Men's Health: cancers - Prostate-Penile-Testicular
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| Most prevalent male cancer | Prostate. Approximately 218,000 new cases diagnosed annually
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| Staging used for prostate cancer | Gleason System
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| Prostate cancer facts | high incidence in AA men, increases with age (>60), adenocarcinoma is the most common type, High fat diet is a risk
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| 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)
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| Advanced Prostate Cancer presentation | Bone pain/pathologic features, hematuria, hematospermia
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| Diagnosing Prostate Cancer | Prostate Biopsy. Multiple specimens (10-12) are collected and evaluated
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| Most common gleason grade | 5 or 6. Grade>8 is associated with aggressive tumors (need a bone scan to identify distant mets)
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| 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.
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| If PSA levels remain detectable post radical prostatectomy, consider | metastasis
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| Iodine 125 is used in | Interstitial Brachytherapy. long term cure rates are questionable.
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| Hormone therapy goal | Lower the levels of circulating androgens. Two methods: medical castration (LHRH analogs), surgical castration (bilateral orchiectomy)
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| _____ blocks the cellular metabolism of androgen and may be used in conjunction with hormone therapy | Anti-androgen therapy
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| _____ is a method that has the ability to kill cells resistant to radiation and hormonal therapy. | Cryotherapy. CIs prior TURP and extensive disease
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| USPSTF recommendations of PSA screening | not recommended due to a lack of evidence showing a reduction in mortality
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| _______ is diagnosed almost exclusively in uncircumcised men | Penile cancer. other risk factors: HPV 16&18, Tobacco use, poor hygeine, chronic inflammation and irritation
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| Clinical Presentation of Penile Cancer | Squamous cell carcinoma produce a painless, non-indurated, ulcerated mass. Location: glans penis, coronal sulcus, foreskin. Inguinal lymphadenopathy
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| 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
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| Poor Prognostic factors in penile cancer | >/=T2, vascular involvement, mets above the inguinal ligament, lymph node involvement
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| Tx for Penile Cancer | Organ Sparing Procedures: 5 fluorouracil (topical), external beam radiation, Moh's microsurgery, laser ablation, circumcision
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| 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
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| Most common type of testicular cancer | 90-95% of all primary tumors are germ cell tumors (GCT)
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| Epidemiology of Testicular Cancer | white males, rare, two types: Seminoma, non-seminoma, usually unilateral, occurs slightly more commonly on the right
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| Embryonal, yolk-sac, teratoma, mixed are features of what type of testicular cancer? | non-seminoma
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| Pure tumor, originates in the test, and the MOST COMMON type of testicular cancer | Seminoma
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| Sx of advanced testicular cancer | cough, supraclavicular lymphadenopathy, GI sx, back pain (retroperitoneal mets), neurological dz (brain mets), LE swelling (iliac vessels/IVC thrombosis)
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| Diagnosing Testicular Cancer | Excisional biopsy. Scrotal US helpful to determine involvement of the testicular parenchyma. Hypoechoic areas in the tunica albuginea is highly suggestive
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| Most common site of initial mets in Testicular cancer | Retroperitoneal nodes
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| Most common site of distant mets in Testicular Cancer | Lungs and Posterior Mediastinum
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| Staging of testicular Cancer | CXR, Abdominal and Chest CT, Serum Tumor Markers (STM): AFP/B-hCG/serum LDH.
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| ____ STM is elevated in non-seminomas and exludes a diagnosis of seminoma | AFP
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| ___ STM is elevated in most testicular tumors | Beta hCG
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| ___ STM is non-specific and used to monitor advanced seminoma | LDH
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| 70% of seminomas present as what stage? | Stage I
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| Spermatic Cord is affected in what type of testicular cancer? | T3
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| NX means | nodes cannot be assessed
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| N2 means | node >2 but less than 5 cm or multiple nodes
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| Risk factors for testicular cancer | cryptorchidism
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| Tx for stage I seminoma | Retroperitoneal radiation recommended
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| Platinum-based chemotherapy provides cure rate of ____ in testicular cancer | 70-80%
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