Male Cancer test 3/4

What is the primary function of the male reproductive system?

What are the primary organs of the male system? and what are formed there? the 2 testes in which the sperm cells are formed.

What are the other 2 groups of accessory organs internal and external reproductive organs

Describe the testes ovoid structures suspended within the cavity of the scrotum by a spermatic cord

What are the seminiferous tubules? each testis is filled with about 1000 threadlike coiled seminiferous tubules, the sperm cell factories. They are lined with specialized tissue called germinal epithelium which function to produce a million male sex cells daily

What is also known as the sperm cell factories? seminiferous tubules

What are other specialized cells called and where are they located, and what do they secrete and produce? they are called interstitial cells or cells of Leydig, located in the spaces between the seminiferous tubules and function in the production and secretion of male sex hormones.

In young males what are the sperm cells called they are called spermatogonia and are undifferentiated

When and what caused undifferentiated spermatogenic cells to change? Hormones during early adolescence

What do spermatogenic cells do to become primary spermatogonia? they begin to undergo mitosis and some of them enlarge

How many chromosomes do secondary spermatocytes contain? 23

What happens to secondary spermatocytes do soon after they are formed? they each divide again and the result is four spermatids with 23 chromosomes each

How do spermatids become transformed into mature sperm cells? by a process of differentiation which is called spermatogenesis

What is the epidiymis? a coiled tube which lies on the outer surface of each testis

Where do sperm complete there maturation and are stored? in the epididymis

From the seminiferous tubules sperm passes through what? into the ? sperm pass through a network of small tubules into a large tube, the epididymis

Where does the epididymis empty into? a straight tube, the vas deferens or sperm duct

From the scrotum where does the vas deferens pass as part of the spermatic cord. the inguinal canal

Which way does the vas deferens loop after entering the pelvic cavity? they loop over the side and then down the posterior surface of the urinary bladder

What happens to the vas deferens when it nears termination? it becomes dilated into a portion called the ampulla

What does the vas deferens unite with just outside of the prostate gland? it becomes slender and unite with the duct of a seminal vesicle

What is the seminal vesicle? it is a saclike structure near the base of the bladder.

What does the seminal vesicle secrete? It secretes a slightly alkaline fuid which is thought to regulate the pH of he tubular contents and also greatly increase the volume of the fluid that is discharged from the vas deferens

What forms the ejaculatory duct and where does it pass through? The fusion of the ducts of the vas deferens and seminal vesicle and passes the substances of the two through the prostate gland.

Describe the prostate gland? chestnut shaped structure that surrounds the beginning of the urethra (urogenital diaphragm), just below the urinary bladder.

How many lobes compose the prostate gland and what does it secrete? composed of 5 lobes (posterior lobe is what is felt upon rectal exam) and secretes a milky fluid with an alkaline pH which helps neutralize the acidic sperm.

What enhances the motility of sperm cells and why? the milky fluid with alkaline pH from the prostate, because they remain immobile in the acidic contents of the epididymis.

What does the prostatic help do? helps neutralize the acidic secretions of the vagina and help sustain sperm cells that enter the female reproductive tract.

What are the small glands which lie below the prostate? Bulboruethral glands or Cowper's glands

What do the bulboruethral glands or Cowper's glands secrete and it's function. secrete a mucous like fluid which is released in response to sexual stimulation and helps lubricate the penis

Seminal fluid (semen) is slightly _____ __ with the average number present in the fluid is about ______ per __. semen is slightly alkaline pH with 120 million per ml

Sperm cells are _____ and account for ___ of the semen volume. so tiny and account for less than 1% of semen volume.

Semen (seminal fluid) is conveyed by the _____ and consists of (4) conveyed by the urethra and consists of sperm cells and secretions from seminal vesicles, prostate glands, and bulbourethral glands.

What are the male external reproductive organs? scrotum and penis

What encloses the testes? scrotum

Where dose the urethra pass? the penis

Prostatic cancer is the most common cancers for what age? men over 50 and rarely seen in younger age groups

65 is the peak age of incidence for which male cancer. and is higher is which race. prostate cancer and is higher in blacks than whites

Prostate cancer developes in American black men at ____ age and also seems to present in a more ____ stage. Because of this what is the mortality of blacks then whites? at a young age in a more advanced stage. mortality in blacks is twice that then whites

What is prostate cancer seem to be linked to? And who has a higher frequency of it? linked to hormones and is higher in people who had a venereal disease and familial connection.

What is prostate cancer found concurrently with? benign prostatic hyperplasia (BPH)

Prostate cancer is almost exclusively what histology? adenocarcinoma

Where does prostate cancer generally rise? and where does BPH generally arise prostate cancer arises on the periphery of the prostate.

BPH usually originates from the central portion of the gland.

prostate sarcomas are ____ rare

How are tumors of the prostate classified? By the Gleason score. The pathologist evaluates the predominant degree of differentiation of the primary and secondary tumor and gives each a number 1-5.

As per the Gleason score, which score is less aggressive? Low scores are less aggressive than higher scores

What is the appearance of adenocarcinomas of the prostate. range from well differentiated to undifferentiated neoplasms

Majority of prostatic cancers have more than ____ histologic pattern

What is the best way to detect early potentially curable carcinoma of the prostate. digital rectal examination

Where does prostate cancer usually originate. in the posterior lobe which is easily reached by the index finger.

Normal BPH feels similar to _____, while prostate cancer feels like _____ BPH- tip of nose

Prostate Ca- one's knuckle

Which other way may be of value in screening for prostate ca? transrectal ultrasound

50% of asymptomatic prostate ca are found by digital exam

How do most symptomatic prostate patients present? with local symptoms- urinary outflow blockage or unexplained cystitis

When does diagnosis of prostate ca occur? when prostatic tissue is removed to relieve bladder outlet obstruction for what was thought to be BPH

What are late presenting symptoms of prostate ca? -bone pain

What is the preferred method of obtaining histologic diagnosis for prostate ca? transrectal or perineal needle biopsy

What may be used for moderately advanced lesions producing obstructive symptoms (prostate)? transurethral resection of the prostate (TURP)

Only __% of patients undergoing TURP for BPH have a malignancy 10%

What is very suggestive of metastatic disease of prostate? an elevated serum prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) levels appear to be proportional to prostatic volume

Normal level of prostate ca are? due to the age of the patient

How do you rule out bone mets from prostate ca? What is recommended for detection of pelvic lymphadenopathy. -bone scans rule out bone mets

Approx __% of localized prostatic cancers are ____ at time of dx. 85%

What is present in almost all cases of prostate ca? perineural invasion

Extension to the capsule occurs early in prostate ca, but usually not before invasion of the prostate has caused obstructive symptoms

What has a profound influence on survival in prostate ca? perforation of the capsule and/or extention into the seminal vesicles

What else gets involved late in prostate ca? bladder, rectal, and extention to pelvic wall

What does lymph node invasion in prostate ca depend on? the size of the tumor and the degree of differentiation

What is the most frequent sites of regional node mets in prostate ca? 1-obturator

Is regional lymphatic mets common from cancer of prostate? yes

In terms of blood borne disease the veins draining the prostate form a well defined plexus around the base of the gland

The plexus around the base of the gland has connections to the _____, which is believed responsible for high incidence of mets to _____ (prostate)-. vertebral system

What are the 5 treatment options for prostate ca? 1- observation for pts w/ stage 1A

Radical prostatectomy is effective in treating what? what occurs and what percent of pts are eligible for this procedure? treating disease confined to the capsule (T1 and T2), the prostate gland, seminal vesicles and a cuff of bladder neck are removed. Approx 5-10% are eligible

What occurs in almost all pts w/ radical prostatectomy? What new procedure is helping this? What are other complications? Impotence.

What is the major issue of radiotherapy for prostate ca? the incorporation of pelvic and para-aortic lymph nodes

When utilizing XRT to treat prostate ca what energy is used? dose to tumor? dose to nodes? high energy units above 10 mV

What are XRT portal arrangements for prostate ca? 4 field box or IMRT followed by boost to the tumor itself

What is interstitial treatment for prostate ca? -if only treatment and is early stage- Iodine 125

How is interstitial tx done for prostate ca? What are the doses? This procedure is done under anethesia and the seeds may be implanted by Mick gun.

After irradiation for prostate ca regression rates are ____ and ___ may be required for clinical evidence of tumor to disappear. slow

What are side effects of irradiation of prostate -similar to pelvic irradiation

What happens with palliative RT of prostate ca? What doses? Because pts with mets may survive many months or years, a relatively high dose should be used to avoid retreatment.

What is hormonal tx of prostate ca reserved for? demonstration of symptomatic local reccurrence or distant mets

Describe hormonal tx for prostate ca. it centers around orchiectomy or the administration of estrogens. Both will remove 90-95% of circulating testosterone. Current medicines are Zoladex and Lupron.

What is the prognosis of prostate ca? 10 yr survival involving radical surgery for small tumors was 60%.

Which cancer is rare accounting for only about 1% of male malignancies? testis cancer

Why is testis cancer important? because it is commonly found in pts between 20-34 and potential of productive yrs of life lost.

Testicular cancer is now one of the most ____ of the solid cancers in adults curable

What are the commonest form of cancer in men between 15-44 testis cancer, leukemia, and lymphoma

Who are testis tumor rarely found in? American blacks, Africa, Asia, and New Zealand

What is the etiology of testis cancer? -more frequent in identical twins

What is the incidence of undecended testicles? 1 in 80 inguinal testes and 1 in 20 abdominal testes

What have been suspected with testes cancer? -gonadal dysgenesis

What is the histology of testicular cancers? 95%- germ cell

What is the peak age of incidence for seminomas of testicular ca? 40 yrs -most testes cancers occur at relatively young ages; the most common testicular cancer in elderly men is lymphoma

Which makes up 1-3% of all germ cell tumors of testes? Choriocarcinoma- which has the worst prognosis

What are other types of testicular cancers? -embryonal carcinomas

How does testicular cancer present? as a painless scrotal mass ranging 1- over 10 cm in diameter.

90% of testicular masses are brought to doctors attention by the patient making self exams

What are signs of testicular ca? -feeling of heaviness

Approx 96% of solid tumors of testis are ___. malignant

Pts w/ testicular tumors should exam for mets- -mass of epigastrium

Gynecomastia (testes tumor) may be present if it produces HCG (human chorionic gonatropin) or estrogens

The 2 biochemical markers (testes) serves as guides for staging

To bx testes inguinal exploration followed by orchiectomy

How do testicular neoplasms spread? orderly to lymphatics and adj tissues

Where do advanced and ingnored testicular neoplasms disseminate to? lungs, liver, and brain

Where do majority of testis lymph terminate? in lumbar lymph nodes between T11 and L4

What testis tumors are radiosensitive? lyphomas and tumors from germinal epithelium

Nongerminal cell of testis require what tx? they are radioresistent and require surgery

How do you surgically dx testicular tumors? orichectomy

Tx for nonseminomatous testes tumors Surgery w/ chemo

If retroperitoneal disease of testes RT if disease is less than 5 cm

What is the RT tx for testes? AP/PA fields to 2000-2500 cGy in 2-3 wks

What dose can induce permanant sterility in men? max dose of 200 cGy in one fx

Complication of testes RT is decreased sperm

Stage I and II pure seminoma (testes) cure rate is? What tx process? close to 100% cure

Stage I and IIA nonseminomatous germ cell cure rate is (testes)? 95%

In the US penis cancers is? Non-circumcized and bad hygiene %? US- less than 1%

What is the histology of penile ca? squamous

What give most protection against developement of penile ca? neonatal circumcision

How does penile ca present? penile growth, ulcer, or foul smell

What symptoms of penile ca? painless w/ erosion w/ attendant bleeding w/o pain

About __% of pt will delay med attention for more than one year (penis) 50%

After bx confirms dx cancer, penile ca is evaluated with regard to size, location, and if lesion is fixed

How does penile cancer spread? direct extention and lymphatics- tx prevents future spread

What is primary tx of penis ca? surgery and XRT

What is the goal of surgery of penis? remove lesions w/ adequate margins to guard against local failure

Small tumors of penis can be managed with ____ alone. circumcision

Penectomy w/ urethrostomy is for malignant lesions of proximal shaft

RT is used for tx of (penis)

RT for penis techniques and doses

5 year survival penis