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Male Cancers

Men's Health: cancers - Prostate-Penile-Testicular

QuestionAnswer
Most prevalent male cancer Prostate. Approximately 218,000 new cases diagnosed annually
Staging used for prostate cancer Gleason System
Prostate cancer facts high incidence in AA men, increases with age (>60), adenocarcinoma is the most common type, High fat diet is a risk
Majority of prostate cancers occur in the peripheral zone (palpable on the DRE). Large tumors may cause obstructive voiding sx. Lymph node mets (LE lymphedema)
Advanced Prostate Cancer presentation Bone pain/pathologic features, hematuria, hematospermia
Diagnosing Prostate Cancer Prostate Biopsy. Multiple specimens (10-12) are collected and evaluated
Most common gleason grade 5 or 6. Grade>8 is associated with aggressive tumors (need a bone scan to identify distant mets)
If life expectancy is >10 years after diagnosing prostate cancer, then curative therapy is done. Radical prostatectomy, external beam radiation. If <10 years, watchful waiting.
If PSA levels remain detectable post radical prostatectomy, consider metastasis
Iodine 125 is used in Interstitial Brachytherapy. long term cure rates are questionable.
Hormone therapy goal Lower the levels of circulating androgens. Two methods: medical castration (LHRH analogs), surgical castration (bilateral orchiectomy)
_____ blocks the cellular metabolism of androgen and may be used in conjunction with hormone therapy Anti-androgen therapy
_____ is a method that has the ability to kill cells resistant to radiation and hormonal therapy. Cryotherapy. CIs prior TURP and extensive disease
USPSTF recommendations of PSA screening not recommended due to a lack of evidence showing a reduction in mortality
_______ is diagnosed almost exclusively in uncircumcised men Penile cancer. other risk factors: HPV 16&18, Tobacco use, poor hygeine, chronic inflammation and irritation
Clinical Presentation of Penile Cancer Squamous cell carcinoma produce a painless, non-indurated, ulcerated mass. Location: glans penis, coronal sulcus, foreskin. Inguinal lymphadenopathy
Most important diagnostic test of Penile Cancer Lesion Biopsy. May be excisional biopsy if the cancer is small or confined to the foreskin. No specific lab test or tumor marker associated with penile cancer. MRI and CT useful for staging purposes
Poor Prognostic factors in penile cancer >/=T2, vascular involvement, mets above the inguinal ligament, lymph node involvement
Tx for Penile Cancer Organ Sparing Procedures: 5 fluorouracil (topical), external beam radiation, Moh's microsurgery, laser ablation, circumcision
If a patient has a penile cancer that is a distant tumor, the tx is penectomy with shaft preserved. If proximal tumor, then total penectomy
Most common type of testicular cancer 90-95% of all primary tumors are germ cell tumors (GCT)
Epidemiology of Testicular Cancer white males, rare, two types: Seminoma, non-seminoma, usually unilateral, occurs slightly more commonly on the right
Embryonal, yolk-sac, teratoma, mixed are features of what type of testicular cancer? non-seminoma
Pure tumor, originates in the test, and the MOST COMMON type of testicular cancer Seminoma
Sx of advanced testicular cancer cough, supraclavicular lymphadenopathy, GI sx, back pain (retroperitoneal mets), neurological dz (brain mets), LE swelling (iliac vessels/IVC thrombosis)
Diagnosing Testicular Cancer Excisional biopsy. Scrotal US helpful to determine involvement of the testicular parenchyma. Hypoechoic areas in the tunica albuginea is highly suggestive
Most common site of initial mets in Testicular cancer Retroperitoneal nodes
Most common site of distant mets in Testicular Cancer Lungs and Posterior Mediastinum
Staging of testicular Cancer CXR, Abdominal and Chest CT, Serum Tumor Markers (STM): AFP/B-hCG/serum LDH.
____ STM is elevated in non-seminomas and exludes a diagnosis of seminoma AFP
___ STM is elevated in most testicular tumors Beta hCG
___ STM is non-specific and used to monitor advanced seminoma LDH
70% of seminomas present as what stage? Stage I
Spermatic Cord is affected in what type of testicular cancer? T3
NX means nodes cannot be assessed
N2 means node >2 but less than 5 cm or multiple nodes
Risk factors for testicular cancer cryptorchidism
Tx for stage I seminoma Retroperitoneal radiation recommended
Platinum-based chemotherapy provides cure rate of ____ in testicular cancer 70-80%
Created by: ltm12
 

 



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