MICROBIO 160 1st Edition Lecture 17 Outline of Last Lecture I. Cervical Cancer HistoryII. HPV TypesIII. How does HPV cause CancerIV. Risk FactorsV. Prevalence of HPV InfectionVI. Pap test VII. Colposcopy and Cervical ExamVIII. Treating Cervical CancerIX. Advanced StagesX. HPV Vaccines and CancerOutline of Current Lecture I. What is Prostate Cancer?II. Staging Tests and Staging III. Gleason ScoreIV. Prostate Cancer Grade and Stage are used Together to Determine Prognosis:V. Treatments and StatisticsVI. SurgeryVII. Hormones VIII. ComplicationsIX. Testicular CancerThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.X. SymptomsXI. Risk FactorsXII. Diagnosis and treatmentCurrent Lecture Prostate Cancer: cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum)—it usually occurs in older men—very slow growing- Estimated new cases and deaths from prostate cancer in the US in 2013: o New cases: 238,590o Deaths: 29,720 (spread to bladder or rectum or higher up in the bladder)Staging Tests and Staging: - Physical exam (Digital rectal exam): if the tumor in the prostate is larger enough to be felt, your doctor may be able to examine it (doctor can feel the cancer)o Bone scan (to look to see if the prostate cancer has metastasized to the bone—like the spine and pelvic bones), CT scan, MRIo Staging depends on: Whether the tumor has invaded nearby tissue, such as the bladder or rectum Whether prostate cancer cells have spread to lymph nodes or other parts of the body, such as the bones Grade (Gleason score) of the prostate tumor PSA level (prostate-specific antigen) blood level rises when carcinoma of the prostate is present (random fluctuations—what is PSA, why has it fallen out of favor?) Gleason Score: looking at the cells themselves so you have to get a sample of the tissueGleason Score 2 to 4 - Well differentiated- Small glands that are closely packed- Cancer cells behave in “predictable” manner- Least aggressive, least likely to metastasizeGleason Score 5 and 6 - Moderately well differentiated- Variable-sized glands with little stroma- May also see a cribiform pattern of severalcells fused together- Cancer cells behave in “predictable” manner- Most common placeGleason Score 7 - Can be considered a moderately well differentiated or poorly differentiated cancer- Glands are incompletely formedGleason Score 8 to 10 (most aggressive and most dangerous)- Poorly differentiated- Single cells have broken away and may be found within vascular lumen (loses adhesion)- Cancer cells can behave in unpredictable manner Prostate Cancer Grade and Stage are used Together to Determine Prognosis:Treatments and Statistics:- What can be done? (What stage are you in and how active is the cancer)o Active surveillance (come back yearly for check ups)o Surgeryo Radiation therapyo Hormone therapyo Chemotherapyo Immunotherapy- What is considered?The TNM staging scheme is used for prostate cancer,however some clinicians use a different method- TNM is gained via fully body imaging—this information is combined with Gleason Grading to generate a prognosis and a treatment regime- Anything higher than a Gleason score of 4 will push you to different stages o Stage 4: T4—very severe (might not have lymph node/metastasis)o Your ageo Gleason score (grade) of the tumoro Stage of prostate cancero Your symptomso Your general health (comorbidity: presence of two or more chronic diseases present in the patient)- Diagnosis rate=1 in 6, death rate=1 in 35o Most men are over 70 at time of diagnosis and die of other causeso Overall 5-year survival rate=99%o For localized prostate cancer 5-year survival=100%o For metastatic prostate cancer, 5-year survival=33%o Long term survival: The relative 10-year survival rate is 91% The relative 15-year survival rate is 76%Surgery:- The entire prostate can be removed in several ways:o Radical retropublic prostatectomy (trying to go through the body wall)o Laparoscopic prostatectomy (small tiny cuts in the abdomen)o Robotic prostectomy (robots can be very tiny—remotely trying to find the prostate and remove as much as possible)o Radical perineal prostatectomy (- Other surgery options for treating prostate cancer or relieving its symptoms are:o Cyrosurgery (insert the probe and freeze the surgery)o Heating: trying to heat up the prostate to destroy the tissueo TURP (transurethral resection of the prostate)—they can surgically start snipping away at the prostate gland—has the least riskHormones therapy: if you don’t want surgery - Men with advanced prostate cancer usually receive hormone therapy—a man with early-stage prostate cancer may have hormone therapy before, during, and after radiation therapy- Hormone therapy prevents prostate cancer cells from getting androgens (such as testosterone)—androgens can cause prostate cancers to grow- Types of hormone therapy include:o A drug that can prevent the testicles from making testosterone (LH-RH agonist)o A drug that can block the action of male hormones (anti-androgen)—prevents growth o Surgery to remove the testicles, which are the body’s main source of testosteroneo A drug that can prevent the adrenal glands from making testosteroneComplications:- Urinary incontinence: o Loss of urine flow—most men regain at least some bladder control after a few weeks Your nurse or doctor can teach you an exercise to help you recover control of your bladder Some men, however, incontinence may be permanent Viagra created to treat- Erectile dysfunction:o Surgery may also damage nerves near the prostate and cause Sexual function usually improves over several months, but for some men, this problem can be permanent - There are ways to help manage the sexual side effects of prostate cancer treatmento Viagra created to treat- Hormone therapy side effects:o Most common—erectile dysfunction, hot flashes, and loss of sexual desireo Other possible side effects include breast growth, an increase in body fat around the waist, an increase in sugar level in your blood (can become diabetic), and osteoporosis- An LH-RH agonist may make pain and other symptoms worse at first—this temporary problem is called flareo To prevent a flare, your doctor may give you an anti-androgen, for a few weeks along with the LH-RH
View Full Document
Unlocking...