I) Non-malignant Gynecologic Disorders

1. Infectious Diseases

• numerous infectious agents
• bacteria - streptococcus
• fungus - Candida albicans
• virus - herpes simplex
• protozoans - Trichomonas vaginalis
• Pelvic inflammatory disease

1. Dysmenorrhea

• Painful menstrual cramps
• Affects approximately 50% of young females
• May result from excessive prostaglandin production of absorption
• Treatment with prostaglandin inhibitors and NSAID’s

1. Endometriosis

• Implantation of normal endometrial tissue outside of the uterus
• May be caused by regurgitation of endometrial tissue during menstruation however exact cause is not known
• May be a genetic predisposition
• affects 4-17% of women during reproductive years
• Treated with oral contraceptive pills

• Implantation of a fertilized ovum in fallopian tube instead of uterus.
• Increased incidence with PID
• High incidence of recurrence after treatment
• Treatment is excision of tissue

• Enlarged ovaries
• Multiple follicular cysts
• Increase in androgen levels
• Imbalance of LH/FSH levels which interferes with ovulation
• Manifestations include infertility, amenorrhea, obesity and hirsutism

1. Etiology

• Primary or Secondary hypothalmic defect controlling release of LH/FSH
• Increased production of androgens from adrenal gland
• Obesity

1. Treatment

• Correct abnormal hormone responses
• Estrogen/progestogen oral contraceptives
• Antiestrogens or ovarian resection

II) Malignant Gynecologic Disorders

1. Carcinoma of the Cervix

1. General

• The incidence has been declining in certain groups as a result of screening and treatment advances however the incidence in young women has increased
• 90% are squamous cell carcinomas
• Etiology is unknown however many risk factors have been identified

1. Staging

• Stage O - preinvasive
• Stage Ia - microinvasive
• Stage II - vagina involved
• Stage III - spread to pelvic wall
• Stage IV - Distant metastasis

1. Symptoms

• May be asymptomatic
• May have vaginal bleeding or discharge
• Pap Smear indicates abnormal cells

1. Treatment

• Primary treatment is either surgery or radiation therapy
• Excise tumor or hysterectomy
• Chemotherapy

B) Endometrial Carcinoma

1. General

• Incidence higher than cervical cancer in the United States
• Peak incidence among women 50-70
• Frequency increases with age
• Certain risk factors have been identified
• Cause is believed to be stimulation of endometrium by exogenous and/or endogenous estrogen
• Most are adenocarcinomas
• Increased incidence with tamoxifen

1. Staging

• Stage I - confined to uterus
• Stage II - spread to cervix
• Stage III - Spread to pelvic region
• Stage IV - distant metastasis

1. Symptoms

• Abnormal bleeding

1. Treatment

• Total abdominal hysterectomy
• All stages except well-differentiated stage I are treated with post-operative radiation.
• 5 year survival:

III) Disorders of the Breast

A) Fibrocystic Breast Disease

• Local or diffuse lumps in the breast
• Result of fibrosis, cyst formation or adenosis
• May represent a increased risk for breast cancer

B) Breast Cancer

• Affects 1 out of 9 women in the U.S.
• Most common cause of death in females ages 35-50
• Can be intraductal tumors or infiltrating duct carcinomas
• Increased incidence with estrogen replacement therapy
• Decrease incidence with tamoxifen therapy

• Cause unknown but a variety of risk factors have been determined
• Increased exposure to estrogen
• Western culture
• ionizing radiation
• family history
• benign breast disease

• Self-examination
• mammography
• genetic analysis
• receptor status

• Painless mass in the breast - usually first indication
• breast pain, nipple discharge enlarged lymph nodes

1. Prognosis

a) Staging

• Stage I - tumor less than 2 cm, confined
• Stage II - tumor less than 5 cm
• Stage III - tumor more than 5 cm, invaded skin and nodes
• Stage IV - Distant metastasis

1. 5-year survival rate

• Stage I - 85-95%
• Stage IV - 10 %

6) Treatment

• Surgery
• Chemotherapy post-surgery
• endocrine manipulation post-surgery
• receptor positive
• receptor negative

1. Tamoxifen Study

7. Nonmalignant Male Reproductive Disorders

A) Disorders of the Prostate

1. General

• Enlargement of the prostate associated with obstruction to outflow of urine
• Affect older males

1. Benign Prostatic Hypertrophy (BPH)

• increased growth of tissue that leads to prostatic enlargement
• etiology not clear
• Abnormal levels of testosterone may contribute
• Incidence increases over the age of 40
• Main symptoms characteristic of obstruction of urine
• treatment is removal of hyperplastic tissue

1. Prostatitis

• Inflammation of the prostate gland
• Acute and chronic form
• etiology unknown but there is good evidence that both forms may be caused by a bacterial infection (chronic may be bacterial or non-bacterial)
• May be asymptomatic or have some obstructive symptoms
• Treatment: antiobiotic therapy, symptomatic relief, surgery

8. Malignant Male Reproductive Disorders

A) Prostatic Adenocarcinoma

1. General

• Incidence increases with age
• Second leading cause of cancer deaths in the U.S.
• Etiology is unknown however there is strong evidence for environmental/dietary risk factors as well as genetic predisposition

1. Symptoms/Diagnosis

• Usually not detected until it is fairly well progressed
• rectal exam
• acid phosphatase levels
• PAS - some debate on the effectiveness of this diagnostic tool

1. Staging and Treatment

a) Staging

• Stage A - small, localized differentiated tumor
• Stage B - confined to prostate gland/identified by rectal exam
• Stage C - tumor extend outside prostate
• Stage D - distant metastasis

1. Treatment

* Hormone manipulation, surgery, Radiation therapy