Chapter 46 - Disorders of the Female Reproductive System

• one of the most important advances in the early diagnosis and treatment of cervical cancer was made possible by the observation that this cancer arises from precursor lesions, which begin with the development of atypical cells
• atypical cells in cervical cancer gradually progress to carcinoma in situ and to invasive cancer of the cervix
• atypical cells differ from normal cervical squamous epithelium; there are changes in nuclear and cytoplasmic parts of the cell and more variation in cell size and shape, known as dysplasia
• dysplasia, although initially a reversible cell change, if left untreated, can develop into carcinoma
• cervical intraepithelial neoplasia is a one classification system of grading cells in the cervix that are identified as dysplasia
• the finding of dysplasia does not mean a woman has cancer; it is not until CIN 3 that cancer is noted
• at the CIN 3 level, cancer would then be labeled as in situ
• carcinoma of the cervix is considered a sexually transmitted disease and it is rare among celibate women
• risk factors for carcinoma of the cervix include early age at first intercourse, multiple sexual partners, a promiscuous male partner, smoking, and a history of STIs
• there is a casual link between HPV infection and cervical cancer
• because HPV is spread by sexual contact, this association with cervical cancer provides for the relationship of cervical cancer and its association with STIs
• all Pap smears demonstrating SIL often require further evaluation by colonoscopy
• during a colonoscopy, the cervical tissue may be stained with an iodine solution or acetic acid solution to accentuate topographic or vascular changes that differentiate normal from abnormal tissue
• PCOS is a common endocrine disorder affecting 5% to 10% of women of reproductive age and is a common source of chronic anovulation
• most women with PCOS have elevated LH levels with normal estrogen and FSH production
• elevated levels of circulating total testosterone, free testosterone, and DHEAS are not uncommon in PCOS
• a fasting blood sugar can be used to evaluate for insulin resistance, another problem associated with PCOS
• chronic anovulation is the reason for reported amenorrhea and inability to become pregnant
• a disturbance in normal hormonal signals prevents ovulation in women with PCOS
• throughout the cycle in women with PCOS, estrogen levels remain steady, LH levels are high, and FSH and progesterone levels are low
• in PCOS, since eggs are rarely or never released from their follicles, multiple ovarian cysts develop over time
• one of the most important characteristics of PCOS is hyperandrogenism, the excessive production of male hormones (and androgens), particularly DHEAS and testosterone, by the ovaries
• hyperandrogenism accounts for the excessive hair growth in women with PCOS
• when fertility is desired in women who have PCOS, the condition is usually treated by the administration of the hypothalamic-pituitary-stimulating drug clomiphene citrate or injectable gonadotropins to induce ovulation
• when medication to induce fertility in women with PCOS is ineffective, laser surgery to puncture the multiple follicles may restore normal ovulatory function
• weight loss may be beneficial in restoring normal ovulation in women with PCOS when obesity is present
• procedures that are used in the diagnosis of breast cancer:

  • mammography
  • ultrasonography
  • percutaneous needle aspiration
  • stereotactic needle biopsy
  • excisional biopsy
• MRI, PET, and computer-based or digital mammography are available as additional diagnostic modalities for breast cancer, and may be recommended to supplement conventional mammography in women with radiographically dense breasts, a strong family history of cancer, or known carriers of BRCA1 or BRCA2
• sentinel lymph node biopsy is a newer technique for evaluating lymph node involvement in breast cancer
• during an SLN biopsy, a radioactive substance or dye is injected into the region of the tumour; in theory, the dye is carried to the first (sentinel) node to receive lymph from the tumour
• the first (sentinel) node would be the most likely node to contain cancer cells if the cancer has spread
• if the sentinel biopsy is positive, more nodes are removed
• if the sentinel biopsy is negative, further lymph node evaluation may not be needed
• successful identification of the SLN occurs 92% to 98% of the time, and when blue dye and isotope are used together, SLN has a positive predictive value approaching 100% and a negative predictive value near 95%
• adjuvant therapy refers to the administration of chemotherapy or hormonal therapy to women after breast cancer surgery, with and without detectable metastatic disease
• the goal of adjuvant therapy depends on nodal involvement, menopausal status, and hormone receptor status
• adjuvant systemic therapy has been widely studied and has demonstrated benefits in reducing rates of recurrence and death from breast cancer
• tamoxifen in a nonsteroidal antiestrogen that binds to estrogen receptors and blocks the effects of estrogens on the growth of malignant cells in the breast
• studies of tamoxifen have shown decreased cancer recurrence, decreased mortality rates, and increased 5 year survival rates in women with estrogen receptor-positive tissue samples who have been treated with the drug
• cancers of the vulva and cervix are usually squamous cell carcinomas