11.2 Male genital tract tumours Flashcards
What is the most commonly diagnosed cancer in men?
What is the most common cancer causing death in men?
Postate cancer is the most commonly diagnosed cancer in men
Lung is the most common cause of cancer related death in men
What are the 3 main anatomical zones of the prostate and give a condition that arises in each
1) Central zone (part around the urethra): not many associated diseases expect for prostatitis which arises from the urethra and its urine stream.
2) Transitional zone: BPH occurs, causes compression of the urethra and thus presents as difficulty passing urine
3) Peripheral zone: major site where prostatic cancer develops (doesn’t generally present as difficulty passing urine) but important because in can invade the surrounds tissues before it causes compression of the urethra, late presentation
Histologically how would describe the composition of the prostate?
Majority of the prostate is fibromuscular stroma with some secretory function (little)
What is the function of the inner vs the outer portion of the prostate?
How can this be advantageous to diagnosis?
Double layered epithelium
Inner is comprised of columnar secretory cells: makes PSA
Outer is comprised of basal cells (darker staining): Dont make PSA
Diagnosis: we can apply antibodies to tissue slides to identify if there is prostate gland material present. If PSA is identified, it signifies that the glands observed are taken from the prostate.
Does prostate cancer develop from ducts or glands?
List 2 things that would be seen histologically and why these are useful
Cancer develops from the glands NOT the ducts and results in:
1) loss of structure of the double layered epithelium, resulting in a lining of single cells with bigger nuclei
2) if malignant the cells will invade the the “limiting membrane” located outside the gland, through the basement membrane into the fibromuscular stroma
What is seen microscopically in BPH?
Give 4 risk factors
Hyperplasia: increase in cell NUMBERS (not size)
Microscopically would show proliferating cells, glands and fibromuscular stroma BUT that are benign and show NO atypical change
Risk factors:
- age >50 yr
- family history
- most common in black race
- changing hormone levels
Give 4 consequences of BPH and explain why each occurs
1) Infection due to urine accumulation proximal to the obstruction
2) advanced BPH can result in hypertrophy of the bladder wall muscle as it tryies to overcome the obstruction and push urine out, as the pressure rises it can form bladder diverticulum
3) obstructed urine can lead to development of bladder stones either in the ureter or within diverticulum that may have formed
4) hydroureter (sigmoid shaped ureter) due to increased pressure causing dilation and elongation of the ureter, which can be transmitted to the kidneys causing hydronephrosis
Give 4 symptoms of BPH
1) Increased frequency (at night = nocturia) and urgency
2) difficulty starting urination and Inability to completely empty the bladder
3) weak urine stream or a stream that stops and starts
4) dribbling at the end of urination.
What is the main procedures to treat BPH
Trans Urethral Resection of Prostate (TURP): the material is then sent to dept of cellular pathology and processed for histology and microscopy to check for any cancer
Can also do an open operation to remove the whole gland (less common)
Give 4 risk factors for development for Prostatic cancer
1) age: linear relation
2) ethnicity: african-american men
3) family history
4) several genetic links
If men present with prostatic cancer at a younger age what can be said about disease
Younger age at presentation = more aggressive disease
Compare the early and advanced signs and symptoms of Prostate cancer
Early: asymptomatic
Advanced disease:
- difficultly urinating/ decreased force of urination
- increased frequent of urination
- difficulty starting or stopping urine stream
- blood in semen & urine
- pain or discomfort in the pelvic area
- bone pain = indicates metastases
Give common routes of spread of prostate adenocarcinoma
1) direct local invasion: seminal vesicles & bladder base
2) blood stream and lymphatics: particularly to the bones (axial skeleton and some visceral dissemination)
Give 3 consequences of prostate adenocacinoma spread
1) ureteric obstruction
2) urethral obstruction (late symptom)
3) back pain
Prostatic cancer in the bones can be described as osteoblastic, what does this mean?
How can it be described in the prostate itself?
Osteoblastic: bone forming, resulting in thickening and hardening of the bone
In the prostate itself it is fibroblastic, resulting in thickening and hardening of the prostate
Why do we do a DRE and what may be felt that is indicative of prostate cancer?
What 2 investigations could we do to confirm diagnosis?
We known prostate cancer begins in the peripheral zone hence can be palpated in a digital rectal exam. Cancerous tissue would feel gritty and firm
To confirm:
- Trans-rectal biopsy
- Multiple core biopsies
What grading system is used for prostate cancer?
Describe this and how it may useful
Gleason score: determines therapy and prognosis
1) small uniform glands
2) more space stroma) between glands
3) distinct infiltration of cells from glands at margins
4) Irregular masses of neoplastic cells with few glands
5) lack of/ occasional glands, sheets of cells
