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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.