Name the tumours of the penis?
Sqaumous Carcinoma
Bowen’s disease - carcinoma in situ
Describe squamous carcinoma-in-situ of the penis?
Two types:
- Appears as a dry crust on the penile skin
Called Bowen’s disease
- Red velvetly appearance on glans
Called Erythroplasia of Queyrat
Describe erythroplasia of Queyrat?
This a red velvety appearance of glans of the penis
Describe the histological features of Bowen’s disease and Erythroplasia of Queyrat?
What % of these areas of carcinoma in situ go on to develop squamous carcinoma?
- Full thickness dysplasia
5% of these go on to become squamous carcinoma
Describe Squamous Carcinoma of the penis?
- Where is it common?
- Who does this occur in?
- Protective factors?
Uncommon in the UK - high incidence like latin america, africa, far east
Uncircumcised men (almost exclusively)
Early circumsion
Aetitology of squamous cell carcinoma of the penis?
- Poor hygeine (accumulation of chemicals)
- HPV (Human Papilloma Virus)
Where does squamous carcinoma of the penis affect?
Describe the lesion seen in SCC of the penis?
Glans or Prepuce
Ulcerated and deeply invasive mass
OR Exophytic mass (like a caluiflower)
Describe squamous cell carcinoma of the scrotum?
Similar to SCC of the penis
First historical example of occupational exposure having carciogenic effect (Seen in chimneysweeps)
What does this photo show?
Advanced squamous cell carcinoma of the penis
- Shows ulcerated area
Virtually all of the malignant tumours in the penis are…?
(What type)
Squamous Cell Carcinoma
Describe Benign Nodular Hyperplasia of the Prostate (BNHP)
This is a common disorder
Causes irregular proliferation of the glandular and stromal prostatic glandular tissue
How common in Benign Nodular Hyperplasia of Prostate?
Very common
75% of men over 70 are affected
Although only 5% of these men have significant symptoms
Aetiology of Benign Nodular Hyperplasia of Prostate?
Hormone imbalance
As men get older, androgen decreases
Oestrogen levels remain constant
Change in the androgen/oestrogen level though to be important
Which part of the prostate is invovled in BNHP?
Relate this to hormones?
The central part of the prostate gland
More responsive to oestrogen
In BNHP there is bladder sphincter mechanism disturbance. Describe how?
Either:
- Physical Obstruction
(Enlarged tissue mass)
- Physiological Interference
(In/around peri-urethral glands at the internal urethral meatus)
Symptoms of benign nodular hyperplasia of the prostate are collectively called?
List the symptoms?
Prostatism
- Difficulty in intiating micturition
- Poor stream
- Overflow incontinence (bladder doesn’t fully empty)
Most often have chronic urinary retention although there can be acute urinary retention (emergency)
Describe the complications of benign nodular prostatic hyperplasia?
- Bladder hypertrophy which can lead to diverticulae formation
If untreted - hydroureter, hydronephrosis, kidney infection
Treatment of benign nodular prostatitic hyperplasia?
Alpha Blockers
5 Alpha Reductase Inhibitors
Is benign nodular prostatic hyperplasia a pre-malignant condition?
No
It does not increase likelihood of developing cancer
What does the photo show?
Bladder with benign nodular hyperplasia
Prostate can be seen acting as an obstruction
Describe carcinoma of the prostate?
- Common or rare?
- How common is it compared to other cancers?
- Who does it affect?
This is common
One of the most common cancer causes of death (Joint 1st with lung cancer)
Tumour of elderly males - rare before 50yrs, peak between 60-80
Describe link between family history and prostate cancer?
Those with a 1st degree relative who had prostate cancer (especially if they were young) have an increased risk
Describe the link between BNHP and prostate cancer?
They are not linked (Eg: one does not cause the other)
HOWEVER both occur in the same gland
What condition does this photo show?
Describe it?
Benign Hyperplasia of the Prostate
‘Tree like’ proliferation of glandular tissue with increase in the amount of stroma
What part of the prostate does prostate carcinoma develop in?
What part of the prostate does benign nodular hyperplasia develop in?
Prostate Carcinoma: Periperhal parts of prostate
Hyperplasia: Central
Link the location of where prostate carcinoma develops to the stage and symptoms?
Prostate carcinoma develops in central
Late stage affects the periphery
This can cause symptoms of obstruction
SO: Symptoms don’t present until late stage
Symptoms of prostate carcinoma present very early.
True or False?
False - they often present late as the carcinoma doesn’t reach prostate periphery until late stage
Most have advanced stage and metastasis
Describe latent carcinoma of the prostate?
Microscopic cancer foci is found often during autosopy of elderly men
A large number of elderly men will have prostate cancer but it causes no symptoms
Do most elderly people do OF prostate carcinoma or WITH prostate carcinoma?
Most die with prostate carcinoma
It is the latent form and not causing any symptoms - most don’t even know they have it.
Treatment for an 85 year old male with a small foci of prostate cancer on biopsy?
Wouldn’t treat
Unlikely to be clinically significant
Would treat if he was 50
How does prostate carcinoma spread?
Local: Urethral infilitration, pelvic cavity infiltration, bladder infiltration, rectum infilitration
Lymphatic: To sacral, iliac and para-aortic nodes (early)
Blood: Bone, Liver, Lungs
Describe the appearance of metastatic prostate cancer to the bone?
Osteosclerotic Bone Lesions
(Denser than normal bone)
Charactertisitic of prostate cancer
Diagnosis of prostate cancer?
- Rectal Examination
Craggy, hard, irregular prostate
Imaging:
Ultrasound, Skeletal X-Rays, Bone Scans (for mets)
Biochemical:
Prostate Specific Antigen (PSA) - most prostate cancers have a rise in PSA
Biopsy (definitive diagnosis)
What does this photo show?
Prostate Cancer Metastatic
(Osteosclerotic Lesions)
Lumbar Vertebrae
Treatment of prostate carcinoma?
Which is the best treatment?
- Hormonal Therapy (Especially in advanced cases and males - Anti-androgens (Eg: Oestrogen)
- Radiotherapy - Bony metastases
- Surgery - Radical Prostectomy
BEST IS RADICAL PROSTECTOMY
Describe testicular tumours?
- How common?
- Who?
- How often does it cause death?
- Risk factor?
Relatively uncommon although increasingly incidence
Most common solid organ malignancy in young men
Causes about 1% of all cancer deaths
Undescended testicals increases risk
Symptoms of testicular tumours?
Painless Testicular Enlargement
What should you suspect in a painful testicular swelling?
Infection
Torsion
NOT TUMOURS
What can testicular tumours be associated with?
Hydroceles
Gynacomastia
Systemic effects of malignant disease
Classification of testicular tumours?
Germ Cell Tumours - Most common (90%)
Others - (10%)
Paratesticular Tumours
Name the germ cell tumours?
Seminoma
Teratoma
Mixed
Name the other tumours of the testicles?
Leukemia
Lymphoma
Metastases
Describe seminoma?
- Age range?
- Seen before puberty?
- Appearance?
- Histology?
Commonest of the germ cell tumours
Peak age range is 30-50
Never seen before puberty
Cut surface of a potato
Abundant large clear cells
Who would a conventional seminoma appear in?
Who would a spermatocytic seminoma appear in?
Conventinal = Young to middle aged
Spermatocytic = Elderly
Treatment of a Seminoma?
Prognosis?
Radiotherapy
Very sensitive - 95% are cured even with extensive metastatic spread
Describe spread of seminoma?
Lymphatic to para-aortic lymph nodes
Often massive tumours
Can spread via blood to lungs
What does this photo show?
POTATO LIKE TUMOUR
Seminoma
Describe the second most common germ cell tumour?
What does this derive from?
Teratoma
Derived from all germ cell lines
Teratoma:
- Peak incidence?
- Seen before puberty?
- Appearance?
20-30 year old males
Can be seen before puberty
Various appearance - solid malignant areas, cystic areas, areas of necrosis
What does this picture show?
Teratoma Tumour
What biochemical markers are seen in Seminomas?
PLAP
(Placental Alkaline Phosphatase)
What biochemical markers are seen in teratomas?
AFP
(Alpha Feta-Protein)
bHCG (Beta HCG)
Describe a mixed seminoma/teratoma?
This a seminoma with any of the types of teratoma
Describe the use of biochemical markers in testicular tumours?
- Used to assess tumour activity
- Used to assess effectiveness of treatment
- Used to look for recurrence