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Lecture 5

ECO 100 Lecture Notes - Lecture 5: Testicular Cancer, Neisseria Gonorrhoeae, Testicle

5 pages29 viewsSpring 2018

Department
Economics (ECON)
Course Code
ECO 100
Professor
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Lecture
5

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Week 10 Diseases of the Female Genital Tract
1. To discuss this statement: "cancer of the cervix is a preventable venereal
disease" and understand the role of HPV in both vulvar and cervical lesions.
Nearly all cases of cervical dysplasia and cervical cancer are a result of infection
with the human papillomvirus (subtypes HPV 6 and 11 are strongly linked to
genital warts; other subtypes promote pre-cancerous changes (HPV 16, 18, 31,
33, 35)). Risk factors for HPV infection are:
(1) young age at first intercourse
(2) multiple sexual partners
(3) unprotected intercourse
(4) smoking
(5) oral conraceptive use
(6) pregnancy
(7) diabetes
(8) immunosuppression
(9) poor hygiene
Routine screening with a Pap smear can catch cervical dysplasia and treat or
monitor to prevent progression to cervical cancer. The introduction of a safe and
effective vaccine against the major subtypes of HPV implicated in cancer
causation has reduced the number of cases of cervical cancer.
Recommendations for Vaccination:
- The American Cancer Society (ACS) has developed guidelines for the use of
the prophylactic human papillomavirus (HPV) vaccine for the prevention of
cervical (and vulvar) intraepithelial neoplasia and cervical cancer -
http://onlinelibrary.wiley.com/doi/10.3322/canjclin.57.1.7/full - American
Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to
Prevent Cervical Cancer and Its Precursors
- AND they state that "Screening for cervical intraepithelial neoplasia and
cancer should continue in both vaccinated and unvaccinated women
according to current ACS early detection guidelines."
- In Canada there are two vaccines that have been approved for use - Gardisil
and Cervarix - http://www.phac-aspc.gc.ca/std-mts/hpv-vph/hpv-vph-
vaccine-eng.php - Human Papillomavirus (HPV) Prevention and HPV
Vaccines: Questions and Answers
2. To understand the risk factors for endometrial hyperplasia and cancer.
Endometrial hyperplasia (simple --> complex --> atypical hyperplasia) which can
be precursor of endometrial carcinoma. Endometrial ca is the most common
malignancy in FGT.
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Etiology - unopposed estrogen, could be due to:
- Failure to ovulate
o Perimenopausal failure to ovulate
o Polycystic ovarian disorder
- Obesity
- HRT for control of menopausal symptoms - progesterone as well as estrogen
should be prescribed.
- Functional tumours - rare ovarian tumours that produce estrogens (granulosa
cell tumors)
Common presenting symptom = abnormal uterine bleeding (and in a post-
menopausal woman (i.e., who isn't having monthly periods) assume cancer until
proven otherwise). Diagnosis - by biopsy from endometrial sampling.
Treat hormonally for simple and complex hyperplasia; atypical and carcinoma
treat surgically.
3. To understand the theories of pathogenesis for endometriosis and be able to
explain why the symptoms of endometriosis are so diverse.
Presence of benign endometrial tissue outside of normal location. Most common
sites are the ovaries (~80%), fallopian tubes, pelvic peritoneum and bowel.
Several theories have been suggested:
- Retrograde menstruation through the tube, with implantation of endometrial
tissue.
- Metaplasic transformation in the peritoneum and connective tissue.
- Vascular or lymphatic dissemination of endometrial tissue - "benign
metastases".
- Genetic predisposition.
4. To name the most common benign tumour of the female genital tract (leiomyoma
or commonly referred to as "fibroids") and discuss typical symptoms.
The most common tumor of the female genital tract; benign neoplasm
composed of smooth muscle cells which respond to hormonal stimuli (e.g.,
increase in size with pregnancy, decrease in size with menopause).
Often multiple, round, vary in size, location. Clinical presentation - signs and
symptoms - depends on size, location and number of tumors:
- they may be asymptomatic
- or present with
bleeding (menorrhagia - excessive menstrual bleeding) ;
pelvic pain;
dysmenorrhea (painful menstruation);
infertility.
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