Download Testicular and Colorectal Cancer

Men’s Health
• Testicular Cancer
• Colon Cancer
Testicular Cancer
Testicular Cancer
Facts
• Accounts for 1% of cancers in men.
• About 8,000 men are diagnosed with
testicular cancer each year.
• Only 370 deaths from testicular cancer are
expected in the United States annually.
Testicular Cancer
• Types of Testicular Cancer:
– Seminomas (5%)
• A type of cancer of the testicles.
• Seminomas may spread to the lung, bone, liver or brain.
– Non-seminomatous Germ Cell tumor (95%)
• A group of testicular cancers that begin in the germs cells
(cells that give rise to sperm).
• Non-seminomas are identified by the type of cell in which
they begin and include embryonal carcinoma, teratoma,
choriocarcinoma, and yolk sac carcinoma.
Testicular Cancer
Risk Factors
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Age (ages of 20 and 39)
Family History (brother and uncle)
Hereditary Conditions
– Abnormality of testicles, penis or kidneys at birth
Personal History
– Undescended testicle at birth (risk does not change with
surgery to move the testicle into the scrotum.)
– History of testicular cancer
– History of inflammation of the testicles following mumps
Testicular Cancer
Risk Factors
• Race:
– It is more common in white men, especially those of
Scandinavian descent.
– The rate of testicular cancer has more than doubled
among white men in the past 40 years.
– It has only recently begun to increase among black
men. The reason for this is not clear.
Testicular Cancer
Symptoms
– A painless lump or swelling in a testicle
– Pain or discomfort in a testicle or in the scrotum
– An enlargement of a testicle or change in the way it
feels
– A feeling of heaviness in the scrotum
– A dull ache in the lower abdomen, back or groin
Testicular Cancer
Symptoms
• These symptoms can be caused by testicular
cancer.
• However, they can be caused by other
conditions as well, such as:
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hernia,
hydrocele (collection of fluid in scrotum),
spermatocele (fluid-filled cyst at head of epididymis),
varicocele (dilated veins in scrotum),
epididymitis (infection of the epididymis)
Testicular Cancer
Diagnosis
– Your doctor will want to confirm the physical
exam
Testicular Cancer
Diagnosis
– Blood tests to measure tumor markers
• alpha-fetoprotein (AFP)
– Normally produced by fetal yolk sac but is produced by many
tissues that become malignant.
– Especially prevalent in nonseminomatous germ cell tumors.
• Beta-human chorionic gonadotropin (ß-HCG)
– Most commonly elevated tumor larker in testicular cancer.
– HCG is produced in germ cells of men, so when they become
cancerous the levels increase.
• Lactate dehydrogenase (LDH)
– Enzyme that is involved in the Kreb’s Cycle.
– Elevated with tissue breakdown, damage to muscle, and
cancer due to high rate of turnover with destroyed calls.
Testicular Cancer
– These tests may suggest the presence of a
testicular tumor, even if it is too small to be
detected by physical exam or imaging.
Testicular Cancer
Diagnosis
– Ultrasound
• This uses sound waves which bounces off the
testicles to produce a picture called a sonogram.
• Ultrasound of the scrotum can show the presence
and size of a mass in the testicle.
• It may also show another cause for the symptoms.
Testicular Cancer
Testicular Cancer
Testicular Cancer
Diagnosis
– Biopsy
• In nearly all cases of suspected cancer, the entire
affected testicle is removed through an incision in
the groin.
• In rare cases, such as when a man has only one
testicle, a surgeon may remove a sample of the
tissue to examine under a microscope.
Testicular Cancer - Treatment
Treatment
– Surgery to remove the testicle.
• This does not affect your ability to have sexual
intercourse.
• If one testicle is still present, you will not be sterile.
Testicular Cancer
Testicular Cancer
Treatment
– Surgery to remove the lymph nodes
• Some of the lymph nodes located in the abdomen
may also be removed to prevent further spread
and to test for metastasis.
• This is called Retroperitoneal lymph node
dissection.
Testicular Cancer
Treatment
– Radiation Therapy
• Affects only cancer cells in the treated areas
• Only seminomas are sensitive to radiation therapy.
– This is usually given after surgery and may be aimed at
the lymph nodes
• Non-seminomatous germ cell tumors are less
sensitive.
Testicular Cancer
Treatment
- Chemotherapy
• Drugs to kill cancer cells
• Usually given after surgery to help kill any
remaining cancer cells in the body.
• May be given first if the cancer has spread.
Testicular Cancer
Prognosis
The five year survival rate is over 95%.
Testicular Cancer
Prognosis
– While surgery can often cure testicular
cancer, regular follow-up exams are
extremely important.
– Remember, men who have had testicular
cancer are at an increased risk of developing
cancer in the other testicle.
Testicular Cancer
• To screen or not to screen?
• Primary screening tools:
– physician exam of testicles at annual exam
– self exam of testicles.
Testicular Cancer
Screening Recommendations
• United States Preventive Services Task Force:
• There is no evidence to support screening
asymptomatic men
• Why?
• There is no evidence that there are less deaths if
you find the cancer through screening.
• Concern that more harm comes from screening
than benefits
Testicular Cancer
Screening Recommendations
– National Cancer Institute
• No evidence that physician or self-exam will
decrease mortality.
Testicular Cancer
Conclusion
– Talk with your doctor about screening and
self-testicular exams
– See your doctor immediately if you have any
signs of symptoms of testicular cancer.
Colorectal Cancer
Colorectal Cancer
Facts
• Colorectal cancer is the third most common cancer in
men and women.
• Colorectal cancer is the second leading cause of
death in men and third leading cause of death in
women.
Colorectal Cancer
Facts
• New cases in 2007:
• 153,760 new cases of colorectal cancer
– 112,340 (colon), 41,420 (rectal)
• Deaths in 2007
• 52,180 (colon and rectal combined)
• This accounts for 9% of cancer deaths.
Colorectal Cancer
Facts
• Colorectal cancer can be prevented by removing polyps
in the colon years before invasive cancer begins.
• When colorectal cancer is found early and treated, the 5year survival rate is 90%.
Colorectal Cancer
Facts
• In Nebraska, only 38.4% of adults age 50 and over have
ever had a sigmoidoscopy or colonoscopy.
•
Nebraska Comprehensive Cancer Control State Plan, Nebraska C.A.R.E.S. Cancer
Awareness, Research Education and Service 2004-2010
• As many as 60 percent of deaths from colorectal cancer
could be prevented if everyone age 50 and older were
screened regularly.
Colorectal Cancer
Risk Factors
– Age: 50 or older (90% of cases occur after 50)
– Family History: Colorectal Cancer or Polyps
– Personal History:
• Colorectal cancers or polyps in the colon
• A history of ulcerative colitis or Crohn’s disease
• Certain hereditary conditions, such as familial adenomatous
polyposis and hereditary nonpolyposis colon cancer
(HNPCC; Lynch Syndrome)
Colorectal Cancer
Modifiable Risk Factors
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Obesity
Physical inactivity
Smoking
Heavy alcohol consumption
Diet high in red or processed meat
Inadequate intake of fruits and vegetables
Colorectal Cancer
Symptoms
Early Symptoms:
– Early colorectal cancer usually doesn’t have
any symptoms.
Colorectal Cancer
Symptoms
Later symptoms:
– A change in bowel habits
– Blood in the stool
– Stools that are more narrow than usual
– Frequent gas pains, bloating, fullness or cramps
– Weight loss that cannot be explained
Colorectal Cancer
Diagnosis:
– Physical Exam
– Fecal occult blood test
• Tests for blood in stool that may not be seen by
the eye
• Stool placed on card, then sent tested for blood
• May be done by rectal exam or by sending home
pack of three cards.
Colorectal Cancer
Colorectal Cancer
Diagnosis
– Digital Rectal Exam
• Checking for unusual lumps in rectum
– Barium enema
• Series of x-rays of lower gastrointestinal tract after
you have swallowed a silver-white liquid.
– Sigmoidoscopy
• Scope placed inside the rectum and sigmoid (lower
colon) to look for cancer or polyps.
Colorectal Cancer
Diagnosis
– Colonoscopy
• Scope placed through rectum and is able to visualize the
entire colon for unusual findings
– Biopsy
• Removal of cells or tissue during sigmoidoscopy or
colonoscopy
– Virtual Colonoscopy
• Series of computed tomographies (CT’s) to create a detailed
picture of the colon.
Colorectal Cancer
Treatment
• 1) Surgery: Surgery is the most common treatment for
colorectal cancer.
– For those cancers that have not spread, surgery may
be curative.
– Colorectal cancer is always staged. This will
determine the treatment.
Colorectal Cancer
Staging off Colorectal Cancer
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Stage 1:
– Cancer is only in internal and middle wall of colon
Stage 2:
– Cancer has spread to tissue or organs nearby
Stage 3
– Cancer has spread to 3-4 lymph nodes
Stage 4:
– Cancer has spread to other parts of body, such as lungs or liver
Colorectal Cancer
Colorectal
Treatment
• Chemotherapy alone, or in combination
with radiation (for rectal cancer), is given
before or after surgery to most patients
whose cancer has penetrated the bowel
wall deeply or spread to lymph nodes.
Colorectal Cancer
Prognosis depends upon:
– The stage of the cancer
– Whether the cancer has blocked or created a hole in
the colon
– Blood levels of carcinoembyronic antigen (CEA)
before treatment begins
– Recurrence
– Patient’s general health
Colorectal Cancer
• To screen or not to
screen?
• What are the
recommendations?
Colorectal Cancer
Screening Recommendations
• United States Preventive Task Force Services:
– Recommends screening men (and women!) 50 years
of age and older.
– Good evidence that periodic fecal occult blood
testing reduces mortality
– Fair evidence that sigmoidoscopy alone or in
combination with FOBT reduces mortality
Colorectal Cancer
Screening Recommendations
United States Preventive Services Task Force:
– No direct evidence that screening colonoscopy is
effective in reducing colon cancer mortality.
– However, the USPSTF believes that any of the
current screening techniques are cost effective and
does not show a preference for one over the other.
Colorectal Cancer
Screening Recommendations
American Cancer Society
Beginning at age 50, men should begin screening with 1 of
the examination schedules below:
• A fecal occult blood test every year
• A flexible sigmoidoscopy every 5 years
• A double-contrast barium enema every 5 years
• A colonoscopy every 10 years
Colorectal Cancer
Screening Recommendations
American Cancer Society
• Patients with first degree relatives who have had colon
cancer should be screened at an earlier age.
• No clear consensus as to when that should begin.
Colorectal Cancer
• Conclusion
• Screening is recommended for colorectal cancer,
beginning at age 50.
• Discuss with your doctor the types of screening most
appropriate to you.
Colorectal Cancer
• Questions?