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University of Wisconsin - Madison
University of Wisconsin - Madison
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What are the characteristics of dysfunctional uterine bleeding?
Excessive menstrual bleeding or bleeding between menstrual periods
What usually causes dysfunctional uterine bleeding?
Abnormality in the hypothalamic/pituitary/ovarian hormone mechanism
When does dysfunctional uterine bleeding usually occur?
What is endometriosis?
The presence of endometrial glands and stroma outside the uterus
How common is endometriosis?
Common: approx. 10% of women in the 3rd and 4th decades of life
Where does endometriosis typically occur?
Uterine tubes (Fallopian tubes)
What are three s/s of endometriosis?
Pain (especially during menstruation)
Adhesions of abdominal organs
What are three theories of the pathogenesis of endometriosis?
What are three obstetric conditions?
Toxemia of pregnancy (pre-eclampsia/eclampsia)
What is an ectopic pregnancy?
Implantation of the fetus in any site other than the normal intrauterine location
Where do ectopic pregnancies usually occur?
90% occur in the uterine tubes
How common are ectopic pregnancies?
About 1 per 150 pregnancies
What are two common diseases seen in many women with tubal obstructions?
One third to one half have a hx of PID
Can occur in women who have undergone surgical tubal ligation
What is the classic presentation of an ectopic pregnancy?
Severe abdominal pain about 6 weeks gestation (6-10 weeks after LMP)
What can happen if an ectopic pregnancy is not treated promptly?
Can rupture and hemorrhage causing death in the mother
What are the symptoms of pre-eclampsia?
How common is pre-eclampsia?
About 6% of pregnant women
When does pre-eclampsia usually occur?
In 3rd trimester
What are two complications of pre-eclampsia?
Some develop Disseminated intravascular coagulation (DIC)
What are five common gynecological neoplastic conditions?
Vulvar and vaginal carcinoma
Uterine cervical carcinoma
Ovary and uterine tube tumors
What types of cells comprise most vulvar and vaginal carcinomas?
Most are squamous cell type
What are the two general types of vulvar vaginal carcinoma?
What are the characteristics of HPV related vulvar/vaginal carcinoma?
Characterstic pre-invasive phase (VIN or vulvar intraepithelial neoplasia)
Who does HPV related vulvar and vaginal carcinoma usually affect?
Relatively younger women
What is Non-HPV related vulvar and vaginal carcinoma associated with? Who does it usually affect?
Associated w/ squamous cell hyperplasia and lichen sclerosis
Usually affects relatively older women
What are three types of treatment for vulvar and vaginal carcinomas?
Surgical (wide excision, radical vulvectomy)
How common is uterine cervical carcinoma worldwide?
Very common (about 5% of all cancer deaths in women)
How can uterine cervical carcinoma be prevented?
Pap smear programs are very effective at preventive invasive carcinoma by detecting intraepithelial changes (dysplasia), which are then treated before invasive cancer can develop
What are the two histologic types of uterine cervical carcinoma?
Squamous cell carcinoma
What usually causes mortality in uterine cervical carcinoma?
Invasion of local structures (bowel, ureters) rather than metastasis
What are squamous cell carcinoma and adenocarcinoma of the cervix highly associated with?
HPV: Greater than 95% of cases
How common is HPV?
At least 75% of adults have been infected with HPV, but only a few get cancer
How many types of HPV have been identified? What is a key step in the progression of these viruses?
Over 100 types have been discovered, some of which show more propensity to integrate their DNA into that of the host cell (this is a key step in the progression to dysplasia and carcinoma)
What is the difference b/w "High risk" and "Low Risk" strands of HPV?
"High risk" types have a high propensity to integrate their DNA into that of the host cell, where "Low risk" are less likely. Most infections of "High risk" do not result in cancer
What are the s/s of "Low risk" HPV infections?
Usually asymptomatic or present with genital warts
What effect does HPV infection have on future infection?
Infection with one type does NOT make one immune from infection w/ other types
What are three treatments for uterine cervical carcinoma?
Chemo sometimes, but efficacy is limited
When is the peak incidence of endometrial carcinoma?
Peak incidence between 55-65 years old
What is the most common presentation of endometrial carcinoma?
Postmenopausal uterine bleeding
What are 5 risk factors for endometrial carcinoma?
"Unopposed" estrogen: High estrogen w/o correspondingly high progesterone
How is endometrial carcinoma often cured?
What is a subgroup of patients with endometrial carcinoma?
Older patients without risk factors; tend to have more aggressive cancers that histologically look more like ovarian cancers
What are the treatments for endometrial carcinoma?
Surgical - hysterectomy
Depending on prognostic factors (primarily tumor stage) may be followed by radiation or chemo
How is radiation therapy done in patients with endometrial carcinoma?
Applied just to the "vaginal cuff" (most frequent site of recurrence)
Can be applied to the entire pelvis (with corresponding increase in side effects)
What are two types of myometrial neoplasias?
What is a leiomyoma and what are the symptoms?
Benign, very common
Sx may include:
Abnormal uterine bleeding
Compression of bladder
What is a leiomyosarcoma?
Rare and malignant
What is the relationship between leiomyomas and leiomyosarcoma?
Leiomyosarcomas do not arise from pre-existing leiomyoma
What is the main treatment for leiomyosarcomas?
What is the relationship between ovary/uterine tube tumors and menopause?
Most ovarian tumores in premenopausal women are benign, while most in postmenopausal women are malignant
What are the three types of ovary/uterine tube tumors based on cells of origin?
Epithelial tumors - from ovarian surface epithelium precursors
Germ cell tumors - From oocyte precursors
Sex cord-stromal tumors - from supporting stromal cell precursors
How do ovary/uterine tube neoplasms compare to those of other organs?
Compared to most other organs, there are more different types of neoplasms that can develop in the ovaries, although some are much more common than others
What percent of ovary/uterine tube tumors are benign?
What are two types of benign ovary/uterine tube tumors?
Mature teratoma (dermoid cyst) of germ cell origin
Benign cystadenoma of epithelial origin
What types of tumors make up the vast majority of malignant ovarian tumors?
What are three types of malignant epithelial tumors of the ovaries?
Serous carcinoma (papillary serous carcinoma)
What is the prognosis for ovarian epithelial carcinomas? Why?
Have a poor prognosis:
They are not easily visualized or sampled
They do not usually produce early symptoms
What is an area of research in neoplastic gynecological conditions?
Ongoing search for a good screening test for early ovarian carcinoma, so far with little success
What are the treatments for malignant ovary/uterine tube tumors?
Aggressive surgery (de-bulking)
Depending on prognostic factors (primarily stage), may be followed by one or both:
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