deck_17239888 Flashcards
Candidiasis risk factors
hot weather
clothing (esp type of clothes, esp when humid (e.g. tighter, dense clothes?))
immunosuppression
poor hygiene
DIET
—>
“Very high sugar intake may worsen candida infections in people with weakened immune systems.”
PREGNANCY
ANTIBIOTICS
why pregnancy risk factor for CANDIDIASIS
“In addition, some pregnancy-related factors such as increased estrogen levels, increased vaginal mucosal glycogen production, and decreased cell-mediated immunity are likely to cause both asymptomatic colonization and the increased risk of VVC during pregnancy”
why antibiotics a risk factor for CANDIDIASIS?
“Factors that increase your risk of developing a yeast infection include: Antibiotic use. Yeast infections are common in women who take antibiotics. Broad-spectrum antibiotics, which kill a range of bacteria, also kill healthy bacteria in your vagina, leading to overgrowth of yeast.”
clothing and candidiasis?
E.g.
tight (or dense?) yoga clothing, esp when hot humid weather
IUD and candidiasis?
“This study confirms the hypothesis that IUD use predisposes to colonization and infection by Candida albicans and other strains. The fact that the yeast organisms were more prevalent on the IUD tails than in the vaginal mucosa indicates that the IUD tail acts as a reservoir of infection.”
Candidiasis is AKA
AKA – yeast infection
Candidiasis is a ____ infection with ____
Genital infection with CANDIDA ALBICANS
candidiasis – clinical manifestations
Itching, burning
Discharge
Candidiasis – Dx
Symptomatic
SSx
patient history
Candidiasis – Tx
Antifungal medication
Lifestyle modification
where can candidiasis occur?
“A candidiasis infection often appears on your skin, vagina or mouth, where Candida naturally lives in small amounts.”
Candidiasis is …
“Candidiasis is a fungal infection caused by an overgrowth of yeast in your body.”
“Healthy bacteria help balance the amount of yeast and disruption of this balance leads to an infection.”
can men get yeast infections (candidiasis) ?
“Yes, men can get yeast infections, too, which can lead to a condition known as balanitis — inflammation of the head of the penis. Yeast infections in men are common because the fungus that causes yeast infections (candida) is normally present on skin, especially moist skin.”
Genital warts – every single type is caused by …
HPV (human papilloma virus)
—> Keep in mind however that there are many, many strains of HPV
—>
Not all HPV strains cause warts
—>
some are more likely to cause warts in one spot, & others more likely in other spots
genital warts is AKA
venereal warts,
condyloma acuminata,
anogenital warts
condyloma acuminata
“(from Greek κόνδυλος ‘knuckle’, Greek -ωμα -oma ‘disease’, and Latin acuminatum ‘pointed’)”
genital warts are ____ lesions of ____ of the ____
Benign lesions of the skin or mucous membranes of the genitals
some trains of HPV cause ____
Some strains cause flat warts in the cervical canal or anus
Caused by some strains of human papillomavirus (HPV)
___% of women have been affected at least ONCE by age 50
80% of women have been affected once by age 50
most warts ____
Most clear spontaneously within 1-2 years
warts manifestation
Manifestation includes soft, moist, tiny, pink or grey polyps that may become pedunculated
how long after infection do warts show up
could be 6 months
—>
compare to other infections, which generally show up within a few days
genital warts – texture ?
do genital warts typically occur on their own or in clusters?
May be rough or occur in clusters
are genital warts always symptomatic?
Can be asymptomatic
or cause itching/burning
where do genital warts most commonly occur?
vulva,
vaginal wall,
cervix,
perineum,
urethra,
anal region
genital warts – prevention
Prevention includes vaccination
Pelvic inflammatory disease
Infection and inflammation of the upper female genital tract:
Infection and inflammation of the upper female genital tract:
possible locations
cervix,
uterus,
fallopian tubes,
ovaries
pelvic inflammatory disease can cause …
infertility,
chronic pain,
ectopic pregnancy
pelvic inflammatory disease – Etiology
Results from microorganisms ascending from the vagina and cervix into the endometrium and fallopian tubes
which bacteria are MOST COMMON cause
Neisseria gonorrhoeae
Chlamydia trachomatis
pelvic inflammatory disease — ETIOLOGY AND CLASSIFICATION
Cervicitis
Salpingitis
Endometritis
Oophoritis (when severe)
Peritonitis (when severe)
PID – incidence
1 million women affected/year
Young age
Multiple/new sex partners
STIs
why young women more likely to get PID?
more sexually active (?)
multiple sexual partners
Cervicitis
inflammation of the cervix;
can cause mucopurulent discharge
Salpingitis
inflammation of the fallopian tubes;
can become red, swollen, pus-filled
Endometritis
inflammation of the uterus
oophoritis
inflammation of ovaries
peritonitis
inflammation of peritoneum
PID – Clinical manifestations
Widely variable
Asymptomatic (possible)
Pain/chronic pain
Discharge
Irregular bleeding
Fever, chills
Nausea
Vomiting
can PID be asymptomatic
yes
more clinical manifestations of PID
Dyspareunia (painful intercourse)
Dysuria
Abscess
Menstrual irregularities
Ectopic pregnancies (scarring)
Infertility (scarring)
Death
one way PID can lead to death
“If PID infects the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through. If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe and life-threatening internal bleeding.”
PID – Dx
History/exam
Culture
Blood tests
PID – Tx
Antibiotics
Prevention
—> Safe sex practices
—> Checkups
DISORDERS OF CERVIX
..
Cervical polyps
Common benign growths of the cervix or ENDOCERVIX
in what percentage of women does cervical polyps occur?
Occur in about 2 to 5% of women,
possibly due to chronic inflammation.
are cervical polyps usually symptomatic or asymptomatic?
Most cervical polyps are asymptomatic.
however, what is one possible symptom of polyps when symptomatic?
Polyps may bleed between menses or after intercourse or become infected
polyps are usually removed (regardless of where they occur)
WHY?
there is a small chance that polyps can become malignant
polyps – visual description
Polyps are usually reddish pink, < 1 cm in size
are polyps commonly malignant ?
No.
They are rarely malignant (1%)
how are polyps diagnosed?
Diagnosis is by speculum examination
speculum define
“a metal or plastic instrument that is used to dilate an orifice or canal in the body to allow inspection.”
violin-string adhesions (unrelated to cervical polyps notes)
possible adhesion type that can occur @ fallopian tubes
—> d/t scarring / adhesions
—> common risk factor for EP (ectopic pregnancy)
—->
See also:
Fitz-Hugh-Curtis Syndrome
cervical polyps – Tx
Treatment - surgery
cervical cancer – mortality
4000 deaths per year
despite 4000 deaths per year, how has the mortality rate changed since the early 20th century?
Mortality declined rapidly since 1930s
despite current mortality rate of cervical cancer, it is HIGHLY ____
PREVENTABLE
most common cause of cervical cancer
HPV (human papilloma virus)
cervical cancer — RISK FACTORS
Smoking (chemicals)
HPV
Long term oral contraceptives
High parity
LOW socioeconomic class
Ethnicity (esp hispanic)
Multiple sex partners (?)
why is high parity risk factor for cervical cancer?
“Excess risk of cervical cancer among women with high parity is believed to be linked with a high rate of cervical abnormalities during pregnancy,”
high parity define
“High parity (HP), defined as having ≥5 pregnancies of ≥20 weeks of gestation, is among various risk factors which have been hypothesized for fetal growth abnormalities. 2. Although HP has been recognized to be a potential risk factor for abnormal fetal growth, the exact etiological mechanism is not well understood.”
PARITY, define:
“Parity is the number of times a woman has given birth to a live neonate (any gestation) or at 24 weeks or more, regardless of whether the child was viable or non-viable (i.e. stillbirths). Format: 1 digit numeric.”
why oral contraceptives risk factor for cerivical cancer
“In addition, oral contraceptives might increase the risk of cervical cancer by changing the susceptibility of cervical cells to persistent infection with high-risk HPV types (the cause of virtually all cervical cancers).”
cervical cancer – ethnicity as risk factor?
“Importance Black and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer.”
cervical cancer – clinical manifestations
Asymptomatic (possible)
Abnormal bleeding
—>
(Like cervical polyps)
cervical cancer – Dx
Pap test
Conization/LEEP
pap test define
“a test carried out on a sample of cells from the cervix to check for abnormalities that may be indicative of cervical cancer; a Pap smear.”
“from a shortening of the name of the anatomist George Nicholas Papanicolaou, who devised the technique”
Conization define
“A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix. A scalpel, a laser knife, or a thin wire loop heated by an electric current may be used to remove the tissue.”
“The tissue is then checked under a microscope for signs of disease.”
cervical cancer – Tx
Cryotherapy
Laser/excision
Chemotherapy, radiation (metastasis?)
Hysterectomy (uterus)
LEEP diagnosis define
“Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current. It is used to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment for areas that are abnormal or cancer.”
cervical cancer – Prognosis
Good; slow growing neoplasm; responds well to treatment
Depends on early detection
Largely preventable with early screening
what is the mortality rate for late detection of cervical cancer?
75%
Later stages associated with high mortality (~75%)
what is the mortality rate of early diagnosis of cervical cancer?
generally 0%
Early detection = 100% cure
cervical cancer – PREVENTION
regular checkups (?)
Pap test
Barrier protection
Monogamy
Don’t smoke
Endometrial Hyperplasia – define
Benign overgrowth of the endometrium (endometrial cells)
endometrial hyperplasia can be due to …
EXCESS ESTROGEN
and LOW PROGESTERONE
endometrial hyperplasia – MOST COMMON Symptom
abnormal vaginal bleeding
endometrial hyperplasia is a RISK FACTOR for _____.
endometrial cancer
—> Can lead to endometrial
cancer
endometrial hyperplasia — RISK FACTORS
menopausal age,
(skipping or having no periods),
being over-weight,
diabetes,
polycystic ovarian syndrome,
increased levels of unopposed estrogen
why PCOS risk factor for endometrial hyperplasia?
“People with PCOS are more likely to have excess estrogen and higher BMIs. The longer someone goes without shedding the lining of the uterus (or having a period), in the setting of chronic estrogen exposure, the greater their risk for endometrial hyperplasia and endometrial cancer.”
endometrial hyperplasia – Diagnosis
pap smear
endometrial hyperplasia – Treatment
hormones (progesterone?)
hysterectomy
Endometriosis
Estrogen-dependant,
non-cancerous disorder
Functioning endometrial tissue implanted outside the uterine cavity
is endometriosis COMMON?
YES
up to 60% of women
Endometriosis – LOCATIONS (most common)
ovaries,
fallopian tubes,
broad ligaments,
bladder,
pelvic musculature,
perineum,
vulva,
vagina,
intestines
Other unrelated locations endometriosis can occur (implanted)
abdominal cavity,
kidneys,
appendix,
diaphragm,
bone,
lungs,
brain,
nose,
joints
endometriosis — RISK FACTORS
GENETICS
delayed childbearing
short menstrual cycle (<27 days)
long menses (>7 days)
genetics and endometriosis
Incidence of endometriosis is increased in FIRST-DEGREE RELATIVES of women with endometriosis, suggesting that genetics is a factor.
why does not having children increase risk for endometriosis?
“People who have never had a child tend to have a higher risk for endometriosis than people who have given birth. Pregnancy stops the menstrual cycle for a period of time. This break in the menstrual cycle lowers the amount of estrogen a person is exposed to.”
recall – endometriosis –> “estrogen-dependent”
“High estrogen production is a consistently observed feature of endometriosis and this review highlighted the fact that estrogen and its receptors play a key role in the pathophysiology of endometriosis.”
aside –> health risks of not having children?
“Research shows that not having kids can raise the risk of certain health issues, like breast cancer. However, having kids can also raise the risk of cardiovascular disease for some women, and in others it can lead to chronic pain.”
aside – uterine prolapse?
“Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. This allows your uterus to drop down into your vagina. Common symptoms include urine leaking, fullness in your pelvis, bulging in your vagina, low back pain, and constipation.”
endometriosis – Pathogenesis
Endometrial cells transported from the uterine cavity and subsequently become implanted at ectopic sites
how does menstrual tissue reach the abdomen?
Retrograde flow of menstrual tissue through the fallopian tubes could transport endometrial cells intra-abdominally;
how does menstrual/endometrial tissue reach distant sites?
the lymphatic or
circulatory system
could transport
endometrial cells to
distant sites
—>
(this is one theory)
compare endometrial tissue implants to intrauterine endometrium?
Microscopically, endometriotic implants are identical to intrauterine endometrium. These tissues contain estrogen and progesterone receptors and thus usually grow, differentiate, and bleed in response to changes in hormone levels during the menstrual cycle
what does bleeding of endometrial implants (E.g. peritoneal implants) lead to during menstrual cycle?
Bleeding from peritoneal implants is thought to initiate inflammation, followed by fibrin deposition, adhesion formation, and –
eventually – scarring, which
distorts peritoneal surfaces of
organs and pelvic anatomy.
endometriosis may be related to dysregulation of ____ & …
May also be related to
—>
dysregulation of immune system;
metaplasia;
surgical procedures;
abnormal differentiation during embryology
endometriosis – clinical manifestation
Depends on the location of the implants
pain,
dysmenorrhea,
fatigue,
mood changes,
dyspareunia,
pain during defecation,
fever,
diarrhea,
rectal bleeding,
alternation of menses,
infertility
SYMPTOMS DO NOT NECESSARILY CORRELATE WITH SEVERITY OF ENDOMETRIOSIS
Extensive endometriosis can be
asymptomatic;
minimal disease
can cause incapacitating pain.
endometriosis classifications
I – minimal
II – mild
III – moderate
IV – severe
V – extensive
endometriosis – Dx
Biopsy
Imaging
History and symptoms
endometriosis — Tx
Pregnancy
NSAIDs and analgesics
Meds to inhibit ovulation
Synthetic male hormones
Birth control pills
Surgery
leiomyoma aka
AKA uterine fibroids
leiomyomas are…
Benign uterine tumours of smooth muscle origin
hysterectomy and leiomyomas
Primary reason for hysterectomies
leiomyoma – clinical manifestations
can be ASYMPTOMATIC
Pain
Heavy bleeding
Anemia
Constipation
Frequency
LOWER BACK PAIN
leiyomyoma – Tx
Medications
Surgery
Diet
leiomyoma and chickpeas
“Legumes like beans, lentils, peas, and chickpeas are excellent sources of protein and fibre which can help maintain healthy hormone levels. Additionally they contain phytoestrogens, compounds that can help reduce the impact of excess estrogen in the body which may be a contributing factor for uterine fibroids.”
UTERINE CANCER
Cancer of the lining of the uterus
most common cancer of the female reproductive organs
Uterine cancer
uterine cancer – high mortality?
10th most common cancer related cause of death in women
not as common
uterine cancer risk factors
Age
Caucasian
Family history
Low parity
Post-menopause
Hypertension
Type II diabetes
PCOS
Obese
uterine cancer pathogenesis
Related to any condition that increases estrogen exposure, unopposed by progesterone
smoking and uterine cancer
Cigarette smoking, physical activity, hormonal contraceptives appear to DECREASE the risk
uterine cancer metastasis
The cancer may spread:
from the surface of the uterine cavity to the cervical canal
through the myometrium to the serosa and into the peritoneal cavity
via the lumen of the fallopian tube to the ovary, broad ligament, and peritoneal surfaces
via the bloodstream or the lymphatics
uterine cancer clinical manifestations
Irregular bleeding
Dysuria
Dyspareunia
uterine cancer, Dx
Biopsy
Pap smear
Dilation & curettage
uterine cancer, Tx
Radiation,
chemotherapy,
surgery
Uterine cancer, Px
Extremely treatable with early detection but can recur
uterine cancer, prevention
Healthy weight,
diet,
exercise
LECTURE 1 (Male reproductive pathologies)
..
genital herpes
…
genital herpes is caused by
HSV2 usually
can HSV1 occur in genitals?
HSV-2 is primarily the cause of genital herpes, but HSV-1 can be transmitted to the genital area
what percentage of Americans have HSV 1
what percentage of Americans have HSV 2
Estimated 1/5 Americans have HSV-2,
4/5 have HSV-1
what happens during transmission of HSV?
Asymptomatic viral shedding
(uncommon for infections)
Asymptomatic viral shedding is common with HSV and
—> is responsible for transmission, usually just before the onset of sores
what is somewhat unique to HSV?
ASYMPTOMATIC during viral shedding
—> other viral infections are symptomatic during shedding
how does HSV present on the penis/scrotum?
Herpes simplex virus produces recurring episodes of small, painful, fluid-filled ulcers on the glans penis or the skin of the shaft of the penis or the scrotum
what are lesions like in HSV?
which symptoms accompany them?
Lesions are often small
and grouped with itching or burning
what happens to vesicles (blisters/lesions)
The vesicles rupture, transform into shallow, painful ulcers
do the ulcers cause scarring?
heal without scarring
does herpes recur?
Tends to recur
where does genital herpes remain dormant?
virus remains dormant in the DRG (dorsal root ganglia)
what causes genital herpes to recur?
reactivated (by stress, infection, decreased immune system)
genital herpes diagnosis is ____
Diagnosis is symptomatic
is there a cure to (genital) herpes?
No permanent cure
medication for (genital) herpes
Some antiviral drugs provide relief
or decrease asymptomatic shedding
(acyclovir, Valtrex ®)
GENITAL WARTS
AKA
verrucae
genital warts is commonly
benign
genital warts is ___ infection of ____
viral infections of the genital region
genital warts, etiology
Caused by the sexually transmitted human papillomaviruses (HPV)
how many strains of HPV exist?
There are many strains of HPV (between 150-200)
what percentage of HPV strains are associated with genital warts?
~1/3 are associated with genital warts
are all strains of HPV that cause genital warts the same?
in what way are they the same or different?
No.
Some are high risk, others are low risk
where do genital warts usually affect men?
Usually affect men on the end of the shaft of the penis and below the foreskin
how long after infection do genital warts appear?
The warts usually appear 1-6 months after infection
how do genital warts appear initially?
beginning as tiny, soft, moist, pink or red swellings;
how do genital warts develop/grow?
grow rapidly and may develop STALKS
do warts occur in close proximity, or with spaces in between?
Multiple warts often grown in the same area,
what do the warts appear similar to?
their rough surfaces give them the appearance of a small cauliflower
how are genital warts diagnosed?
Usually diagnosed based on appearance
how are genital warts treated?
Treatment can include laser, cryotherapy, or surgery
do genital warts recur?
Yes
Usually requires repeated treatments
how are genital herpes differentiated from genital warts?
Genital warts may be the color of your skin,
while genital herpes can cause blisters or ulcers that may result in red sores.
—> also the unique appearance of warts described in previous slide
orchitis
Inflammation of the testes
orchitis etymology
orkhis = testicle
itis = inflammation
orchitis acute or chronic?
Acute or chronic
what other condition commonly occurs alongside ORCHITIS?
May be isolated
but more often it is combined with EPIDIDYMITIS
what infection does Orchitis commonly come after?
Often follows chlamydia infection
(Chlamydia trachomatis)
orchitis can be a complication of these conditions:
bladder infection,
urethritis,
gonorrhea,
prostate surgery,
mumps,
pneumonia,
scarlet fever,
or procedures such as urinary catheterization
common symptoms of orchitis
The testis becomes swollen and painful and may be warm;
fever; malaise
risk factors for orchitis
multiple partners
STIs
orchitis, Dx
palpation of the testes;
lab tests,
urinalysis,
imaging
orchitis, Tx
antibiotics, bed rest, ice packs, and pain meds
epididymitis
Inflammation of the epididymis
epididymitis is commonly a complication of …
urethritis or prostatitis (UTI)
in young men, epididymitis is commonly a complication of …
sexually acquired infections
in older people, epididymitis is commonly a complication of …
urinary obstruction,
catheterization,
or prostate surgery
epididymitis clinical manifestations
pain,
urinary dysfunction,
fever,
discharge,
scrotal swelling,
is epididymitis usually unilateral or bilateral?
typically unilaterally
epididymitis, Dx
SSx,
UA (URINALYSIS),
blood tests,
US (ultrasound)
epididymitis, Tx
scrotal elevation and support,
NSAIDS,
antibiotics,
rest
what is a complication of UNTREATED EPIDIDYMITIS?
testicular infarct
urethritis
Inflammation of the urethra
urethritis can occur with …
gonorrhoeae or chlamydia
if URETHRITIS occurs with gonorrhoeae or chlamydia, what SSx occur?
purulent exudate present (discharge)
prostatitis is
Inflammation of the prostate
prostatitis is common complication of
UTI
(Typically preceded by UTI)
prostatitis classifications
Acute bacterial prostatitis
(Category I)
Chronic bacterial prostatitis
(Category II)
Chronic prostatitis/chronic pelvic pain syndrome (CPPS)
(Category III)
Asymptomatic inflammatory prostatitis (Category IV)
Acute bacterial prostatitis
(Category I)
Acute bacterial infection
SSx: Chills, fever, pain, frequency, urgency, burning
Dx: UA or blood test
Tx: antibiotics
Chronic bacterial prostatitis
(Category II)
Chronic bacterial infection
SSx: Recurring UTIs
Dx: blood tests, UA, semen test
Tx: antibiotics
Chronic prostatitis/chronic pelvic pain syndrome (CPPS)
(Category III)
Most common
Idiopathic inflammatory or non-inflammatory condition
NO SIGN OF INFECTION
SSx: pain, dysuria, myalgia, pain post-ejaculation
Dx: diagnosis by exclusion
Tx: No standard treatment, but may include: pelvic floor massage, NSAIDs, stress relief
Asymptomatic inflammatory prostatitis (Category IV)
Asymptomatic (no pain or discomfort), but findings of WBC in semen are present
SSx: leukocytosis
Dx: SSx, and rule out other conditions
Tx: none
prostatitis – incidence & risk factors
Millions
what percentage of men have prostatitis at least once in their life?
Half of all men have at least one episode in their lifetime
most common age of prostatitis?
Most common over 40
prostatitis, risk factors
UTIs
Instrumentation (ie. catheterization)
multiple sexual partners, stress, possibly diet
prostatitis, bacteria (etiology)
Escherichia coli
Klebsiella pneumoniae
Pseudomonas aeruginosa
Staphylococci
Streptococci
Gonococci
Chlamydia
Gonorrhea
prostatitis, clinical manifestations
Variable depending on chronic, acute, bacterial, non-bacterial:
Frequency
Urgency
Nocturia
Dysuria
Discharge
prostatitis, clinical manifestations (systemic)
Fever
Chills
Malaise
Myalgia
Arthralgia
Pain
Impotence, decreased libido
prostatitis, Dx
Clinical manifestation
Digital rectal exam
CT scan
prostatitis, Tx
Category I – antibiotics
Category II – antibiotics
Category III – antibiotics; anti-inflammatories; biofeedback; pelvic floor re-education; alpha-blockers; pain medication; herbal treatment; surgery
Category IV – no treatment
testicular torsion
Abnormal twisting of testis and the spermatic cord
what happens when spermatic cord twists during testicular torsion?
The twisted cord cuts off blood supply to the testis
what is testicular torsion often associated with?
congenital abnormalities
(Bell-clapper deformity)
bell-clapper deformity define
“A bell clapper deformity is a predisposing factor in testicular torsion in which the tunica vaginalis has an abnormally high attachment to the spermatic cord.”
“called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell.”
testicular torsion usually results from
Usually results from an
abnormal development of the spermatic cord or the membrane covering the testis
(Bell clapper deformity)
testicular torsion most often occurs with males @ ages …
Most often occurs in males between puberty and 25 y.o. (however it can occur at any age)
testicular torsion – is it commonly spontaneous or after strenuous activity?
May happen spontaneously or after strenuous activity
testicular torsion, common clinical manifestation
Severe pain and swelling in the scrotum along with nausea and vomiting occur immediately
—> Like after getting hit in the groin
how can testis be saved after torsion occurs?
The only hope of saving the testis is surgery to untwist the cord immediately after onset of symptoms
how is the issue prevented from re-occurring?
surgery
also:
During surgery the other testis is usually better secured to prevent torsion on that side
testicular cancer
Cells in testicles become malignant
testicular cancer:
___% of tumours are of germ cell origin
___% of tumours are sex cord stromal origin
95% of tumours are of germ cell origin
5% of tumours are sex cord stromal origin
testicular cancer, two types
seminoma and nonseminoma
is metastasis (secondary cancer) common with testicular cancer?
no.
rare.
testicular cancer 10 year mortality rate
“around 90 out of 100 men (around 90%) will survive their cancer for 10 years or more after diagnosis.”
“The 5-year net survival for testicular cancer is 97%. This means that about 97% of men diagnosed with testicular cancer will survive for at least 5 years.”
“10-year relative survival increased from 78% in 1960–1969 to 99% in 1990–2004 for seminomas, and from 55 to 95% for nonseminomas.”
testicular cancer, incidence
Rare – occur during prime of life and potentially affect sexual and reproductive capabilities
testicular cancer mainly affects which ethnicity/population
Mainly affects Western populations
why is testicular cancer incidence rising?
chemicals in the environment, to fetal exposure, to increased levels of estrogen.
testicular cancer, developed countries vs developing countries
Six times higher in developed world
testicular cancer, ethinicty
White individuals > black individuals (5:1)
testicular cancer, most common age group
Most common cancer in 15-35 y.o. age group
testicular cancer, etiology and risk factors
Poorly understood
Hormonal imbalance
High estrogen exposure in utero may have an effect
Low birth weight
testicular cancer, congenital risk factors
Cryptorchidism
Klinefelter’s syndrome
testicular cancer, genetic factors
(acne)
Having severe acne is considered protective
cryptorchidism, definition & etymology
“Cryptorchidism, also known as undescended testicles, is a condition where one or both testicles fail to move from the abdomen into the scrotum.”
“hidden” + “testicle”
testicular cancer, clinical manifestations
Enlargement of testis
Diffuse pain
Swelling
Hardness
Heaviness
Back pain
Gynecomastia
even though metastasis is rare during testicular cancer, where does it metastasize to commonly if it does?
lymphatics, bone, lung, liver
testicular cancer, Dx
UA (urinalysis)
Physical exam
Transillumination
Blood test (AFP, hCG)
CT
MRI
Biopsy
transillumination define
“Transillumination is a diagnostic technique that involves shining a light through a body part to examine it for abnormalities. It can be used on many parts of the body, including the head, chest, scrotum, and breasts. “
testicular cancer, Tx
Surgery
Radiation
Chemotherapy
testicular cancer, Px
95% cure with early detection
BPH
Benign prostatic hypertrophy
or hyperplasia
BPH, description
Age-related
non-malignant
enlargement of the prostate gland
what percentage of men over 50 experience BPH to some degree?
75% of men over age 50
BPH – what age is most common? What age is rare?
Rare under 40
which areas of the world is BPH most common
m/c in US and Western Europe
which areas of the world is BPH less common?
Uncommon further East
BPH, ethnicity
Higher in black individuals than white individuals
BPH and alcohol link
Drinking moderate reduces the risk of incidence
but decreasing alcohol intake decreases symptoms
BPH and smoking
Smoking increases the risk
BPH, pathogenesis
Idiopathic
Hormone imbalance, androgens and estrogens
Multiple prostatic nodules develop
Proliferation of epithelial cells, smooth muscle cells, fibroblasts
what does BPH do to urethra?
Lumen of urethra becomes progressively narrowed
(issues urinating)
BPH, clinical manifestations
Decreased calibre and force of stream
Difficulty initiating or continuing urination
Frequency
Nocturia
urgency
Dribbling
Hematuria
Dysuria
Fatigue
Sleep disturbance
BPH, clinical manifestations are related to
Related to secondary involvement of the urethra and restriction of urine flow
BPH, other clinical manifestations
Increased UTIs
Bladder distension
Renal failure
BPH, Dx
History
Palpation
Urodynamic tests
Blood test (Prostate specific antigen)
UA (urinalysis)
Imaging
BPH, Tx
Watch and wait
Medications
Surgery
Botox
BPH, complications
Chronic UTIs, ED, not related to cancer
BPH, prevention
Antioxidants – saw palmetto, lycopene, tomatoes
The evidence for all of these is tentative at best
or even shows no help at all
saw palmetto, DHT
Saw palmetto also might prevent testosterone from being converted to a more potent form called dihydrotestosterone (DHT).
BPH, Px
Variable
PROSTATE CANCER
incidence
4th most common cause of cancer (both sexes)
But does not make the top 5 causes of cancer death
Most people die WITH prostate cancer, but not OF prostate cancer
Increasing incidence
prostate cancer – ethnicity
Blacks > whites > Asians
prostate cancer – risk factors
Age > 50
Ethnicity
Geography
Family history
Environment
Diet
prostate cancer – Etiology
Unknown
Endocrine system dysfunction
Higher levels of androgens especially testosterone
Viral exposure
prostate cancer – clinical manifestations
Extremely variable
Asymptomatic
Urinary obstruction
Pain
Fatigue
Weight loss
Painful ejaculation
prostate cancer – Dx
DRE (digital rectal exam)
Imaging
Blood test (PSA)
Biopsy
Prostate cancer – Tx
Variable
Watch and wait
Surgery
Radiation
Hormone therapy
Chemotherapy
Prostate cancer – px
Variable
prostate cancer – complications
Incontinence
Rectal cancer
Bone cancer
prostate cancer – prevention
possibly diet
Supplements
Screening – blood test (PSA), DRE
Physical activity
Control weight
