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Cancer in Men
Magnitude of Cancer Problem
in the Philippines
INCIDENCE
3rd in incidence after communicable &
cardiovascular diseases
1 out of 1,000 Filipinos has cancer
114:103 Females to Males, Filipino
Incidence rates increase w/ Age:
0-14 yr.: 3.6% of cancers
>35 yr.: 91% of cancers
>=50 yr.: 76% of cancers
What are the Top Ten
Cancers in the Philippines?
Male
Female
Child
Lung
Breast
Leukemia (ALL)
Liver
Cervix
Lymphoma (NHL)
Stomach
Lung
Colon
Ovary
Brain/ Spinal (Medullablastoma;
Astrocytoma)
Retinoblastoma
Rectum
Stomach
Bone (Osteosarcoma)
Nasopharynx
Leukemia
Oral cavity
Pancreas
NHL
Liver
Thyroid
Oral cavity
Colon
Rectum
STS (Rhabdo-myosarcoma)
Kidney (Wilm’s)
Gonadal GCT
Epithelioma
TEN LEADING CANCER SITES
IN MALES
NASOPAHRYNX(7)
LUNG(1)
PROSTATE (3)
COLON(5)
RECTUM(9)
ORAL(10)
LYMPHOMA (8)
STOMACH(6)
LIVER(2)
LEUKEMIA(4)
Philippine Cancer Facts and Estimates, 1998
Male-Gender Related
More Common
Cancer Sites
Prostate
Testis
Prostate Cancer
Cancer originating in the prostate gland and can
eventually spread to other organs, bones, and tissues.
The prostate is a cluster of small glands located beneath the
bladder that surrounds the urethra, the tube that carries urine
from the bladder out through the penis. Its principle function
is to manufacture fluid that constitutes a portion of the semen.
Prostate
Cancer
Prostate cancer:
3rd most common cause of death from cancer in men of all ages and
Most common cause of death from cancer in men over 75 years old.
Prostate cancer is rarely found in men younger than 40.
Men at higher risk include African-America men older than 60,
farmers, tire plant workers, painters, and men exposed to cadmium.
Lowest number of cases occurs in Japanese men and those who do not
eat meat (vegetarians).
Fortunately, prostate cancer tends to be slow-growing compared
to many other cancers -- the majority of prostate cancers either do
not spread or cause harm for decades.
Prostate Cancer –
Signs & Symptoms
Many people with prostate cancer experience no symptoms at all.
Some symptoms that may indicate prostate cancer include:
Difficult and painful urination
Frequent urination and a feeling that one has to urinate even when the bladder is
empty
Incomplete emptying of the bladder, which may lead to dribbling of urine
Awakening frequently in the night to urinate
Decreased force of urine stream
Blood in the urine
Hip and back pain
When the cancer has spread to other parts of the body, symptoms can include:
Bone pain
Weakness or paralysis caused by compression of the spinal cord
Weight loss
Anemia
Kidney failure
Prostate Cancer Causes
The cause of prostate cancer is unknown, although:
Influence of genes on the development of prostate cancer is suggested by the fact that prostate cancer tends
to occur in men who are related to one another - researchers have identified a gene that is associated with 30%
of family-related prostate cancers.
Farmers as well as men who work in tire, rubber, and sheet metal factories tend to have
high rates of prostate cancer or more aggressive forms of the cancer.
environmental exposure to cadmium (present in commercial fungicides) and other harmful substances
may be responsible for the high rates of prostate cancer in these men.
Nutrition has been implicated in the development of prostate cancer because disease rates among men from
countries with low prostate cancer rates (such as Japan) increase when they immigrate to the United States.
high in saturated fat.
thought to be due to the switch to a typical American diet, which is
some studies have shown a relationship between high dietary fat intake and increased testosterone levels..
Elevated levels of male sex hormones, such as testosterone, may also
play a role in the development of prostate cancer
Prostate Cancer –
Risk Factors
The following factors may increase a man's risk for prostate cancer:
Older age -- prostate cancer is most common among men who are older than
55.
Race -- African-Americans have a greater risk of developing prostate cancer
than Caucasians who, in turn, have a greater risk than Native and Latin
Americans.
Family history of prostate cancer -- having a brother with prostate
cancer makes a man 4.5 times more likely to develop the disease. Having a father
with prostate cancer makes a man 2.3 times more likely to develop prostate cancer.
High-fat diet -- foods rich in saturated fat may increase testosterone levels.
Lack of exercise may increase the risk in those who eat a high-fat diet.
Occupation -- people who are regularly exposed to the chemicals dimethyl
formamide and acrylonitrate, and the metal cadmium
(such as metal workers and farmers), have high rates of prostate cancer.
Prostate Cancer Diagnosis
Two standard tests are used for early detection of prostate cancer:
Digital rectal exam (DRE) -- in this test, the physician
inserts a gloved, lubricated finger into the patient's rectum in
order to feel the prostate for bumps or other abnormalities. Many
malignant tumors originate in the outer part of the prostate
where they may be detected by this exam. Some men find this test
embarrassing, but the DRE is quick and relatively painless, and
helps detect many prostate cancers. Although some tumors
identified using DRE have already spread outside of the prostate
gland, studies indicate that regular DREs still save lives.
PSA test -- blood test measuring the level of prostate-specific
antigen (PSA), a protein produced in the prostate gland that
keeps semen in liquid form. Prostate cancer cells produce elevated
quantities of PSA, so measuring PSA levels allows physicians to
detect cancer while it is still microscopic. Unfortunately, the test is
not accurate enough to definitively rule out or confirm cancer.
For example, advancing age and benign conditions such as
enlarged prostate can also elevate PSA levels.
Prostate Cancer Diagnosis
If either the DRE or PSA test suggests
the possible presence of cancer, the
following tests will be performed to
make a definite diagnosis:
Transrectal Ultrasound -- a
visual image of the prostate is
obtained by using ultrasound.
Biopsy of the prostate -- a tissue
sample is obtained through the
rectum and examined for
cancerous cells under the
microscope.
Prostate Cancer Diagnosis
If the biopsy confirms the presence of cancer,
several tests will be performed to detect any
spread of the disease. This information gauges
how serious the prostate cancer is at the time of
diagnosis. Likely tests include the following:
Imaging tests (CT and MRI) -- computerized
tomography (CT) or magnetic resonance imaging
(MRI) scans may pinpoint the location of cancer
that has spread beyond the prostate.
Bone scans and x-rays -- these techniques look for
spread of cancer to the bones.
Lymph node dissection -- this is part of a surgical
procedure to determine if the cancer has spread to
the lymphatic system.
Prostate Cancer Disease Stages
Prostate Cancer –
Preventive Care
Regular screening with the DRE and PSA exams by a
doctor may help detect prostate cancer in the early
stages, before it has spread.
Men between the ages of 50 - 70 should have annual
DRE or PSA tests.
Men with high risk profile should begin screening at
age 40.
Follow lifestyle modifications may minimize the risk of
prostate cancer:
Low-fat diet, rich in fruits and vegetables
Eat foods rich in selenium (such as brewer's yeast,
wheat germ, chicken liver, nuts and seeds, tuna and
herring) and vitamin E (such as wheat germ, organ
meats, sweet potatoes, leafy vegetables including
spinach, nuts and seeds, eggs, soybeans, and lima
beans)
Exercise regularly
Prostate Cancer –
Treatment Overview
Treatment for prostate cancer depends on the stage of the disease, the age of the
individual, the presence of other medical conditions, and the man's
preferences in conjunction with the physician's recommendations.
If prostate cancer is detected early, treatment usually involves either surgical
removal of the prostate or radiation therapy.
For more advanced cases of prostate cancer, or if cancer spreads beyond the
prostate, hormone medications are the preferred treatment.
If the man is older than 70 and has only a slow-growing tumor, the physician
may adopt a strategy called "watchful waiting," in which the man returns
frequently for check-ups. Treatment occurs only if the man's condition
worsens.
Dietary modifications may slow the growth of the cancer in men undergoing
watchful waiting, as well as those who have had surgery or are being treated
with with medication or radiation. For example, eating a low-fat diet, rich in
fruits, vegetables, soy, selenium, and fiber has been associated with a
decreased risk of prostate cancer.
Meditation and massage may reduce stress and anxiety associated with having
prostate cancer.
Prostate Cancer Surgery
Removal of the prostate (prostatectomy) -- offers an
excellent cure for men with prostate cancer that is
completely confined to the prostate, and is performed
if life expectancy is at least 10 years and cancer is
confined to the prostate. Side effects include
incontinence and impotence, but new procedures that
spare nerves near the prostate preserve sexual
function in 25 - 90 % of men.
Surgical exploration of lymph nodes -- may be performed
to evaluate whether prostate cancer has spread to the
lymphatic system.
Resection of the prostate (called TURP or transurethral
resection of the prostate) -- removal of all or part of
the prostate gland to eliminate cancer and to relieve
obstruction of urine.
Removal of the testes (orchiectomy) -- lowers testosterone
levels, but side effects can include impotence and hot
flashes.
Prostate Cancer Radiotherapy
Radiation therapy may be effective for cancer
confined to the prostate, particularly for
older men.
Radiation can be administered through an
external source, or irradiated seeds can be
placed internally near the prostate.
Using irradiated seeds actually lowers the
risk of damage to organs surrounding the
prostate from radiation because
administration can be more precise in
both amount and location.
Side effects can include proctitis
(inflammation of the lining of the rectum),
urinary tract infections, and impotence.
Prostate Cancer Medications
Medications are considered the best therapy for people with advanced stages of
prostate cancer or when cancer spreads from the prostate to other parts of the
body.
Drugs may also be prescribed prior to radiation therapy or when surgical
procedures fail to lower PSA levels.
Most medications for prostate cancer lower levels of male sex hormones (such as
testosterone). Lowering testosterone levels can cause tumors to shrink or slow their
growth.
Some commonly prescribed medications include:
Luteinizing Hormone-Releasing Hormone (LH-RH) agonists (such as leuprolide,
goserelin, and buserelin) -- LH-RH is natural hormone, released by the
hypothalamus in the brain, that lowers the production of testosterone, and the
medication encourages the release of this natural hormone. Side effects can include
hot flashes, weight gain, development of male breast tissue, breast pain, and
nausea.
Hormones including antiandrogens (such as flutamide, bicalutamide, and
nilutamide) and estrogens (such as diethylstilbestrol) -- these medications reduce
testosterone levels, but side effects can include reduced sex drive, fatigue, nausea,
impotence, diarrhea, and hot flashes.
Chemotherapeutic medications (such as mitoxantrone and estramustine) -improve symptoms in advanced cancer but do not increase life expectancy
Prostate Cancer – Nutrition &
Dietary Supplements
Following these nutritional tips may help reduce symptoms:
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole
grains (if no allergy), dark leafy greens (such as spinach and kale), and sea
vegetables. A study found that men who consumed 28 or more servings of
vegetables per week were 35% less likely to develop prostate cancer than
those who had less than 14 servings per week.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and
tomatoes) and vegetables (such as squash and bell peppers).
Avoid refined foods, such as white breads, pastas, and especially sugar.
Quality protein sources, such as organic meat and eggs, whey, and vegetable
protein shakes, may be used as part of balanced program aimed at gaining
muscle and preventing weight loss that can sometimes be a side effect of
cancer therapy. Try to eat fewer red meats and more lean meats such as
chicken and fish, tofu (soy, if no allergy), or beans for protein.
Eat cruciferous vegetables (such as broccoli, cabbage, and cauliflower) -they contain special cancer fighting chemicals.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods
such as cookies, crackers, cakes, French fries, onion rings, donuts, processed
foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.
Prostate Cancer Prognosis
The outlook for a man with prostate cancer depends on
his age, the stage of tumor growth, whether he has any
underlying medical illnesses, and his PSA levels.
The prognosis for men with cancer that has not spread
beyond the prostate is quite good. Most of these cancers
are curable with appropriate treatment, and after 15
years the same number of these men will be alive as
those who never had prostate cancer.
If the cancer spreads beyond the prostate and does not
respond to hormone medications, however, there is
little hope for a cure. Still, prostate tumors are slowgrowing, and even men with advanced prostate cancer
can survive for 5 years or more.
Male-Gender Related
More Common
Cancer Sites
Prostate
Testis
Testicular Cancer
Testicular cancer occurs in the testicles (testes), which are
located inside the scrotum, a loose bag of skin
underneath the penis. The testicles produce male sex
hormones and sperm for reproduction.
Compared with other types of cancer, testicular cancer
is rare.
Most common cancer between the ages of 15 and 34.
The cause of testicular cancer is unknown.
Testicular cancer is highly treatable, even when cancer
has spread beyond the testicle.
Depending on the type and stage of testicular cancer, you
may receive one of several treatments, or a combination.
Regular testicular self-examinations can help identify
growths early, when the chance for successful treatment of
testicular cancer is highest.
Testicular Cancer –
Symptoms
A lump or enlargement in either testicle
A feeling of heaviness in the scrotum
A dull ache in the abdomen or groin
A sudden collection of fluid in the scrotum
Pain or discomfort in a testicle or the scrotum
Enlargement or tenderness of the breasts
Unexplained fatigue or a general feeling of not
being well
Cancer usually affects only one testicle.
Testicular Cancer –
Causes
Nearly all testicular cancers begin in the
germ cells — the cells in the testicles that
produce immature sperm.
What causes germ cells to become abnormal
and develop into cancer isn't known.
Testicular Cancer –
Risk Factors
An undescended testicle (cryptorchidism). The testes form in the
abdominal area during fetal development and usually descend into the
scrotum before birth. Men who have a testicle that never descended are
at greater risk of testicular cancer than are other men are. The risk
remains, even if the testicle has been surgically relocated to the
scrotum. Still, the majority of men who develop testicular cancer don't
have a history of undescended testicles.
Abnormal testicle development. Conditions that cause testicles to
develop abnormally, such as Klinefelter's syndrome, may increase your
risk of testicular cancer.
Family history. If other family members have had testicular cancer,
you may have an increased risk.
Age. Testicular cancer affects teens and younger men, particularly
those between ages 15 and 34. However, it can occur at any age.
Race. Testicular cancer is more common in white men than in black
men. The reason for racial differences in the incidence of testicular
cancer is unknown.
Testicular Cancer –
Diagnosis
Most men discover testicular cancer themselves, either unintentionally or
while doing a testicular self-examination to check for lumps. In other
cases, your doctor may detect a lump during a routine physical exam.
To determine whether a lump is testicular cancer, your doctor may
recommend:
Ultrasound. A testicular ultrasound test uses sound waves to create a
picture of the scrotum. During an ultrasound you lie on your back
with your legs spread; a clear gel is applied to your scrotum. A handheld probe is moved over your scrotum to make the ultrasound image.
Determine the nature of any testicular lumps, such as if the lumps are solid
or fluid filled.
Determine whether lumps are inside or outside of the testicle. .
Blood tests. To determine the levels of tumor markers in your blood.
Tumor markers (AFP, B-HCG) are substances that occur normally in your
blood, but the levels of these substances may be elevated in certain
situations, including testicular cancer.
Testicular Cancer –
Surgery & Biopsy
Surgery to remove a testicle (radical inguinal orchiectomy). If your
doctor determines the lump on your testicle may be cancerous, he
or she may recommend surgery to remove the testicle. Your
testicle will be analyzed in a laboratory to determine if the lump is
cancerous and, if so, what type of cancer.
In general, a biopsy or removal of the lump alone isn't used when
testicular cancer is suspected. However, a biopsy may be an option
in certain situations, for instance, if you have only one testicle.
Surgery is done also to remove the lymph nodes in your groin
(retroperitoneal lymph node dissection). Sometimes this is done at
the same time as surgery to remove your testicle. In other cases it
can be done later.
In cases of early-stage testicular cancer, surgery may be the only
treatment needed.
Testicular Cancer –
Pathology Types
Determining the type of cancer
The type of testicular cancer you have determines your treatment and
your prognosis.
In general, there are two types of testicular cancer:
Seminoma. Seminomas occur in all age groups, but if an older man
develops testicular cancer it is more likely to be seminoma. Seminomas, in
general, aren't as aggressive as nonseminomas, and are particularly
sensitive to radiation therapy.
Nonseminoma. Nonseminoma tumors tend to develop earlier in life and
grow and spread rapidly. Nonseminomatous tumors are sensitive to
radiation therapy, but not as sensitive as seminomas. Chemotherapy is
often very effective for nonseminomas, even if the cancer has spread.
Several different types of nonseminomatous tumors exist, including
choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor.
Sometimes both types of cancer are present in a tumor. In that case, the
cancer is treated as though it is nonseminoma.
Testicular Cancer –
Chemotherapy
Chemotherapy treatment uses drugs to
kill cancer cells. Chemotherapy
drugs travel throughout your body
to kill cancer cells that may have
migrated from the original tumor.
Chemotherapy is done after surgery.
Chemotherapy may be used before
or after lymph node removal.
Testicular Cancer –
Radiotherapy
A treatment option for seminoma
type of testicular cancer.
Radiation therapy uses highpowered energy beams, such as Xrays, to kill cancer cells.
Testicular Cancer –
Advanced or Recurrent
The cancer can be localized in the scrotal
sac or has spread into the pelvic area
or distant sites. Ct Scans can detect if
the cancer is advanced or metastatic at
diagnosis or has recurred elsewhere.
Rising titers of tumor markers also
indicates presence of cancer
Treatment of choice is chemotherapy and
supportive care
Early Detection of Testicular Cancer –
Testicular Self Exam
Examine your testicles once a month, after a warm bath or shower. The heat from the water relaxes
your scrotum, making it easier for you to check for anything unusual.
To do a testicular self-exam, follow these steps:
Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
Examine each testicle with both hands. Place the index and middle fingers under the testicle while
placing your thumbs on the top.
Gently roll the testicle between the thumbs and fingers. Feel for lumps and bumps. Remember
that the testicles are usually smooth, oval shaped and somewhat firm.
If you find a lump, call your doctor as soon as possible. Signs and symptoms of cancer include
lumps, swelling, a heavy-feeling testicle and pain. Don't be embarrassed about calling your doctor
if you find a lump or other problem. Early diagnosis is important — over time, testicular cancer
can spread and it becomes more dangerous and difficult to treat.
When to seek medical advice
See your doctor if you detect any pain,
swelling or lumps in your testicles or
groin area, especially if these signs and
symptoms last longer than two weeks.
Make an appointment with your doctor
even if a lump in your testicle isn't
painful. Only a small percentage of
testicular cancers are painful from the
outset.