Endometrial Carcinoma: Risk Factors & Diagnosis

Prostate Cancer

• Epidemiology: Most common cancer in men; usually diagnosed in men over 50. Frequency increases with age.
• Risk Factors & Etiology: Age, family history (diagnosis under 50 increases risk threefold), African origin, prolonged androgen exposure, obesity, poor diet. Genetic mutations like TMPRSS2-ERG fusion gene, hypermethylation of certain genes, and others.
• Presentation: Asymptomatic in early stages. Later may experience pain when urinating. Symptoms can also include hematospermia, impotence, and impaired semen production.
• Advanced Stages: Characterized by bone pain -osteoblastic metastasis.
• Diagnosis: Prostate-specific antigen (PSA) test (not cancer-specific, repeat if elevated). Digital Rectal Exam (DRE). MRI with Gleason score. Ultrasound-guided biopsies.
• Staging: Determined by tumor size, location (T1-T4), and lymph node involvement(N), and presence of distant metastasis (M).
• Treatment: Watchful waiting for low-grade, early-stage cancers. Prostatectomy (surgical removal of prostate), radiation therapy (RT), or hormonal therapy. Choices depend on stage, patient's overall health.
• Progression & Prognosis: Deadly in only a small portion of cases if caught early. Prognostic factors include PSA score, Gleason score, TMN stage.

Bladder Cancer

• Epidemiology: Sixth most common cancer worldwide, third most common cancer in men. More frequent in men over 50–80 years old.
• Risk Factors & Etiology: The most important risk factor is smoking; Exposure to chemicals (arylamine, phenacetine), prior chemotherapy (cyclophosphamide), radiotherapy, chronic UTIs, neurogenic bladder and schistosomiasis. Genetics may play a low role.
• Subtypes: Urothelial carcinoma (vast majority), Squamous cell carcinoma(SCC), Adenocarcinoma
• Presentation: Hematuria (blood in urine) is most common symptom. Dysuria. Urinary urgency. Bladder irritation. Recurring urinary tract infections. Pelvic/lumbar pain and leg edema, Bone pain.
• Diagnosis: Cystoscopy and biopsy. Urine tests - dipsticks & cytology, full blood counts, liver/kidney function. CT/MRI, IV pyelography, bone scan, PET scan may be used for investigation
• Treatment: Depends on the stage of the disease; no muscle involvement (T1) treatment involves TURB cystoscopy and BCG intravesical or high-risk group, cystectomy is used for muscle involvement (T2). Muscle invasion T3/T4 tumors are treated with aggressive surgery.
• Progression & Prognosis: Often recurrent. Around 80% of cases present with muscle invasion. A poor prognosis is expected in cases with a tumor stage T4.

Renal Cancer

• Epidemiology: More common in men over 60.
• Risk Factors & Etiology: Smoking, obesity, and hypertension are factors that may correlate with the disease.
• Subtypes: Clear cell carcinoma (most common), papillary carcinoma, chromophobe carcinoma.
• Presentation: Mostly painless, but some with hematuria (blood in urine), abdominal mass, or dull flank pain, fever and weight loss (SAA). Hypertension is a symptom in some cases.
• Diagnosis: Urine sample (Blood, Leukocytes, Nitrates). USG to locate the tumor. CT scan (high-resolution). PET-CT. No biopsy.
• Treatment: Nephrectomy (surgical removal of the kidney) for potentially cure able stages. Ablation for inoperable cases. RT and targeted therapy (VEGFR TK+ mTOR) are palliative.
• Progression & Prognosis: Invasion possible to the renal vein or perinephric fat. May metastasize to lungs, bones, liver, and adrenal glands.

Penile Cancer

• Epidemiology: Rare in Europe, common in central Africa and Brazil.
• Risk Factors & Etiology: Caused by HPV 16, 18, 31, 33. Risk factors include poor hygiene, circumcision status, phimosis, lichen sclerosis, smoking, and UVA exposure.
• Presentation: Presence of mass on the penis. Variations in morphology include lump, ulcer, sore, crust, and wart-like lesions.
• Diagnosis: Biopsy of the affected area, USG/MRI of the penis and adjacent structures. Lymph node biopsy is performed if lymph nodes are palpable.
• Treatment: Circumcision if Penile Carcinoma in situ (CIS). Treatments like topical imiquimod, 5-FU, lasers ablation in T1/T2 cases. Radical surgery like partial or total glansectomy is selected for T3/T4 cases. Radiation therapy or inguinal lymph node removal may be part of the treatment.
• Progression & Prognosis: Poor prognosis. Sentinel nodes are inguinal nodes.

Testicular Cancer

• Epidemiology: Most common cancer in young men (20-35).
• Risk Factors & Etiology: Cryptorchidism (undescended testicle) is the only known risk factor, others are Testicular dysgenesis syndrome and Klinefelter syndrome.
• Subtypes: Seminoma (most common type in adults), embryonal carcinoma, yolk sac tumor, teratoma, choriocarcinoma.
• Presentation: Often painless enlargement or lump. Diagnosis can be made by USG, serum markers like LDH, AFP and B-HCG, and biopsies are usually not performed as there is a risk of further spreading.
• Treatment: Orchiectomy (surgical removal of testis). RT or chemo with the stage of the tumor.
• Progression & Prognosis: Good prognosis for seminomas. High chemosensitivity for nonseminomas.

Breast Cancer

• Epidemiology: Most common non-skin malignancy in women; second most common cancer death after lung cancer.
• Risk Factors & Etiology: Female gender, age, family history, BRCA1/2 & TP53 mutations. Other known factors include Caucasian ethnicity, early menarche, late menopause, exposure to estrogen, alcohol, obesity.
• Subtypes: Luminal A, Luminal B, HER2+, Triple-negative,
• Presentation: Painless breast mass, skin changes (retraction, dimpling), nipple inversion, satellite nodules, inflammation.
• Diagnosis: Mammography, USG, MRI, biopsy, receptor status tests (estrogen/progesterone/HER2), and other tests as required depending on the stage.
• Treatment: Breast-conserving surgery + RT, total mastectomy, chemotherapy, hormonal therapy (tamoxifen, aromatase inhibitors).
• Progression & Prognosis: Determined by subtype, tumor size, nodal involvement, estrogen receptor status, and other prognostic factors- Good prognosis with luminal A; poor for triple-negative.

Endometrial Cancer

• Epidemiology: Most common gynecologic malignancy. Primarily affecting postmenopausal women.
• Risk Factors & Etiology: Age, obesity, diabetes mellitus. Exposure to estrogen, early menarche, and late menopause. Genetic mutation (PTEN, MSI, BRCA mutations), family history of breast, ovarian cancer, DES.
• Subtypes: Endometrioid (90%+), Non-endometrioid (serous, clear cell, carcinosarcoma).
• Presentation: Abnormal bleeding (Postmenopausal bleeding, intermenstrual bleeding. vaginal discharge)
• Diagnosis: Pelvic exam, biopsy, dilatation and curettage. Additional investigations like USG, CT, MRI, and staging to assess spread.
• Treatment: Total hysterectomy (often with removal of ovaries), and possible chemotherapy or radiotherapy in advanced stages for metastasis and high-risk factors.
• Progression & Prognosis: Good prognosis for endometrioid; poor prognosis for serous, clear cell, or carcinosarcoma due to higher risk of risk of metastasis (spread) via the peritoneum.

Cervical Cancer

• Epidemiology: Fourth most common cancer in women globally, incidence varies by region.
• Risk Factors & Etiology: HPV, smoking, multiple pregnancies, immunodeficiency (AIDS), DES in utero exposure.
• Subtypes: Squamous cell carcinoma (SCC) accounts for ~ 80–90%. Adenocarcinoma (AC) accounts for ~ 10–15%.
• Presentation: Often asymptomatic in pre-invasive stage. Later presents with bleeding, vaginal discharge, vaginal bleeding, irregular menstrual cycle, pelvic pain, and back pain.
• Diagnosis: PAP smear, HPV testing. After detection, colposcopy, biopsy and tissue analysis is required to know the grade and extent of the disease.
• Treatment: Stage 1A: hysterectomy (removal of uterus). Stage 1B-IIA: Radical hysterectomy with Lymphadenectomy. Stage IIB-IVB: Radiation therapy with chemo.
• Progression & Prognosis: Slow progression; slow process over 10-20 years; HPV → CIN → CIS → invasive carcinoma.

Ovarian Cancer

• Epidemiology: Most lethal gynecologic malignancy.
• Risk Factors & Etiology: Hereditary (BRCA1/2, HNPCC, Lynch syndromes, other syndromes. ) Nulliparity, infertility. Long-term estrogen use.
• Subtypes: Surface epithelial cell tumors (70%): Serous, mucinous, endometrioid, clear cell. Germ cell tumors (15-20%). Sex-cord stromal tumors (2-3%).
• Presentation: Non-specific symptoms, like bloating, abdominal discomfort, loss of appetite, vaginal bleeding, or urinary symptoms.
• Diagnosis: First transvaginal USG and abdominal CT to determine extent of disease. Staging and biopsy.
• Treatment: Surgical staging, oophorectomy and possibly hysterectomy + chemo or RT. Types of chemo therapy depend on the stage of the tumor and the type of cancer.
• Progression & Prognosis: Often discovered late. High risk of peritoneal metastasis.

Vaginal Cancer

• Epidemiology: Rare in both women and men. Primarily affects older adults.
• Risk Factors & Etiology: HPV. Early age DES exposure, vaginal adenosis, history of cervical cancer, vaginal irritation. Smoking and other long-term exposure.
• Subtypes: Squamous cell carcinoma (SCC), adenocarcinoma, clear cell adenocarcinoma, and other subtypes.
• Presentation: Bleeding and discharge (especially after menopause), pain during intercourse, difficulty peeing and other systemic symptoms such as pelvic pain and constipation.
• Diagnosis: Pelvic examination, colposcopy, and biopsy.
• Treatment: Depends on the stage of the tumor; surgical removal of the vaginal tissue in early stages. RT or chemo in advanced stages.
• Progression & Prognosis: Prognosis depends on the stage and the type of cancer.

Assessment covering genetic risk factors, diagnosis, and characteristics of endometrial carcinoma. It focuses on identifying risk factors associated with uterine sarcomas and understanding the spread of malignant cells. The assessment will cover different types of endometrial cancers and associated symptoms.