PROSTATE CANCER

- 2nd most common in men

- It is associated with the long arm of chromosome 1

The PCAP and CAPB genes component of chrome.

- Typically rise from the peripheral zone

- As it metastasizes it interrupts the function of the

Urinary and other organs

- RF

 Sexually active males - same w/ prostate

Enlargement

 Multiple sexual partners

 Pts exposed to cadmium
 Low fat diet
 50y/o and above
 Lifestyle

- DX

 TSE
 Digital rectal exam

- SX

 Enlargement
 Pain on urination & defecation
 Hesitancy on urination
 Hematuria
 Urinary retention - d/t obstruction
 Prostitis
 Benign prostatic hypertrophy
 Radiating pain hips to legs
 Elevated - PSA - 2.6 nannogram/ml

- MGT

 High fat diet

 Radiation Therapy
 Hormonal Deprivation
 Chemotherapy
- SGT

 Radical Prostatectomy
- involves removing the entire prostate gland, its outer capsule, the seminal vesicle, sections of
the vast deferens, adjacent lymph nodes and the Bladder neck.
 Cryosurgical Ablation
-the surgeon uses guided TRUS to insert cryoprobes into desired areas of the prostate to freeze
and thereby destroy the tissue.
 TURP
-transurethral resection of the prostate (TURP), a combined visual and surgical instrument
(resectoscope) is inserted through the urethra where it's surrounded by prostate tissue. An
electrical loop cuts away excess prostate tissue to improve urine flow.
 TULIP
- Transurethral ultrasound-guided laser-induced prostatectomy - an alternative to
transurethral resection of the prostate. The surgeon inserts a laser into the urethra in order to
make incisions in the prostate so that the urine can flow more easily from the bladder.

- COMP

 Epididymitis
 Retrograde ejaculation
 Bleeding - hemorrhage – infections

TESTICULAR CANCER

- Common in men between 15 and 35 yo. - Family history, exogenous estrogen, cryptorchidism
(undescended testicles) - germinal cell growth kay: seminoma, embryonal carcinoma,
teratocarcinoma, choriocarcinoma;

RISK FACTOR
 The male offspring of women who used estrogen in the form of diethylstilbesrtol (DES)
 Undescended Testicles

PATHO:

-Most testicular cancers ( 90% to 95%) are germinal cell tumors, such as seminoma (about 30% to 40%
of all tumors) embryonal carcinoma (about 20%) teratocarcinoma, or chorioczrcinoma.Seminomas are
generally carry a favourable prognosis (about a 90 % 5-year survival rate ) because they are usually
loczlized, metastasize Late and radiosensitive.

Nongerminal tumors make up the remainder of testicular tumors and are classified as either interstitial
cell tumors or testicular adenomas.
CLINICAL MANIFESTATION

 Mass or lump in the testicle

 Painless enlargement of the testis
 Heaviness in the scrotum, inguinal area, or lower abdomen.
 Backache
 Abdominal pain
 Weight loss
 General weakness results of metastasis.

DIAGNOSTIC TEST

 Blood test (alpha-fetoprotein “AFP” & human chorionic gonadropin “hCG”

 Chest x-ray to assess for metastasis in the lungs and a transscrotal testicular ultrasound will be
performed.
 Inguinal orchiectomy is the standard way to establish the diagnosis of cancer.
 Abdominal/pelvic CT scan and chest CT scan
 Brain MRI or bone scan
 Ultrasonography

Medical Management

 Radiation Therapy
 Chemotherapy

Surgical Management

 Radical Inguinal Orchiectomy (removal of the affected testis)

 Retroperitoneal lymph node dissection (RPLND) Prevent lymphatic spread of the cancer

Nursing M:

 Assessment of the patient’s physical and psychological status and monitoring of the patient for
response to and possible effects of surgery, chemotherapy, and radiation therapy
 The nurse reminds the patient about the importance of performing TSE in the treated or
remaining testis.
 The patient is encouraged to participate in healthy behaviors, including smoking cessation,
healthy diet.

COMPLICATION

 Solid tumors
 Leukemia
CERVICAL CANCER

 -usually results from infection with the human papillomavirus, transmitted during sexual
intercourse.
 usually spreads by direct extension into surrounding tissues or via the lymphatic to the pelvic
and para-aortic lymph nodes. Hematogenous spread is possible but rare. If cervical CA spreads
to the pelvic or para-aortic lymph nodes, the prognosis is worse, and the location and size of
the radiation therapy field is affected.

RISK FACTOR

 HPV is the leading cause of cervical cancer, with a notable relationship between the
presence of HPV strains 16 and 18

CLINICAL MANIFESTATION

 Early - none
 Late
-Post coital bleeding - light spots - cervix only
-Excessive menses
-Abnormal uterine bleeding

DIAGNOSTIC TEST

 Papsmear
 Endometrial biopsy
 Cervical intraepithelial neoplasia (CIN) - usus starts @ neck part
Moderate
Severe
Carcinoma
 Vaccination – Gardasil 9 vaccine

MEDICAL MANAGEMENT

 Radiation Therapy
 Chemotherapy

SURGICAL MANAGEMENT

 TAHBSO
- Is a radical procedure involving removal of pelvic organs including the uterus, fallopian tube,
ovaries and vagina
 COLD CONIZATION
- Is a procedure during which a cone shaped biopsy of the cervix is obtained
 LOOP ELECTROCAUTERY EXCISION PROCEDURE ( LEEP)
- Is performed to excise the cervical area causing concern.
  CRYOSURGERY and LASER
- Cryosurgery is the freezing of diseased cervical tissue.
- Laser surgery uses a direct beam or heat to remove diseased tissue.

COMPLICATIONS:

 Minor to severe bleeding

 Kidney failure

UTERINE CANCER

- Develops in the lining of the uterus (endometrium) also called endometrial cancer. It usually affects
women after menopause. It sometimes causes abnormal vaginal bleeding. Many women with
endometrial cancer have obesity, which increases the risk of morbidity and mortality from this disease.

Often classified as follows:

 TYPE 1 – CAs are common, respond to estrogen, and are not very aggressive. Usually occur in
younger or obese women or in women going through perimenopause.
 TYPE 2 – CAs are more aggressive and occur in older women.

RISK FACTOR:

 Cumulative exposure to estrogen

 Infertility
 Diabetes
 Use of tamoxifen
 Age >50 years
 Nulliparity
 Early menarche
 Late menopause

PATHO:

Most uterine cancers are endometrioid (i.e., originating in the lining of the uterus). Endometrial cancer
may spread as follows:

 From the surface of the uterine cavity to the cervical canal

 Through the myometrium to the serosa and into the peritoneal cavity
 Via the lumen of the fallopian tube to the ovary, broad ligament, and peritoneal surfaces
 Via the blood stream, leading to distants metastases
 Via the lymphatics

The higher (more undifferentiated) the grade of the tumor, the greater the likelihood of deep
myometrial invasion, pelvic or para-aortic lymph node metastases, or extrauterine spread.
CLINICAL MANIFESTATION:

 Abnormal vaginal bleeding

 Pain during sexual intercourse
 Vaginal bleeding after menopause

STAGES:

 Stage 1 – CAs occurs only in the upper part of the uterus, not in the lower part (cervix)
 Stage 2 – cancer has spread to the cervix
 Stage 3 – cancer has spread to nearby tissues, the vagina, or lymph nodes
 Stage 4 – cancer has spread to the bladder and/or intestine or to distant organs.

DIAGNOSTIC TEST

 Endometrial biopsy
 Transvaginal ultrasound
 CT scan
 MRI
 Bone scan

MED. & SURG. M:

 Surgical staging
 Total or radical hysterectomy
 Bilateral salpingo-oophorectomy
 Lymph node sampling
 Laparoscopy
 Radiation therapy (such as: external-beam radiation or vaginal brachytherapy)
 Surgery

NGS. M:

 Encourage patient to maintain a healthy weight

 Encourage exercise
 Educate patient about considering taking birth control pills.

COMPLICATION:

 Anemia
ENDOMETRIOSIS

Chronic disease affecting women of reproductive age, occurring more frequently in women who have
never had children. Endometriosis consists of a benign lesion or lesions that contain endometrial tissue
(similar to that lining the uterus) found in the pelvic cavity outside the uterus.

PATHO:

Misplaced endometrial tissue responds to and depends on ovarian hormonal stimulation. During
menstruation, this ectopic tissue bleeds, mostly into areas having no outlet, which causes pain and
adhesions. The lesions are typically small and puckered, with a blue/brown/gray powder-burn
appearance and brown or blue-black appearance, indicating concealed bleeding.

Endometriosis may increase the risk of ovarian cancer. Currently, the best-accepted theory regarding
the origin of endometrial lesions is the transplantation theory, which suggests that a backflow of menses
(retrograde menstruation) transports endometrial tissue to ectopic sites through the fallopian tubes.
Why some women with retrograde menstruation develop endometriosis and others do not is unknown.
Endometrial tissue can also be spread by lymphatic or venous channels

CM:

 Dysmenorrhea
 Dyspareunia
 Pelvic discomfort or pain
 Dyschezia (pain with bowel movements)
 Depression
 Loss of work due to pain
 Infertility

RF:

 Family history of endometriosis

 Early age of menarche
 Short/Long menstrual cycle
 Heavy bleeding during menses
 Delayed childbearing
 Defects in the uterus or fallopian tubes
 Hypoxia

STAGES:

 Stage 1 – patients have superficial or minimal lesions

 Stage 2 – mild involvement
 Stage 3 – moderate involvement
 Stage 4 – extensive involvement and dense adhesions, with obliteration of the cul-de-sac
DX:

 Bimanual pelvic examination

 Laparoscopy
 Ultrasonography
 MRI
 CT scan

MED. M:

Treatment depends on the symptoms, the patient’s desire for pregnancy, and the extent of the disease.
If the woman does not have symptoms, routine examination may be all that is required.

 NSAIDs
 Oral contraceptive agents
 GnRH agonist
 Surgery

Pharmacologic therapy:

 Analgesic agents and prostaglandin inhibitors for pain

 Hormonal therapy

SURG. M:

 Laparoscopy – used to fulgurate endometrial implants and to release adhesions

 Laser surgery
 Endocoagulation and electrocoagulation
 Laparotomy
 Abdominal hysterectomy
 Oophorectomy
 Bilateral salpingo-oophorectomy

NSG. M:

 Explaining the various diagnostic procedures may help to alleviate the patient’s anxiety.
 Relief of pain, dysmenorrhea, dyspareunia, and avoidance of infertility.
 Patient education involves: - That pregnancy is not easily possible. - Dispel myths and encourage
the patient to seek care if dysmenorrhea or dyspareunia occur.

COMPLICATIONS:

 Infertility
 Chronic pelvic pain and subsequent disability
 Anatomic disruption of involved organ systems (ex. Adhesions, ruptured cysts)
BLADDER CANCER

-Appears to result from exposure of the bladder wall to carcinogens such as cigarette smoking that may
result to carcinogenic metabolites produced by abnormal tryptophan metabolism, with the metabolite
excreted in the urine.

- Premalignant proliferative changes often found in the transitional cell layer called dysplasia (refer to
abnormal cell configuration found in several degrees of severity.

- Tumors are mostly found in the trigone of the bladder and lateral wall of the bladder

RISK FACTORS:

 Smoking
 A job involving exposure to chemicals
 Exposure to radiation
 Recurrent infections in the bladder

SX

 Painless hematuria - can lead to gross hematuria

 Fistula - abnormal opening b/w bladder & rectum o Mixture of fecal matter and urine
 Dysuria

MEDICAL MANAGEMENT

 Radiation therapy
 Chemotherapy
 Bacillus Calmette-Guérin (BCG therapy) Immuno therapy

SURGICAL MANAGEMENT

 Transurethral Resection
 Radical Cystectomy
- Removal of the bladder, urethra, uterus, fallopian tube, ovaries and the anterior segment of
the vagina
 Ileal conduit
- A type of urinary diversion. Using a segment of the intestine as a conduit, the surgeon
construct a system in which urine empties through an artificial opening in the skin called
stoma.
 Indiana pouch
- Indiana Pouch is a continent urinary reservoir, meaning no bag is necessary to store the
urine outside the body. Instead of a bag, the right colon is removed from the rest of the
bowel and re-fashioned into a pouch that can hold

COMPLICATION

 Anemia
 Urinary Incontinence