Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

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Transcript of Women’s Health Bryan E. Mosora D.O. Intern/IM Resident.

  • Womens HealthBryan E. Mosora D.O.Intern/IM Resident

  • Women in your PracticeSpecial considerations with regards to health maintenance and preventionImportant to understand cultural issues Women are not the same as a men!!!

  • Women in your PracticeTypically more involved with there healthcare then men. This equals more opportunity to play a preventative roleUsually will be armed with information from various sources, i.e. magazines, internet, television.Important role of the physician is to help her sort through the garbage and address meaningful issues

  • Issues Breast cancerOvarian CancerCervical CancerUterine cancerMenopause/HRTHeart DiseaseDiabetesDepression

  • Statistics213,000 cases of breast cancer per year with 41,000 deaths.9,700 cases of cervical cancer per year with 3,700 deaths41,200 cases of uterine cancer per year with 7,350 deaths20,200 cases of ovarian cancer per year with 15,310

  • Breast Cancer

  • Breast CancerThe most common cancer in women, no matter your race or ethnicity. The most common cause of death from cancer among Hispanic women. The second most common cause of death from cancer among white, black, Asian/Pacific Islander, and American Indian/Alaska Native women.

  • Risk FactorsResearch has shown that the following conditions increase a woman's chances of getting breast cancer:Personal history of breast cancer. Family history..Certain breast changes. Genetic alterations.5% to 10% of all breast cancer.

  • Warning SignsNew lump in the breast or underarm (armpit). Thickening or swelling of part of the breast. Irritation or dimpling of breast skin. Redness or flaky skin in the nipple area or the breast. Pulling in of the nipple or pain in the nipple area. Nipple discharge other than breast milk, including blood. Any change in the size or the shape of the breast. Pain in any area of the breast.

  • Detection

  • Signs of Breast Cancer

  • DetectionRegular self breast exam is nearly as good as mammography in terms of the size of the lesion that can be detected.Second only to regular breast exam by a skilled physician

  • The Breast Exam

  • The Breast ExamWomen should undergo breast examination by a clinician as part of their normal health maintenance program. This should be done every two to three years from age 20 to 40, and annually after the age of 40.

  • Breast cancerOver 50 years: All women over the age of 50 years should have annual mammography examinations.40-50: The National Cancer Institute recommends that these women get a mammogram every 1-2 years. Under 40 years: Most women under the age of 40 years do not need annual mammograms

  • PrognosisSTAGE 0. In Situ ("in place") disease in which the cancerous cells are in their original location within normal breast tissue. STAGE I. Tumor less than 2 cm in diameter with no spread beyond the breast STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary (armpit) lymph nodes STAGE IIB. Tumor greater than 5 cm in size without spread to axillary lymph nodes STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary lymph nodes which are attached to each other or to other structures, STAGE IIIB. The tumor has penetrated outside the breast to the skin of the breast or of the chest wall or has spread to lymph nodes inside the chest wall along the sternum STAGE IV. A tumor of any size with spread beyond the region of the breast and chest wall, such as to liver, bone, or lungs

  • PrognosisThe clinical stage of breast cancer is the best indicator for prognosis (probable outcome). Five-year survival rates for individuals with breast cancer who receive appropriate treatment are approximately:95% for stage 0 88% for stage I 66% for stage II 36% for stage III 7% for stage IV

  • Ovarian CancerOvarian cancer is the fifth leading cause of cancer death in women The leading cause of death from gynecological malignancies.The second most commonly diagnosed gynecologic malignancy

  • Ovarian CancerThe risk for developing ovarian cancer appears to be affected by several factors:Early age of first pregnancyMultiparityLater age of final pregnancyTubal Ligation

  • Symptomsdigestive symptoms, bloating, distention or cramping abdominal or low-back discomfort pelvic pressure or frequent urination unexplained changes in bowel habits nausea or vomiting pain or swelling in the abdomen loss of appetite (anorexia) unexplained weight gain or loss pain during intercourse vaginal bleeding in post-menopausal women

  • Diagnosisa complete medical history to assess all the risk factors a thorough bi-manual pelvic examination CA-125 assay one or more various imaging procedures a lower GI series, or barium enema diagnostic laparoscopy

  • PrognosisStage I: Cancer is confined to one or both ovaries. Stage II: Cancer is found in one or both ovaries and/or has spread to the uterus, fallopian tubes, and/or other body parts within the pelvic cavity. Stage III: Cancer is found in one or both ovaries and has spread to lymph nodes or other body parts within the cavityStage IV: Cancer is found in one or both ovaries and has spread to other organs such as the liver or lung.

  • PrognosisStage I cancer 95% survival rate at 5 years post diagnosisStages III and IV may have a survival rate of 17-30% at five years post-diagnosis.

  • Cervical CancerWorldwide, it is the second-most common cancer of women. Human papilloma virus (HPV) infection is responsible for >90% of the cases of cervical cancer An effective vaccine for the two most common strains of HPV has recently been licensed

  • Genital warts (HPV)

  • Normal Cervix

  • Cervical Cancer

  • DiagnosisThe early stages of cervical cancer may be completely asymptomaticVaginal bleeding, contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy In advanced disease, metastases may be present in the abdomen, lungs, or elsewhere.

  • DiagnosisDiagnosis is made by doing a biopsy of the cervix.Often involves colposcopy, or a magnified visual inspection of the cervix aided by using an acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix.A Pap smear is insufficient for the diagnosis.

  • Colposcopy

  • TreatmentPrevention may be the best treatmentMerck has developed a vaccine against four strains of HPV, called Gardasil.Targeted at girls and women of age 9 to 26.Vaccine only works if given before infection occurs. They are targeting girls before they begin having sex.

  • Uterine CancerUterine cancer is the most common cancer of the female reproductive systemThere are two different types of uterine cancer: endometrial cancer uterine sarcoma (less common)

  • Endometrial Cancer

  • Risk FactorsObesity Use of Tamoxifen Use of unopposed estrogen Hypertension (high blood pressure) Polycystic ovarian syndrome and/or skipping menstrual periods for months at a time Family history of endometrial, ovarian or colon cancer Never having had children Menopause at a late age Endometrial hyperplasia (excessive build up of the uterine lining) Diabetes

  • Signs and SymptomsBleeding after menopause (experienced by over 90% of endometrial cancer patients) Change in bowel or bladder habits and/or pain during intercourse A thickened endometrial lining (which can be seen on an ultrasound of the uterus)

  • PrognosisThe American Cancer Society estimates that 41,200 women will be diagnosed with uterine cancer in 2006, and of those 7,350 will die. A womans chance of developing this cancer through out her life time is about 1 in 38. This cancer is 40% more prominently found in white women.On average the five-year survival rate is at 84%, and this percentage increases if the cancer is detected in early stages.

  • Menopause/HRTMenopause occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. Technically, menopause refers to the cessation of mensesThe average onset of menopause is 50.5 years

  • Menopause

  • Sign and SymptomsThe clinical features of menopause are caused by the lessening in the amount of estrogen in the woman's body.hot flashes, hot flushes, including night sweats sleep disturbances

  • Sign and SymptomsUrogenital atrophy dyspareuniaitching dryness bleeding urinary frequency urinary urgency urinary incontinence

  • Sign and SymptomsSkeletalosteoporosisjoint, muscle pain back pain Skin, soft tissuebreast atrophy skin thinning decreased elasticity

  • Sign and SymptomsPsychologicalmood disturbance irritability fatiguedecreased libido memory loss

  • Treatment OptionsWhile menopause is a natural stage of life, some symptoms may be alleviated through medical treatments. Most notably, Hormone Replacement Therapy (HRT), has been used to reduce osteoporosis.A large, randomized, controlled trial (the Women's Health Initiative) found that women undergoing HRT had an increased risk of:Alzheimer's diseaseBreast cancerHeart disease Stroke

  • Heart DiseaseHeart disease isn't just a man's disease. Heart attack, stroke and other cardiovascular diseases are devastating to women, too. Coronary heart disease, is the leading cause of death for American women. Nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer.

  • Heart Disease

  • Heart Disease

  • Heart Disease Risk FactorsIncreasing ageAs women grow older, their risk of heart disease and stroke begins to rise and keeps rising with age. Heredity (family history)Both wome