1a Tumours of the testis, penis, urethra and scrotum 1b Neurogenic bladder Flashcards
Testicular tumor types
Germ cell tumors (5)
95% of testicular tumors.
Usually are a mixed type of tumor and prognosis is based on the worst component.
Seen in men age 15-40.
Painless testicular mass that doesn’t transilluminate.
Seminoma – Highly Radiosensitive, very good prognosis. increased LDH and ALP
Non-seminomas – Not radiosensitive, poor prognosis.
- Yolk sac tumors (increased AFP)
- Choriocarcinoma (increased hCG, can cause gynecomastia or hyperthyroidism. hCG has same alpha subunit as LH, FSH, and TSH.)
- Teratoma (mature teratoma in males is malignant)
- Embryonal carcinoma (painful, hemorrhagic and necrotic mass, worst prognosis)
Non-Germ cell tumors (3)
5% of testicular tumors
- Leydig cell tumor. Reinke crystals, gynecomastia in men, precocious puberty in boys. boys become men men become women. Benign
- Sertoli cell tumors. Benign.
- Testicular lymphoma, the most common testicular cancer in elderly men, malignant, formed as a metastasis from another primary lymphoma
Testicular tumors metastasize to
Choriocarcinomas metastasize hematogenously to the Lung and Brain
Other testicular tumors spread lymphatically, to lumbar paraaortic nodes.
Lung and retroperitoneal nodes are most common sites.
Also: liver, brain, bones, kidney.
Retroperitoneal mets cause back pain
Pulmonary mets cough, dyspnea.
Testicular cancer treatment
Radical orchiectomy, removing testis and spermatic cord, for ALL testicular tumors.
Chemotherapy for all cases with vascular or lymphatic spread.
For seminomas, radiotherapy to the paraaortic retroperitoneal regions.
For non-seminomatous germ cell tumors, radical retroperitoneal node dissection is needed.
Staging of testicular cancer
TNM staging or clinical staging. Clinical: 1 - lesion confined to testis 2 - retroperitoneal node involvement 3- supradiaphragmatic nodes or visceral metastases.
TNM
Tis Intratubular germ cell neoplasia (carcinoma in situ, confinced to the seminiferous tubules)
T1 Tumor limited to testis
T2 Tumor extends outside tunic albuginea or shows vascular–lymphatic invasion
T3 Tumor invades spermatic cord
T4 Tumor invades scrotum
N1 Regional lymph nodes <2 cm and/or 5 or fewer nodes
N2 Regional lymph nodes of !5 cm or more than 5 nodes involved
N3 Lymph nodes >5 cm
M1a Nonregional lymph nodes or pulmonary metastases
M1b Other distant metastases
Tumors of the Penis
95% are squamous cell carcinoma
Others: basal cell carcinoma, melanoma, kaposi sarcoma.
Risk factors are poor hygeine in elderly males that are uncircumcised.
About 50% occur on the glans
Are associated with HPV, 16, 18, 31, 33
Precursor lesions to penile scc
Bowen disease - Leukoplakia on the shaft.
Erythroplasia of Queyrat - Erythroplakia on the glans
Bowenoid papulosis - carcinoma in situ presenting as red papules.
Penile tumor metastases
Lymphatic spread
Glans - drains to the deep inguinal lymph nodes
Shaft and scrotum - superficial inguinal lymph nodes.
Corpus spongiosus , prostate, and lower bladder -> internal illiac.
TNM staging of penile tumors
Classification (TNM): • T1: Invades subepithelial connective tissue • T2: Invades corpus cavernosum or spongiosum • T3: Invades urethra or prostate • T4: Invades other adjacent structures • N1: Single inguinal lymph node • N2: Multiple inguinal lymph nodes • N3: Pelvic lymph nodes • M: Distant metastasis
Treatment of penile tumors
Excision with adequate margins
Chemo with MTX, 5FU, Bleomycin
Urethra cancer
More common in women.
High risk in urethral diverticula
85% are distal and are squamous cell carcinomas, has a better prognosis.
15% are proximal and are transitional cell carcinoma
Treatment of urethral cancer.
Radical cystectomy in women and radical cystoprosatectomy in men.
Removal of the bladder, prostate, tumor, and distal ureter with acceptable margins, and lymph nodes.
Tumors of the scrotum
Malignant: SCC
Benign: sebaceous cysts.
Neurogenic bladder
- what are the two phases of the bladder’s function
• Storage phase: The bladder passively fills with urine. Bladder compliance allows the bladder accommodate the increased urine volume by 2 main factors:
o Neuronal reflexes that control bladder tension
o Passive elastic properties
• Voiding phase: Occurs by contracting the detrusor muscle in the bladder and simultaneously relaxing the urethral sphincter and pelvic floor muscles.
Motor (efferent) control:
• Storage phase is under sympathetic control (hypogastric n.): Relaxation of detrusor muscle and contraction of sphincter and pelvic floor (+ pudendal
nerve)
• Voiding phase is under parasympathetic control (pelvic n.): Contraction of detrusor muscle and relaxation of sphincter and pelvic floor.
Neurogenic bladder
- involuntary storage reflex
As the bladder fills the reflexive activity of the sympathetic system will increase and inhibit the parasympathetic.
What drives the urge to urinate
Stretch receptors activate parasympathetic afferents.
Ascend via the spinal cord in the PAG.
Activate the Pontine Micturition Center. in the Suprapontine region of the midbrain.
Concious inputs to the PMC will then switch it to favoring the parasympathetic innervation of the bladder, switching to the voiding phase.
Once voiding begins, feed-forward reflexes increase and maintain the contraction until it is empty.
