CARCINOMA PROSTATE

The risk of carcinoma of the prostate increases with age, being increasingly detectable from 50-80 years. Though the cause is unknown, several factors influence the risk. Geographical (Sweden and USA), racial (blacks) and occupational (rubber workers) factors and altered oestrogen and androgen levels are some of the risk factors.



Adenocarcinoma arising from the glandular acini is the most common. Sarcomas, and squamous cell, transitional cell and small cell carcinomas are other tumours. Apart from these, metastases to prostate are seen from the bladder, lung, colon and lymphomas. Grossly, multifocal lesions and invasion of the prostatic capsule are the characteristic features of this disease. It most commonly metastasises to bone, with dense osteoblastic or osteolytic lesions, and less frequently to the liver and lung with paraneoplastic syndromes.

Early prostatic carcinoma is usually asymptomatic and can be detected by routine rectal examination. Induration or non tender nodularity are the frequent findings. The presence of symptoms indicates advanced disease. Urinary symptoms like sudden onset of urinary tract obstruction, poor urine flow, urgency and terminal haematuria, back pain or paraplegia may be due to extradural secondaries. Acute and chronic prostatitis, nodular hyperplasia and benign adenomas have to be clinically differentiated from prostatic carcinoma.

The histological diagnosis is established by transperitoneal needle biopsy or by transrectal fine-needle aspiration cytology (FNAC). Routine investigations like urine analysis, complete blood picture, renal and liver profile, serum alkaline phosphatase, serum calcium and phosphorus levels, chest X-ray, and X-ray of bony secondary sites are carried out (Fig. 14.6). Ultrasonography, CT scan, isotope bone scan and lymphangiogram are optional. Estimation of acid phosphatase levels in serum is not considered very specific for carcinoma prostate. Prostate-specific antigen (PSA) is more sensitive and useful. Carcinoembryonic antigen is increased in a few cases.

Routine and careful examination of the prostate after 50 years of age is essential for prevention and early diagnosis of carcinoma prostate. Surgery, radiotherapy and hormonal manipulation are modalities of treatment.In cases diagnosed incidentally at histology during transurethral resection of suspected benign prostatic hyperplasia, random multiple needle biopsies are carried out. If no further foci are detected, patients are kept on follow-up without any further treatment.A tumour which is palpable but is confined to the prostate (single nodule of less than 2 cm) is managed with radical prostatectomy. However, few patients with carcinoma are diagnosed early and are fit for surgical treatment. Tumours with multifocal lesions or those localised to the periprostatic area are managed by radical prostatectomy or radiotherapy. This group of patients needs pelvic lymphadenectomy for pathological staging before prostatectomy, as radical treatment depends on the stage of the disease. The increased incidence of impotency, lymphoedema, pulmonary embolism are limiting factors of radical surgery.

External radiotherapy is widely employed in the management of carcinoma prostate, either alone or as adjuvant to radical prostatectomy. Interstitial implant irradiation using I-125, Ir-192, Au-198, P-32 isotopes is also used. Neither hormonal therapy nor chemotherapy has improved survival in early stages of carcinoma prostate.In advanced stages transurethral resection of the prostate is done to relieve the bladder outlet obstruction as a purely palliative measure. Orchidectomy is also effective. Radiotherapy is useful in isolated painful bony secondaries, spinal cord compression, pelvic pain syndromes and haematuria. Endocrine therapy is the mainstay of treatment of symptomatic prostatic malignancy. Orchidectomy, luteinising hormone-releasing hormone (LH-RH) agonists and oestrogens result in dramatic improvement. Long-acting oestrogen chlorotriamisene (TACE), progestins, flutamide (anti-androgen), aminoglutethamide and diethylstilbesterol diphosphate can be used. Chemotherapy is given for hormone-resistant cases. Multi-drug chemotherapy has not shown superior results over single-agent therapy. Adriamycin, 5-fluorouracil, methotrexate, cyclophosphamide, cisplatin and DTIC are used.

Survival is directly related to stage: stages I and II-70%, stage III-56% and stage IV-25% at 5 years. Well differentiated carcinomas have better prognosis. Grades I, II, III and IV carry 5-year survival of 60%, 35%, 15% and 5%, respectively. Involvement of seminal vesicles is associated with poor prognosis.

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Colon Cancer Information And Treatment

Colon cancer also well known as colorectal cancer and large bowel cancer. Colon cancer is cancer that begins in the large intestine (colon) or the rectum (end of the colon). Colorectal cancer causes 655,000 deaths worldwide per year, including about 16,000 in the UK. Almost a quarter of all adults in the U.S. over the age of 50 will have at least one colorectal polyp. Colorectal cancer become the second most common cancer in US women. Most colorectal cancers develop from polyps in glandular tissue of the intestinal lining. Symptoms of colon cancer are various and nonspecific.

The first symptoms of colon cancer are commonly vague, like weight loss and fatigue (tiredness). Local (bowel) symptoms are rare until the tumor has grown to a large size. Other symptoms of colon cancer include fatigue, weakness, shortness of breath, change in bowel habits, narrow stools, diarrhea or constipation, red or dark blood in stool, weight loss, abdominal pain, cramps, or bloating.
There are several risk factors for the disease. Diet also contributes to the risk, although the cause-and-effect relationship is still unclear. People whose diets are high in fruits and vegetables seem to have a reduced risk.
Certain genetic syndromes also reduce the risk of developing colon cancer. Heavy exposure to certain chemicals, including chlorine , which in small amounts is commonly used to purify drinking water may increase the risk of colorectal cancer. Smoking cigarettes is other risk factor for colorectal cancer.



The first treatment of colon cancer is to surgically remove part or all of colon. Surgery is depend on the stage and size of your tumor. Chemotherapy uses drugs to destroy cancer cells. Chemotherapy is also used to treat patients in stage IV colon cancer.

Chemotherapy is often utilized as a first-line treatment for metastatic colorectal cancer to destroy cancer cells that have metastasized. It may be used prior to surgery to increase the staging of tumor as well. Eating a low-fat, high-fiber diet, and increasing physical activity can help prevent the disease. Radiation therapy may be used after surgery to kill any remaining areas of cancer or before surgery to shrink the tumor. Radiation also can be utilized to cure cancer from coming back to the place it started and to alleviate symptoms of advanced cancer. Biological treatment, also reffers immunotherapy, attempts to make your body fight against your cancer.
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