OB: neoplasms of reproductive system

Altered pelvic support

• Uterine displacement (NORMAL): can be posterior, retroversoflexion, or anteflexion

• Womb/Uterine prolapse (ABNORMAL): uterus/cervix protrudes through the ____

• Risk factors:

  • weak pelvic support structures d/t strain, trauma, stress, aging, vaginal birth

• SX: _____

• Treatment:

  • kegel exercise

  • ___: silicone support thingy placed inside uterus

  • ____: this position uses gravity to help displace the uterus back into normal position

• fatigue, pelvic pressure, back pain

• fitted pessary

• knee chest position

Other prolapses

• ____: bladder protrudes into vagina d/t trauma to vesicovaginal septum’s supporting structure 

• ____: anterior rectum protrudes into vaginal fascia and rectovaginal septum

Manifestations

• ?

Treatment

• Fitted pessary (silicone support thingy placed inside uterus)

• Colporraphy (vaginal wall repair surgery) 

• cystocele (aka bladder prolapse)

• rectocele (aka rectal prolapse)

• manifestations

  • constant “bearing down” feeling

  • recurrent UTI ← for cystocele

  • constipation ← for rectocele

Ovarian cysts

• are ovarian cysts BENIGN or MALIGNANT?

Types

• ____: mature follicle doesnt rupture or immature follicle doesnt reabsorb fluid after rupturing 

  • Common @ young women

• ____: corpus fails to degenerate → fluid accumulation inside corpus → continued progesterone secretion

  • SX?

• ____: abnormal tissue overgrowth from fertilized egg or placenta (due to excessive HCG)

• ____: germ cell tumor that develops during childhood 

  • This tumor contains teeth, hair, nails

• benign

• follicular

• corpus luteum

• pain/tender + delayed period (bc it fails to degenerate thus no shedding occurs)

• theca lutein

• dermoid cyst

PCOS (polycystic ovarian syndrome)

PCOS: endocrine imbalance d/t hypothalamic-pituitatuary issue

• HIGH levels of____ and LOW levels of ___

• Due to hypothalamic-pituitary issue OR can be inherited as dominant trait

Manifestations

• ?

Risk factors

• Diabetes

• Cardiovascular disease

Treatment

• ?

• estrogen, testosterone, LH

• FSH (low levels of FSH result in accumulated immature follicles in ovary —> poly-cystic)

• irregular periods + hirtuism + infertility

• oral contraceptives + weight loss + weight loss meds (ex: Metformin)

Uterus abnormalities

Uterine polyps

• benign tumors; derived from which layer of uterus?

• Caused by hormones or inflammation 

• Manifestations: ____

• Treatment: surgical removal 

Leiomyomas (aka fibroids, fibromas, myomas, fibromas):

• derived from which layer of uterus?

• Manifestations: ____

• uterine lining

• abnormal bleeding ***bc imagine it ruptures during sex or just on a random day → bleeds***

• muscle layer of uterus

• manifestations:

  • Heavy periods (menorrhagia) ← bc fibroids are super vascular, thus heavy bleeding when you shed  

  • Back pain

  • Bladder pressure/urinary frequency + Constipation ← bc pressure on rectum = poop cant squeeze thru

  • Distended abdomen

Endometrial cancer

• Common @ post-menopause women (usually age 60)

Risk factors

• Obesity

• Diabetes

• Infertility

• Late menopause onset

• Hormone imbalance

• which drug? 

Pathophysiology

• Cancer starts in fundus → spreads to myometrium and cervix → remainder of reproductive organs (fallopian tubes, ovaries, vagina…)

Manifestations

• ?

Diagnosis

• Pap smear

• Endometrium biopsy 

Treatment

• Radical hysterectomy 

• Chemo or radiation (based on staging)

• tamoxifen

• post-menopausal bleeding or just abnormal bleeding + back pain

Ovarian cancer

Caused by

• Unknown!

Risk factors

• BRCA1/BRCA2

• Obesity

• Nullparity (never giving birth) ← bc more lifetime ovulations increases the risk

• Pregnancy at LATE age ← bc more lifetime ovulations increases the risk

Protective factors against ovarian cancer

****think: the less you ovulate = the better u can protect ovaries from wear/tear***

• Birth control for 5+ years ← bc less lifetime ovulations decreases the risk

• Giving birth ← bc less lifetime ovulations decreases the risk

• Tubes tied to prevents cancer from migrating into ovaries

Manifestations

• ?

Diagnosis

• Ultrasound

Treatment

• Surgical removal of tumor

• chemo/radiation

• Hormone therapy 

• manifestations:

  • Abdominal bloating

  • Ascites 

  • Increased satiety 

  • Weight loss  

Cervical cancer

• Most PREVENTABLE cancer for women (ex: HPV vaccine!!!!)

Pathophysiology

• Pre-invasive stage is called ____ when it remains @ ______

• Invasive stage is called _____ when it penetrates @______

Staging of precancerous 

• CIN 1 = how much of the epithelium do abnormal cells take over?

  • Self-limiting; regresses to normal 

• CIN 2 = how much of the epithelium do abnormal cells take over?

• CIN 3 = how much of the epithelium do abnormal cells take over?

Risk factors

• HPV 

• Mutliple partners

• HIGH # of pregnancies 

***think of the cervical trauma during successful pregnancies = increases risk for cervical cancer**

Manifestations 

• ?

Diagnosis

• ?

Treatment for pre-invasive 

• Cryosurgery: freezes the abnormal cells

• Laser ablation

• Conization: removal of cone-shaped portion of cervix which contains preinvasive tissue

• Loop electrosurgical excision procedure (LEEP): cauterizes-off the preinvasive tissue 

Treatment for invasive 

• Surgery

• radiation/chemo

• cervical intraepithelial neoplasia (CIN)

• transformation zone

• invasive carinoma

• stroma cells

• lower 1/3

• lower ½

• entire thickness of epithelium

• bleeding after sex or abnormal bleeding

• pap smear AFTER AGE 21

Vulva cancer

Manifestations

• ?

Diagnosis

• Biopsy

Treatment

• Potential vulvectomy 

• chemo/radiation

• manifestations:

  • Vaginal itching

  • Lump @ labia majora 

  • Lump @ groin ← indicates that the cancer has spread to inguinal lymph nodes

Womens diagnostic and surgical procedures 

• Laparsopy: uses camera to view ____

• Hysterocopy: uses camera to view _____ 

• _____: removes entire uterus

• _____: removes entire uterus AND nearby tissue

• _____: remove BENIGN tumor

• _____: removal of fallopian tube (either just 1 or both)

• _____: surgical OPENING of fallopian tube

• _____: removal of ovaries (either 1 or both)

Dilation and curettage (D&C)

• Opening the cervix with dilator → uterine walls scraped with a currette tool

Pap test/smear

• Used as screening for cervical cancer

• Performed after age 21

Cancer and pregnancy 

• Cancer is rare during pregnancy 

• Its a tricky/difficuly topic so just be supportive of the family

• pelvis

• uterus

• hysterectomy

• radical hysterectomy

• myomectomy

• salpingectomy

• salpingostomy

• oophorectomy