Male Reproductive Cancers

Front 1

What is the primary function of the male reproductive system?

Back 1

to produce sperm cells and deliver them into the female reproductive tract.

Front 2

What are the primary organs of the male system? and what are formed there?

Back 2

the 2 testes in which the sperm cells are formed.

Front 3

What are the other 2 groups of accessory organs

Back 3

internal and external reproductive organs

Front 4

Describe the testes

Back 4

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

Front 5

What are the seminiferous tubules?

Back 5

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

Front 6

What is also known as the sperm cell factories?

Back 6

seminiferous tubules

Front 7

What are other specialized cells called and where are they located, and what do they secrete and produce?

Back 7

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.

Front 8

In young males what are the sperm cells called

Back 8

they are called spermatogonia and are undifferentiated

Front 9

When and what caused undifferentiated spermatogenic cells to change?

Back 9

Hormones during early adolescence

Front 10

What do spermatogenic cells do to become primary spermatogonia?

Back 10

they begin to undergo mitosis and some of them enlarge

Front 11

How many chromosomes do secondary spermatocytes contain?

Back 11

23

Front 12

What happens to secondary spermatocytes do soon after they are formed?

Back 12

they each divide again and the result is four spermatids with 23 chromosomes each

Front 13

How do spermatids become transformed into mature sperm cells?

Back 13

by a process of differentiation which is called spermatogenesis

Front 14

What is the epidiymis?

Back 14

a coiled tube which lies on the outer surface of each testis

Front 15

Where do sperm complete there maturation and are stored?

Back 15

in the epididymis

Front 16

From the seminiferous tubules sperm passes through what? into the ?

Back 16

sperm pass through a network of small tubules into a large tube, the epididymis

Front 17

Where does the epididymis empty into?

Back 17

a straight tube, the vas deferens or sperm duct

Front 18

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

Back 18

the inguinal canal

Front 19

Which way does the vas deferens loop after entering the pelvic cavity?

Back 19

they loop over the side and then down the posterior surface of the urinary bladder

Front 20

What happens to the vas deferens when it nears termination?

Back 20

it becomes dilated into a portion called the ampulla

Front 21

What does the vas deferens unite with just outside of the prostate gland?

Back 21

it becomes slender and unite with the duct of a seminal vesicle

Front 22

What is the seminal vesicle?

Back 22

it is a saclike structure near the base of the bladder.

Front 23

What does the seminal vesicle secrete?

Back 23

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

Front 24

What forms the ejaculatory duct and where does it pass through?

Back 24

The fusion of the ducts of the vas deferens and seminal vesicle and passes the substances of the two through the prostate gland.

Front 25

Describe the prostate gland?

Back 25

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

Front 26

How many lobes compose the prostate gland and what does it secrete?

Back 26

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.

Front 27

What enhances the motility of sperm cells and why?

Back 27

the milky fluid with alkaline pH from the prostate, because they remain immobile in the acidic contents of the epididymis.

Front 28

What does the prostatic help do?

Back 28

helps neutralize the acidic secretions of the vagina and help sustain sperm cells that enter the female reproductive tract.

Front 29

What are the small glands which lie below the prostate?

Back 29

Bulboruethral glands or Cowper's glands

Front 30

What do the bulboruethral glands or Cowper's glands secrete and it's function.

Back 30

secrete a mucous like fluid which is released in response to sexual stimulation and helps lubricate the penis

Front 31

Seminal fluid (semen) is slightly _____ __ with the average number present in the fluid is about ______ per __.

Back 31

semen is slightly alkaline pH with 120 million per ml

Front 32

Sperm cells are _____ and account for ___ of the semen volume.

Back 32

so tiny and account for less than 1% of semen volume.

Front 33

Semen (seminal fluid) is conveyed by the _____ and consists of (4)

Back 33

conveyed by the urethra and consists of sperm cells and secretions from seminal vesicles, prostate glands, and bulbourethral glands.

Front 34

What are the male external reproductive organs?

Back 34

scrotum and penis

Front 35

What encloses the testes?

Back 35

scrotum

Front 36

Where dose the urethra pass?

Back 36

the penis

Front 37

Prostatic cancer is the most common cancers for what age?

Back 37

men over 50 and rarely seen in younger age groups

Front 38

65 is the peak age of incidence for which male cancer. and is higher is which race.

Back 38

prostate cancer and is higher in blacks than whites

Front 39

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?

Back 39

at a young age in a more advanced stage. mortality in blacks is twice that then whites

Front 40

What is prostate cancer seem to be linked to? And who has a higher frequency of it?

Back 40

linked to hormones and is higher in people who had a venereal disease and familial connection.

Front 41

What is prostate cancer found concurrently with?

Back 41

benign prostatic hyperplasia (BPH)

Front 42

Prostate cancer is almost exclusively what histology?

Back 42

adenocarcinoma

Front 43

Where does prostate cancer generally rise? and where does BPH generally arise

Back 43

prostate cancer arises on the periphery of the prostate.
BPH usually originates from the central portion of the gland.

Front 44

prostate sarcomas are ____

Back 44

rare

Front 45

How are tumors of the prostate classified?

Back 45

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.

Front 46

As per the Gleason score, which score is less aggressive?

Back 46

Low scores are less aggressive than higher scores

Front 47

What is the appearance of adenocarcinomas of the prostate.

Back 47

range from well differentiated to undifferentiated neoplasms

Front 48

Majority of prostatic cancers have more than ____

Back 48

histologic pattern

Front 49

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

Back 49

digital rectal examination

Front 50

Where does prostate cancer usually originate.

Back 50

in the posterior lobe which is easily reached by the index finger.

Front 51

Normal BPH feels similar to _____, while prostate cancer feels like _____

Back 51

BPH- tip of nose
Prostate Ca- one's knuckle

Front 52

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

Back 52

transrectal ultrasound

Front 53

50% of asymptomatic prostate ca are found by

Back 53

digital exam

Front 54

How do most symptomatic prostate patients present?

Back 54

with local symptoms- urinary outflow blockage or unexplained cystitis

Front 55

When does diagnosis of prostate ca occur?

Back 55

when prostatic tissue is removed to relieve bladder outlet obstruction for what was thought to be BPH

Front 56

What are late presenting symptoms of prostate ca?

Back 56

-bone pain
-uremia (toxic condition; retention of nitrogen in blood)
-anorexia

Front 57

What is the preferred method of obtaining histologic diagnosis for prostate ca?

Back 57

transrectal or perineal needle biopsy

Front 58

What may be used for moderately advanced lesions producing obstructive symptoms (prostate)?

Back 58

transurethral resection of the prostate (TURP)

Front 59

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

Back 59

10%

Front 60

What is very suggestive of metastatic disease of prostate?

Back 60

an elevated serum prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) levels appear to be proportional to prostatic volume

Front 61

Normal level of prostate ca are?

Back 61

due to the age of the patient

Front 62

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

Back 62

-bone scans rule out bone mets
-pelvic CTs detect pelvic lymphadenopathy

Front 63

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

Back 63

85%
multifocal

Front 64

What is present in almost all cases of prostate ca?

Back 64

perineural invasion

Front 65

Extension to the capsule occurs early in prostate ca, but usually not before

Back 65

invasion of the prostate has caused obstructive symptoms

Front 66

What has a profound influence on survival in prostate ca?

Back 66

perforation of the capsule and/or extention into the seminal vesicles

Front 67

What else gets involved late in prostate ca?

Back 67

bladder, rectal, and extention to pelvic wall

Front 68

What does lymph node invasion in prostate ca depend on?

Back 68

the size of the tumor and the degree of differentiation

Front 69

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

Back 69

1-obturator
2-external iliac
3-hypogastric lymph nodes
in that order

Front 70

Is regional lymphatic mets common from cancer of prostate?

Back 70

yes

Front 71

In terms of blood borne disease the veins draining the prostate form

Back 71

a well defined plexus around the base of the gland

Front 72

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

Back 72

vertebral system
axial skeleton

Front 73

Mets of prostate ca go to

Back 73

-liver
-lungs
-brain
-and sometimes preferentially to the bones of the pelvis and spine

Front 74

What are the 5 treatment options for prostate ca?

Back 74

1- observation for pts w/ stage 1A
2- radical prostatectomy (limited to healthy males w/ early stage and no mets)
3-interstitial (iodine or gold) therapy + ext XRT
4- external XRT
5- hormonal manipulation

Front 75

Radical prostatectomy is effective in treating what? what occurs and what percent of pts are eligible for this procedure?

Back 75

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

Front 76

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

Back 76

Impotence.
newer nerve sparing procedure
other complications- blood loss and fistula formation between the bladder and rectum

Front 77

What is the major issue of radiotherapy for prostate ca?

Back 77

the incorporation of pelvic and para-aortic lymph nodes

Front 78

When utilizing XRT to treat prostate ca what energy is used? dose to tumor? dose to nodes?

Back 78

high energy units above 10 mV
tumor- 75-80 Gy
nodes- 50-55 Gy

Front 79

What are XRT portal arrangements for prostate ca?

Back 79

4 field box or IMRT followed by boost to the tumor itself

Front 80

What is interstitial treatment for prostate ca?

Back 80

-if only treatment and is early stage- Iodine 125
-xtra cap extent- Palladium 103
=as an initial boost to the tumor

Front 81

How is interstitial tx done for prostate ca? What are the doses?

Back 81

This procedure is done under anethesia and the seeds may be implanted by Mick gun.
Dose 125-145 Gy followed by 40-50 Gy of XRT to gland itself and primary echelon of nodes

Front 82

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

Back 82

slow
many months
-tumors have long cell cycle time and takes several divisions before lysis occurs

Front 83

What are side effects of irradiation of prostate

Back 83

-similar to pelvic irradiation
-impotence in up to 35%- XRT and 15%- interstitial

Front 84

What happens with palliative RT of prostate ca? What doses?

Back 84

Because pts with mets may survive many months or years, a relatively high dose should be used to avoid retreatment.
Doses 40-50 Gy in 3-4 wks

Front 85

What is hormonal tx of prostate ca reserved for?

Back 85

demonstration of symptomatic local reccurrence or distant mets

Front 86

Describe hormonal tx for prostate ca.

Back 86

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

Front 87

What is the prognosis of prostate ca?

Back 87

10 yr survival involving radical surgery for small tumors was 60%.

Front 88

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

Back 88

testis cancer

Front 89

Why is testis cancer important?

Back 89

because it is commonly found in pts between 20-34 and potential of productive yrs of life lost.

Front 90

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

Back 90

curable

Front 91

What are the commonest form of cancer in men between 15-44

Back 91

testis cancer, leukemia, and lymphoma

Front 92

Who are testis tumor rarely found in?

Back 92

American blacks, Africa, Asia, and New Zealand

Front 93

What is the etiology of testis cancer?

Back 93

-more frequent in identical twins
-higher in undescended testis

Front 94

What is the incidence of undecended testicles?

Back 94

1 in 80 inguinal testes and 1 in 20 abdominal testes

Front 95

What have been suspected with testes cancer?

Back 95

-gonadal dysgenesis
-elevated temp
-interference w/ blood supply
-atrophy

Front 96

What is the histology of testicular cancers?

Back 96

95%- germ cell
5%- non-germ cells

Front 97

Of germ cell testicular tumors the most common kinds are?

Back 97

seminomas 35-50% of all germ cell tumors

Front 98

What is the peak age of incidence for seminomas of testicular ca?

Back 98

40 yrs -most testes cancers occur at relatively young ages; the most common testicular cancer in elderly men is lymphoma

Front 99

Which makes up 1-3% of all germ cell tumors of testes?

Back 99

Choriocarcinoma- which has the worst prognosis

Front 100

What are other types of testicular cancers?

Back 100

-embryonal carcinomas
-teratoma carcinomas
-yolk sac tumors

Front 101

How does testicular cancer present?

Back 101

as a painless scrotal mass ranging 1- over 10 cm in diameter.

Front 102

90% of testicular masses are brought to doctors attention by

Back 102

the patient making self exams

Front 103

What are signs of testicular ca?

Back 103

-feeling of heaviness
-pain due to hemorrhage w/in tumor

Front 104

Approx 96% of solid tumors of testis are ___.

Back 104

malignant

Front 105

Pts w/ testicular tumors should exam for mets-

Back 105

-mass of epigastrium
-enlarged spclv node (Virchow's node) palpable

Front 106

Gynecomastia (testes tumor) may be present if

Back 106

it produces HCG (human chorionic gonatropin) or estrogens

Front 107

Testicular ca has 2 biochemical markers

Back 107

HCG and AFP (alpha-fetoprotein)

Front 108

The 2 biochemical markers (testes) serves as guides for

Back 108

staging
-choice of therapy
-its effectiveness
-early reoccurrence

Front 109

(testes) To stage germ cell what method? stage pure seminoma?

Back 109

abd pelvic CT- germ cel
lymphangiography- seminoma

Front 110

To bx testes

Back 110

inguinal exploration followed by orchiectomy

Front 111

How do testicular neoplasms spread?

Back 111

orderly to lymphatics and adj tissues

Front 112

Where do advanced and ingnored testicular neoplasms disseminate to?

Back 112

lungs, liver, and brain
blood borne mets from seminoma of testes is lung

Front 113

Where do majority of testis lymph terminate?

Back 113

in lumbar lymph nodes between T11 and L4

Front 114

What testis tumors are radiosensitive?

Back 114

lyphomas and tumors from germinal epithelium

Front 115

Nongerminal cell of testis require what tx?

Back 115

they are radioresistent and require surgery

Front 116

How do you surgically dx testicular tumors?

Back 116

orichectomy
as well as bilateral retroperitoneal lymph node dissection

Front 117

Tx for nonseminomatous testes tumors

Back 117

Surgery w/ chemo

Front 118

RT for seminomas (testes) is tx of choic if

Back 118

-no disease above diaphragm
-no lymph mets
-no elevated serum markers
-Stage 1

Front 119

If retroperitoneal disease of testes RT if

Back 119

disease is less than 5 cm

Front 120

Where is RT of testes given?

Back 120

zone of nodal drainage- the lumbar periaortic area and in ipsilateral groin region

Front 121

What is the RT tx for testes?

Back 121

AP/PA fields to 2000-2500 cGy in 2-3 wks

Front 122

What dose can induce permanant sterility in men?

Back 122

max dose of 200 cGy in one fx

Front 123

Complication of testes RT is

Back 123

decreased sperm
sterility

Front 124

Chemo is tx of choice for (testes)

Back 124

-nonseminomas
-stage 3 and 4
-when RT fails

Front 125

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

Back 125

close to 100% cure
tx- radical orchiectomy followed by RT

Front 126

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

Back 126

95%

Front 127

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

Back 127

US- less than 1%
non-circumcized/ bad hygeine -10-12%

Front 128

What is the histology of penile ca?

Back 128

squamous

Front 129

What give most protection against developement of penile ca?

Back 129

neonatal circumcision

Front 130

How does penile ca present?

Back 130

penile growth, ulcer, or foul smell
-inguinal adenopathy or ulceration

Front 131

What symptoms of penile ca?

Back 131

painless w/ erosion w/ attendant bleeding w/o pain

Front 132

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

Back 132

50%

Front 133

After bx confirms dx cancer, penile ca is evaluated with regard to

Back 133

size, location, and if lesion is fixed
w/ attention should be given to penile base and scrotom to check for extention

Front 134

How does penile cancer spread?

Back 134

direct extention and lymphatics- tx prevents future spread

Front 135

Where does lymphatics of penis drain?

Back 135

into superficial inguinal nodes
then external iliac nodes
then periaortic nodes

Front 136

What is primary tx of penis ca?

Back 136

surgery and XRT

Front 137

What is the goal of surgery of penis?

Back 137

remove lesions w/ adequate margins to guard against local failure

Front 138

Small tumors of penis can be managed with ____ alone.

Back 138

circumcision

Front 139

Penectomy w/ urethrostomy is for

Back 139

malignant lesions of proximal shaft

Front 140

RT is used for tx of (penis)

Back 140

-small primary carcinomas
-palliation
-nonresectable tumors
-lymph node mets
-avoid the cosmetic and functional deficits left by surgery and devastating psychological effects on patients

Front 141

RT for penis techniques and doses

Back 141

electrons- superficial lesion
mV- infiltrating tumors over .5 cm thick
65-70 Gy in 5-7 wks
-interstitial implants with Radium 226, cesium, or iridium 60 Gy -6 days
-surface molds w/ radioactive sources

Front 142

5 year survival penis

Back 142

25-80% depending on stage