Male cancers Flashcards
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for testicular cancer in men if
they have a non-painful enlargement or change in shape or texture of the testis.
Risk factors for testicular cancer
Undescended testis ( risk factor for tumour development in the undescended testis and the normal descended testis)
Infertility (increases risk by a factor of 3)
family history
Klinefelter’s syndrome
mumps orchitis
Seminoma features
30-40 years, raised beta HCG, do not raise AFP, radiosensitive
metastasise initially to para-aortic nodes and produce back pain
Teratoma features
raised AFP and beta-HCG
Young adult
blood borne spread to the liver, lung bone and brain
Tx testicular cancer
Orchidectomy (surgical removal of one or both testicles,offer testicular prosthesis)
Lymph node excision
Chemotherapy / radiotherapy based on staging
Monitoring post treatment with tumour markers and imaging
Refer men using a suspected cancer pathway referral for prostate cancer if
prostate feels malignant on digital rectal examination and also if their PSA levels are above the age specific reference range
Risk factors for prostate cancer
Age
Black Africans/Caribbean
Obesity
Use of anabolic steroids
Prostate cancer grading system
Gleason scoring system
The higher the grade the worse the prognosis
Grade 1: Well differentiated cancer.
Grade 2: Moderately differentiated cancer.
Grade 3: Moderately differentiated cancer. might grow moderately.
Grade 4: Poorly differentiated cancer.
Grade 5: Anaplastic (poorly differentiated) cancer.
Clinical presenation prostate cancer
Haematuria and haematospermia
Erectile dysfunction
Raised PSA
sign of prostate cancer
or
an enlarged prostate,bph
Prostatitis
urinary infection
vigorous exercise,riding a bike, prostate stimulation,prostate examination, intercourse recent ejaculation, anal sex and certain mendications, cytoscopy, acute urinary retenion,old age, recent instrumentation of the urethra e.g. urinary catheterisation or TURP
Cancerous prostate on dre
firm/hard, asymmetrical, craggy or irregular with loss of the central sulcus
Patients wont move
Ix prostate cancer
Bloods, PSA + DRE rectal exam +MRI + TRUS biopsy
Mx Prostate cancer
Active surveillance
Watchful waiting
Radical prostatectomy
Radical radiotherapy
Brachytherapy
Cryotherapy
Androgen deprivation therapy /hormone therapy ( eg v elderly/not fit for surgery,metastatic disease)
MOA hormone therapy for prostate cancer
Prostate tissue grows in response to androgens like testosterone
Hormonal therapy aims to block androgens and slow or stop prostate cancer growth
LHRH/GnRH agonists cause chemical castration,result LH & FSH blockade at the pituitary by causing over stimulation
Androgen receptor blockers (e.g. bicalutamide and Enzalutamide.) These can be offered in addition to GnRH analogues to prevent an increase in disease activity following a transient surge in LH & FSH
Side effects of hormonal therapy for prostate cancer
Reduced testosterone: Decreased labido, Impotence, Infertility, Gynecomastia
Metabolic side effects :Weight gain, Osteoporosis, Diabetes, Ischaemic heart disease
Haematological side effects: Anaemia
