily) 3. fungi: Candida albicans (yeast infection) 4. virus: human papilloma virus (HPV), or herpes simplex 5. pinworms a. Enterobius vermicularis 6. foreign bodies (kids putting things up vagina etc) marbles :-) |
|
|
Vulvovaginitis sxs + sns
|
sxs & sns
1. vaginal discharge a. erythematous vaginal mucosa, vulva (smtimes smelly, itchy, pain, or not) b. malodorous, pruritic, irritated, painful 3. bacterial a. white, gray, or yellow discharge (bacterial- fishy odor) b. foul or fishy odor c. MILD vaginal or vulvar pruritis, irritation, or erythema Some sx in women, done in men a chlamydia tricky 4. candida a. moderate to severe vaginal pruritis and burning b. vaginal and vulvar erythema c. thick cheesy discharge - clumpy white (mild, mod, severe) 5. trichomonas a. white, yellow, or green discharge b. malodorous (very odorous) c. severe pruritis d. vaginal erythema 6. * watery bloody discharge - malignancy |
|
|
Vulvovaginitis dx
|
* wet prep
* culture |
|
|
vulvovaginitis tx
|
1. depends on cause (irritation of underwear/ non cotton,)
2. flagyl (metronidazole) for trichomonas 3. doxycycline for Chlamydia (ADD vit c / less sx, recovery faster) 4. *boric acid suppositories 600 mg caps 2-4 wks (2x day) Candida - grapes/goldenseal/lactobacillus (may not be best alone/ need broad spectrum) |
|
|
Salpingitis (PID) definition
|
A. pelvic inflammatory disease (PID)
1. also includes endometritis, cervicitis, oophoritis B. infection of the fallopian tubes |
|
|
Salpingitis etiology
|
C. etiology
1. mostly in sexually active women under the age of 35 2. RARE before menarche, after menopause or during pg 3. Chlamydia trachomatis most common organism to cause 4. Neisseria gonorrhoeae 2nd most common (aftersyphillus) 5. can occur after insertion of IUD, childbirth, abortion |
|
|
Salpingitis sxs + sns
|
1. onset shortly after menses
2. progressively severe lower abdominal pain 3. guarding, rebound tenderness 4. worse with movement of cervix 5. usually bilateral 6. low to high fever, mild to severe abdominal pain, scant to copious cervical discharge 7. possible abscess formation in tubes, ovaries, pelvis 8. may become chronic a. tubal and pelvic scarring and adhesions b. chronic pain c. menstrual irregularities d. infertility |
|
|
Salpingitis diagnosis
|
1. recent coitus, childbirth, IUD, abortion
2. T, ESR, WBC may be elevated 3. severe pain on moving of the cervix 4. gram stain, culture 5. may need laparoscopy |
|
|
salpingitis tx
|
treatment
1. immediate antibiotics a. prevent infertility 2. identify and tx sexual contacts |
|
|
PMS definition + etiology
|
A. recurrent sns & sxs usually 1-2 weeks before menses
B. etiology 1. imbalances in body biochemistry 2. E & P fluctuations 3. xs aldosterone 4. changes in CHO metabolism |
|
|
PMS sxs + sns
|
1. general
a. anxiety, tension, irritability, depression, mood swings, fatigue, HA, fluid retention, mastalgia, insomnia, food cravings b. broad range of sxs and timings i. almost any sx at any time regularly during cycle c. a few hours to 14 days before onset of menses d. usually cease within a few hours of onset of menses but may continue through and after |
|
|
PMS types
|
2. PMS-A
a. high E, low P b. anxiety, irritability, mood swings, nervous tension 3. PMS-C a. low PGE1 b. CHO cravings, increased appetite, HA, fatigue, dizziness, syncope, palpitations 4. PMS-D a. low E, high P b. depression, crying, forgetfulness, confusion, insomnia 5. PMS-H a. increased aldosterone b. also increased E c. fluid retention, weight gain, abdominal bloating, mastalgia 6. PMDD a. depressed, anxiety, irritability, emotional lability b. suicidal ideation c. ADLs affected |
|
|
PMS diagnosis - pmdd
|
1. sx chart
a. may take a few months to totally sort out 2. PMDD a. must have 5 or more of the following symptoms for most of the week before menses and at least one symptom must be from the first 4 i. sadness, hopelessness, self-deprecation ii. anxiety, tension iii. emotional lability with tearfulness iv. persistent irritability, anger v. loss of interest in daily activities vi. decreased concentration vii. fatigue, lethargy viii. eating habit changes ix. insomnia x. overwhelm, loss of control xi. other physical sxs as in PMS b. sxs for most of previous 12 months i. interfere with ADLs 3. serum, urinary, salivary E & P |
|
|
PMS tx
|
1. stress reduction
2. hormonal manipulation a. progesterone cream, oral micronized progesterone 3. diet a. increase protein b. low fat c. decrease saturated fat i. arachidonic acid from animal fats stimulates PGF2 d. increase fiber to bind E e. decrease salt, sugar, caffeine 4. EPO, black currant oil, flax oil a. 3-4 gm EPO daily 5. Mg 400 mg/d 6. vitamin B6 100 mg TID 7. B complex 8. tx liver 9. exercise |
|
|
Dysmenorrhea def
|
A. cyclic pain associated with menses during ovulatory cycles
B. primary (functional) 1. without demonstrable lesion affecting reproductive structures 2. from uterine contractions and ischemia probably from PGF2 3. often begins in adolescence, decreases with age and after pg C. secondary (acquired) 1. sx with demonstrable lesion 2. endometriosis, adenomyosis, leiomyomas, narrow cervical os, PID |
|
|
dysmenorrhea sxs + sns
50% women (PMS 80%) dys: more likely w early menarche / obese women /13x more f2alpha |
1. lower abdominal pain
2. crampy or colicky 3. may be dull constant ache 4. may radiate to low back or legs 5. often starts 1 – 3 days before or during menses a. most commonly 24 hours after onset of menses 6. usually decreases after 2 days 7. HA, N, V, C, D, urinary frequency |
|
|
dysmenorrhea tx + diagnosis
|
diagnosis: rule out 2nd degree, clinical
tx: tx cause of 2nd degree, like pms |
|
|
PMS def + etiology
|
A. recurrent sns & sxs usually 1-2 weeks before menses
B. etiology 1. imbalances in body biochemistry 2. E & P fluctuations 3. xs aldosterone 4. changes in CHO metabolism |
|
|
PMS sxs + sns
|
1. general
a. anxiety, tension, irritability, depression, mood swings,fatigue, HA, fluid retention, mastalgia, insomnia, food cravings b. broad range of sxs and timings i. almost any sx at any time regularly during cycle c. a few hours to 14 days before onset of menses d. usually cease within a few hours of onset of menses but may continue through and after 2. PMS-A a. high E, low P b. ANXIeTy, irritability, mood swings, nervous tension 3. PMS-C (CARBS/cravings) a. low PGE1 b. CHO cravings, increased appetite, HA, fatigue, dizziness, syncope, palpitations 4. PMS-D a. low E, high P b. depression, crying, forgetfulness, confusion, insomnia 5. PMS-H (hydration) a. increased aldosterone (cause sodium retention) b. also increased E c. fluid retention, weight gain, abdominal bloating, mastalgia 6. PMDD (dysphoric disorder) a. depressed, anxiety, irritability, emotional lability (Prozac) b. suicidal ideation c. ADLs affected Increase estrogen, increase norepinephrine (changes dopamine/Serotonin adversely, goes down) |
|
|
PMS diagnosis
|
1. sx chart
a. may take a few months to totally sort out 2. PMDD a. must have 5 or more of the following symptoms for most of the week before menses and at least one symptom must be from the first 4 i. sadness, hopelessness, self-deprecation ii. anxiety, tension emotional lability with tearfulness persistent irritability, anger loss of interest in daily activities decreased concentration fatigue, lethargy eating habit changes insomnia overwhelm, loss of control other physical sxs as in PMS sxs for most of previous 12 months i. interfere with ADLs 3. serum, urinary, salivary E & P |
|
|
PMS Tx
|
1. stress reduction
2. hormonal manipulation a. progesterone cream, oral micronized progesterone 3. diet a. increase protein b. low fat c. decrease saturated fat i. arachidonic acid from animal fats stimulates PGF2 (foul worst) d. increase fiber to bind E e. decrease salt, sugar, caffeine 4. EPO, black currant oil, flax oil a. 3-4 gm EPO daily 5. Mg 400 mg/d smooth muscle relaxation (with b6) 6. vitamin B6 100 mg TID 7. B complex 8. tx liver (naturopathic way) 9. exercise |
|
|
Dysmenorrhea def/etiology
|
A. cyclic pain associated with menses during ovulatory cycles
B. primary (functional) 1. without demonstrable lesion affecting reproductive structures 2. from uterine contractions and ischemia probably from PGF2 3. often begins in adolescence, decreases with age and after pg C. secondary (acquired) 1. sx with demonstrable lesion 2. endometriosis, adenomyosis, leiomyomas, narrow cervical os, PID |
|
|
Dysmenorrhea sxs + sns
|
1. lower abdominal pain
2. crampy or colicky 3. may be dull constant ache 4. may radiate to low back or legs 5. often starts 1 – 3 days before or during menses a. most commonly 24 hours after onset of menses 6. usually decreases after 2 days 7. HA, N, V, C, D, urinary frequency E. diagnosis 1. rule out 2o 2. clinical F. treatment 1. tx cause if 2o 2. like PMS |
|
|
Abn uterine bleeding definition
|
A. menorrhagia
1. excess duration of menses B. hypermenorrhea 1. excess amount of menses C. polymenorrhea 1. too frequent menstruation D. metrorrhagia 1. intermenstrual bleeding E. postmenopausal bleeding 1. bleeding more than 12 months after last menstrual period F. oligomenorrhea 1. scanty menstruation |
|
|
Abn uterine bleeding etiology
|
1. organic cause in 25%
2. remainder usually functional abN in hypothalamic-pituitary-ovarian axis a. dysfunctional uterine bleeding (just b4 start or just before end) b. 50% in women >45 yrs old c. 20% in adolescents 3. abN clotting disorders (platelets or clotting factor(genetic)) 4. complications of pregnancy a. ectopic pg b. placenta previa (placenta hanging over Os of cervix) c. endometritis (ESP after birth / infection of endometrium) 5. endometriosis (tissue outside uterine cavity) 6. trauma 7. vaginal lesions (whether cancer or not) 8. cervical CA 9. some benign cervical lesions 10. endometrial hyperplasia (anovulatory women mostly) B4 ovulation, estrogen levels rising (keep keep rising --keeps endometrium thickening to get ready for plantation) finally sluffs off but - incompletely / irregularly a. in anovulatory women b. unopposed E or excess exogenous E c. irregular, incomplete endometrial sloughing 11. adenomyosis (endometrial tissue grows into myometrium) a. invasion of endometrium into myometriuim b. menorrhagia, metrorrhagia 12. leiomyomas (uterine fibroids) a. in 70% of women by age 45 (most common solidpelvic tumor) tumor of myometrium (earlier menarche / Inc chance fibroids, HBP 25% more likely, every 10 mm increase in diastolic, fibroids poss up 10%) b. sx in 25% women c. any type of bleeding abN 13. functional ovarian cysts a. common (fx cyst means changes with menses) b. 50% women present with some type of menstrual irregularity c. if >5 cm adnexal mass for >1 month, surgery to rule out neoplasm i. ultrasound 14. contraceptives a. oral contraceptives, IUD 15. thyroid dysfunction a. oligomenorrhea, amenorrhea, menorrhagia 16. postmenopausal a. rule out malignancy *dermoid (teratoma cyst) keep growing /unusual, not malignant /dermal tissue, hair, skin, teeth, ectoderm H. treatment 1. find cause 2. be careful of anemia |
|
|
Diosgenin
|
Alkaloid in wild yam - to make progesterone companies grow fields of wild yam
|
|
|
Amenorrhea def + etiology
|
A. absence of menstruation
B. primary 1. absence of menarche by age 16 or 2 years after onset of puberty 2. about age 14 in girls who have not gone through puberty C. secondary 1. absence of menstruation for > 6 months in women with previous menses D. classification 1. anovulatory a. hypothalamic dysfunction i. dieting ii. excess exercise iii. eating disorders (not enough fat, can't make hormones) iv. stress v. psychiatric disorders - depression, OCD b. pituitary dysfunction : makes Lh + fsh - cause menses i. tumors c. premature ovarian failure (menopause really early d. PCOS- polycystic ovarian syndrome 2. ovulatory a. genetic E. normal menstruation 1. 25-31 days for 65% of women 2. can be 18-40 days "normal" 3. once pattern established, variation usually not greater than 5 days 4. menses 3-7 days, usually 5 5. 130 ml blood loss, range from 13-300 ml |
|
|
Amenorrhea sxs + sns
|
1. try to find hormonal changes (these usu. Pituitary problems)
2. hirsutism - facial hair, pubic hair up abdomen (increase androgens) 3. virilizationa 4. defeminization 5. galactorrhea - nipple discharge G. diagnosis 1. x-rays of sella turcica for pituitary tumors 2. CT scan, MRI 3. many hormonal tests |
|
|
Polycystic Ovary Syndrome (PCOS; Stein-Leventhal Syndrome) definition + etiology
|
A. clinical syndrome(most common cause anovulation)
1. obesity 2. amenorrhea or irregular menses 3. androgen excess B. etiology 1. unknown 2. found in 10% women 3.. chronic anovulation 4. unopposed E |
|
|
Prostaglandin f2 alpha
|
Inflammatory / at end of cycle progesterone + estrogen decrease and f2 alpha cause shedding
|
|
|
Polycystic Ovary Syndrome (PCOS; Stein-Leventhal Syndrome sxs + sns, diagnosis + tx
|
1.. obesity, amenorrhea, hirsutism
2. may present with irregular profuse uterine bleeding and no other sxs or sns 3. multiple ovarian cysts D. diagnosis 1. 2 out of 3 criteria a. menstrual irregularity due to ovulatory dysfunction b. clinical or biochemical evidence of hyperandrogenism c. greater than 10 follicles per ovary 2. clinical 3. serum testosterone, FSH, prolactin, TSH, glucose, insulin 4. ultrasound E. treatment 1. glucose regulation - hyper insulin / hyper testosterone a. metformin b. natural methods 2. oral contraceptives |
|
|
Menopause def. + etiology
|
A. physiologic cessation of menses as a result of decreasing ovarian function
B. no menses for 1 year (mid 40s may begin) estrogen withdrawal = sx 1. perimenopause from several years before menopause to 1 year after C. etiology 1. decreased ovarian response to FSH, LH (don't do much anymore) 2. shorter follicular phases a. shorter cycles initially 3. fewer ovulations 4. decreased P 5. more cycle irregularity 6. decreased E 7. longer cycles |
|
|
Menopause sxs + sns
|
1. sxs due to large daily fluctuations in E
2. average age of 51 3. climacteric = a. transitional phase from before menopause to - after it during which a woman passes from reproductive stage 4. vasomotor instability a. hot flashes b. 75 – 85% c. often last up to 1 year, 50% last 5 years 4. depression, fatigue, irritability, nervousness 5. insomnia, dizziness, paresthesias 6. vulvar and vaginal dryness and thinning 7. urinary incontinence, cystitis, vaginitis 8. palpitation, tachycardia 9. N, C, D (nausea, constipation, diarrhea) any GI sx 10. osteoporosis a. most rapid loss in 1st two years after E decline Time when hormone therapy may be ok to prevent rapid loss. Best way is to build bone mass up early so not big deal when lose some) |
|
|
Serum hormone binding globulin
|
SHBG - binds up more testosterone /// Inhibit testosterone conversion to dytestosterone (nettle root + saw palmetto)
|
|
|
Menopause diagnosis + Tx
|
E. diagnosis
1. clinical 2. FSH - goes so high, still no response from ovaries - def in menopause F. treatment 1. HRT 2. soy 3. vit. E 400-800 mg/d 4. vit. B6 150 mg/d 5. bioflavonoids 1-3 gm/d 6. black cohosh, vitex |
|
|
Estrogen shi
|
Deep vein thrombosis
Gb disease Breast/ovarian cancers |
|
|
Hormone replacement therapy
|
Premerin (preg mare urine) + estrogen
Hundreds of thousands of horses slaughtered every yr for premarin "Bioidentical hormone therapy" - Estradiol 10% of estrogen in body Estriol 80% weakest fx Estrone 10% w/ progesterone to avoid endometrial hyperplasia Never give women with a uterus unopposed estrogen * soy / high in phytoestrogens Controversy around only 2 studies Look at predominance of evidence Phytoestrogens act on receptor sites (balancing fx it seems) if take when too much estrogen around, will make sites less active, if not enough estrogen around makes sites more active ..."hypothetically" |
|
|
endometriosis etiology + def
|
A. the presence of functional endometrial tissue outside the uterine cavity
B. usually on ovaries, ligaments around uterus, LI, ureters, BL, vagina, pleural cavity, surgical scars C. etiology 1. endometrial cells transported to distant sites 2. retrograde flow through fallopian tubes, lymphatic spread, hematogenous spread |
|
|
endometriosis epidemiology
|
1. familial inheritance
2. 10-15% of women between the ages of 25-40 who are actively menstruating 3. shorter menstrual cycles (<27 days) with prolonged (>8days) |
|
|
endometriosis sxs + sns
|
1. pelvic pain, pelvic mass, changes in menses, infertility
2. dyspareunia a. painful sexual activity of any kind 3. dysmenorrhea that is pre or peri menstrual and midline and that starts after many years of pain free menses 4. other sx depending on location in those organs affected |
|
|
endometriosis diagnosis + tx
|
F. diagnosis
1. suspected clinically, especially with pattern of dysmenorrhea 2. visualization of lesions a. endoscopy, laparoscopy, cystoscopy 3. biopsy of lesions G. treatment 1. medically suppressing ovarian function 2. surgical excision of implants |
|
|
Fibrocystic Breast Disease def + etiology
|
A. mastalgia, breast cysts, lumps
B. often premenstrual breast pain C. cyclical, bilateral D. can be asx E. small risk factor for breast CA |
|
|
Fibrocystic Breast Disease diagnosis + tx
|
F. diagnosis
1. clinical 2. ultrasound to distinguish cystic from solid mass G. treatment 1. diet a. high complex CHO & fiber, low fat b. avoid methylxanthines c. avoid exogenous estrogens 2. supplementation a. vitamin E 800 IU/d b. flaxseed oil 2 T/d c. EPO 1500 mg BID d. B complex i. B6 e. lipotropic factors: choline +inositol (amino acid- like) - artichokes, dandelion, beet, radish good liver herbs f. iodine 150 mcg/day 3. tx liver: pretty much always involved |
|
|
breast cancer def. + etiology
|
A. most common CA in women
B. risk factors 1. family hx in 1st degree relative (parent, sibling, child) 2. BRCA 1 or 2 mutation in 5% of breast CA (mutation of gene - higher risk) a. relatives who also have mutation have 85% risk b. BRCA 1 also has 40% increase risk ovarian CA 3. early menarche, late menopause 4. late (after 30) or no pg 5. FBD 6. oral contraceptives, HRT 7. high fat diet C. types 1. DCIS – ductal carcinoma in situ 2. invasive a. adenocarcinoma b. 80% infiltrating ductal |
|
|
breast cancer sxs + sns
|
1. >80% present as a lump found by woman
2. dominant mass a. distinctly different from rest of breast tissue 3. usually painless, unilateral mass 4. hard, non-moveable mass 5. any mass must be carefully considered 6. may metastasize to any organ a. Lu, Lv, bone, lymph nodes, skin |
|
|
breast cancer diagnosis
|
1. mammography
a. controversial - begin at 50, annual thereafter 2. CBE (clinical b exam) 3. BSE (self breast exam) 4. MRI 5. biopsy a. E & P receptor analysis i. better prognosis if positive b. HER2 - human epidermal growth factor receptor 2 i. more aggressive tumors 6. genetic testing a. BRCA 1 & 2 if relatives positive for CA |
|
|
breast cancer staging + tx
|
F. grading
1. 1 – 3 (how abnormal are these cells: 1 sl., 3 a lot) G. staging 1. 0 – 4 2. TMN a. tumor size b. metastasis c. nodal involvement G. treatment 1. lumpectomy - modified radical mastectomy 2. radiation - chemotherapy 3. endocrine therapy i. tamoxifen ii. raloxifene – SERM 4. diet and other natural tx |
|
|
Gynecological Neoplasms def (ovarian carcinoma)
|
Ovarian carcinoma
1. 2nd most common gynecological CA a. most common cause of death from gynecological CA b. 5th most common cause of death overall for women 2. highest incidence peri and post menopausal 3. incidence higher in developed countries |
|
|
Gynecological Neoplasms etiology (ovarian carcinoma)
|
a. prolonged E exposure
b. nulliparity or late childbearing c. early menarche d. late menopause e. personal or family hx of endometrial, breast, colon CA |
|
|
Gynecological Neoplasms sxs + sns (ovarian carcinoma)
|
a. early detection difficult
b. ovary >6cm diameter watched closely c. any ovarian enlargement in a postmenopausal woman usually signifies malignancy d. usually grow to considerable size before sx e. adnexal mass f. unexplained abdominal bloating g. changes in bowel habits h. abdominal pain i. weight loss |
|
|
Gynecological Neoplasms metastasis (ovarian carcinoma)
|
metastasis
a. local in pelvis b. abdominal c. liver d. lung e. bone |
|
|
Gynecological Neoplasms diagnosis + tx (ovarian carcinoma)
|
a. ultrasound
b. CA 125 i. 80% advanced ovarian CA c. b-HCG, alpha fetoprotein, inhibin i. in younger patients d. laparoscopy e. laparotomy 8. treatment a. surgery i. hysterectomy with bilateral salpingo-oophorectomy b. chemotherapy i. postoperative |
|
|
Gynecological Neoplasms def (endometrial carcinoma)
|
endometrial carcinoma
1. 4th most common CA in women a. mostly postmenopausal b. 50 – 65 years old c. highest in developed countries with high fat diet 2. adenocarcinoma 3. risk factors a. unopposed estrogen i. nulliparity ii. PCOS iii. late menopause iv. anovulation v. estrogen tx without progesterone b. obesity c. diabetes d. hypertension e. tamoxifen use for more than 5 years f. personal or family hx of breast, ovarian CA |
|
|
Gynecological Neoplasms sxs + sns + diagnosis (endometrial carcinoma)
|
a. abN uterine bleeding
b. 1/3 of all postmenopausal bleeding c. premenopausal recurrent metrorrhagia 5. diagnosis a. endometrial biopsy b. D&C |
|
|
Gynecological Neoplasms (endometrial carcinoma) tx
|
a. surgery
i. total hysterectomy with bilateral salpingo-oophorectomy b. radiation, chemotherapy |
|
|
Gynecological Neoplasms def (cervical carcinoma)
|
Cervical carcinoma
1. 3rd most common gynecological CA a. 8th most common in women amongst all CA b. mostly squamous cell 2. 50 years of age 3. CIN – cervical intraepithelial neoplasia a. CIN 1 – mild dysplasia b. CIN 2 – moderate c. CIN 3 – severe, carcinoma-in-situ i. spontaneous regression unlikely 4. greater in women with a hx of early, frequent coitus with multiple sex partners a. HPV i. subtypes 16, 18, 31, 33, 35, 39 |
|
|
Gynecological Neoplasms sxs + sns + diagnosis (cervical carcinoma)
|
a. asx
b. irregular vaginal bleeding i. especially after sexual activity 6. diagnosis a. PAP smear i. with HPV testing b. colposcopy c. Schiller’s test d. conization i. LEEP |
|
|
Gynecological Neoplasms (cervical carcinoma) tx
|
Treatment
a. CIN 1 & 2 i. folic acid 10 mg/day ii. indole-3-carbinol - 200-400 mg/day - 7 ounces raw cabbage or Brussels sprouts daily b. excision c. radiation d. radical surgery e. chemotherapy |
