TESTICULAR
CANCER
Testicular
Cancer:
- Occurs
in young men
- Most
important prognostic factor is histology
- Ages
19 – 34 (peaks at around 30 years old)
- More
common in white males
- People
with undescended testicles are more likely to develop testicular
cancer (crytorchid)
- Symptoms
are : painless mass in the testicles (96% of the masses found
are positive)
- More
common unilaterally
- Testicular
tissue is derived from the kidneys
Nodal
Involvment of Testicular Cancer:
- Para
aortics
- Ipsilateral
iliac chain
- Mediastinal
nodes
- Left
supraclavicular
- The
nodal spread follows the spermatic cord from the inguinal canal
to the kidneys, therefore the paraaortics are commonly involved)
Prognosis
for Testicular Cancer is very good (99%) because of early detection
and the type of cells involved
There
are 2 types of Testicular Carcinoma:
- Seminomas:
•
Tumors are of the pure seminiferous tubules (organ that produces
sperm)
•
Present early and are not aggressive
•
Spread in an orderly fashion
•
Doesn't not usually metastesize
•
Treatment of the nodes is prophylactic
•
Seminomas are the most radiosensitive tumors in man
•
Treatment doses can be low, around 2500 cGy
- Non-Seminomas:
•
Embryological type tumors
•
Tumors of undifferentiated cells (endo, ecto, meso….)
•
Treated with CHEMO (cisplatin)
•
Sometimes they spread to the lung
•
85% curable
Treatments
for Testicular Cancer (Seminomas):
- Orcioectomy
(removal of the involved testi through the inguinal canal) is
the biopsy. When the pathology confirms that it is cancer
the nodes are treated prophylactically
- Ipsilateral
pelvic lymph nodes
- Para-aortic
chain
- Ipsilateral
hilar region of the ipsilateral kidney
- Treatment
field usually goes to the top of T10 (can be localized on flouro
on exhale of the diaphram)
- Patient
given 160 cGy a day to 2500 cGy (cannot go above 160 cGy a day
because of side effects because of the area we must treat AP/PA
- Side
Effects : NVD
Treatment
for Non-Seminomas:
- Chemotherapy
(cisplatin0
- Non-seminomas
can be detected upon blood test for: positive alfeto proteins
(AFT) and HCG which are serum markers that are present in the
blood
CANCER
OF THE PENIS
Cancer
of the penis is a very rare occurance:
- More
common in men from the far east and uncircumsized males
- Men
with poor personal hygiene
- Older
males
- Occurs
under the prepuse near the glans
Pathology
of Cancer of the Penis:
- Skin
cancer SCC (squamous cell carcinoma)
- Spreads
locally (direct invasion to the shaft)
- Also
spreads to the inguinal nodes and pelvic nodes
Treatment
for Cancer of the Penis:
- Patient
can have their treatment of choice and also varies with the age
of the patient
- Surgery
is an option : penilectomy
- RT
is another option :
- 5000
cGy (typical dose for SCC) and bolus is used with 4 –
6 Mv
- erythema
will occur
- also
the inguinal and pelvic nodes must be treated
- prognosis
is good
KIDNEY
Nephron
Unit : functional unit of the kidney
Functions
of the Kidney:
- filters
blood
- produces
urine (elimination of waste)
- maintains
water balance in the body (sodium and potassium)
- water
balance will maintain blood pressure
Loop
of Henle : where water transfer occurs
Collecting
Tubule : collects urine
Ureters
: flow from the kidney to the bladder (carry urine)
The
kidney is located retroperitoneally
Two
types of Kidney Cancer:
- Renal
Cell Carcinoma : occurs in the nephron unit
•
Most common
•
Nephrectomy is the treatment of choice (must include as much of
the perinephric fat as possible as the tumor will seed there upon
removal)
•
Mets : bloodbourne and lymphatic (Hilum)
•
Prognosis is not good
•
Does not present early
•
Early symptom (actually a late one) is back pain
•
RT can be given to the tumor bed 5000 cGy
- Renal
Pelvis Carcinoma : cancer of the transitional cells
•
Spread to the ureters and bladder
•
Treatment is a nephrectomy and removal of the ureters
•
RT to the tumor bed to the bladder (big field) 5000 cGy
•
Patient will be on chemo and other drugs also
•
Worse prognosis than renal cell
Pediatric
Tumor of the Kidney:
Wilm's
Tumor : nephroblastoma
- Genetic
cancer
- Mets
to the lung (patient put on bleomyacin)
Diagnostic
Studies of the Kidney:
- Urinalysis
- IVP
(intravenous pyelogram / constrast so the patient cannot be allergic
to shellfish, iodine)
BLADDER
CANCER:
Bladder:
is a vesical (sac) that holds urine
- Is
surrounded by a ring of muscle (sphincter)
Transitional
Cells : line the bladder, ureters
Transitional
Cell Carcinomas:
- Occur
in the bladder, ureters, renal pelvis
- Also
clear cell may occur in the bladder
- Appears
early with gross hematuria
- Multifocal
Diagnosis
of Bladder CanceR:
- Found
upon cystoscopy under anesthesia
- Biopsy
is done
- Cells
look like cobblestones
Treatment
for Bladder Cancer:
- Partial
cystectomy (can be done over and over if it recurs)
- Intravaside
Radiation Therapy (P32 is placed in the vesicles, also referred
to as washings)
RT
: is used in advanced disease or if nodes are involved
- Must
treat patient with an empty bladder to lower the amount of area
we need to treat / this will cause folds in the bladder that will
act as bolus
- Irritation
will occur
Etiology:
- Occurs
3:1 males over females
- Occurs
in people who work with rubber, leather, shoe workers
- The
chemical in the die
- Some
chemo agents cause it
- Smoking
- Genetics
- Saccharin
- UTI's
- Kidney
stones
- MILK
protects against bladder cancer
Usually
occurs in the trigone regions of the bladder |
