Pelvis Presentation PDF

Presented by Pelvis Jonathan Brack Prostate / Rectum Session outline Aetiology, Signs and epidemiolog Histology, symptoms, y, Staging, Investigatio Treatment...

Presented by Pelvis Jonathan Brack Prostate / Rectum Session outline Aetiology, Signs and epidemiolog Histology, symptoms, y, Staging, Investigatio Treatment grading, ns, and survival spread,  The Prostate Prostate Cancer Statistics UK Prevention Aetiology of Prostate Cancer Epidemiology of Prostate Cancer Prostate Cancer Incidence By Age Trends Over Time Projected Incidence  Adenocarcinoma of the Prostate prostate Adenocarcinomas develop in the Cancer gland cells that line the prostate gland and the tubes of the prostate gland. Gland cells make prostate Histology fluid. Adenocarcinomas are the most common type of prostate cancer. Nearly everyone with prostate cancer There are 2 types of has this type. adenocarcinoma of the prostate: Acinar adenocarcinoma of the prostate Most people have this type. It develops in the gland cells that line the prostate gland. Ductal adenocarcinoma of the prostate Ductal adenocarcinoma starts in the cells that line the tubes (ducts) of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma. Transitional cell carcinoma of the prostate Transitional cell carcinoma of the prostate starts in the cells that line the tube carrying urine to the outside of the body (the urethra). This type of cancer usually starts in the bladder and spreads into the prostate. But rarely it can start in the prostate and may spread into the bladder entrance and nearby tissues. This is sometimes called urothelial carcinoma of the prostate. Between 2 and 4 out of 100 prostate cancers (between 2 and 4%) are this type.  Squamous cell carcinoma of the prostate These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than Less adenocarcinoma of the prostate. Common Small cell prostate cancer Small cell prostate cancer can Forms of also be classed as a type of neuroendocrine cancer. They Prostate tend to grow more quickly than other types of prostate cancer. Cancer Other rarer types of prostate cancers sarcoma lymphoma  Investigations Digital rectal exam (DRE) PSA test Trans rectal ultrasound (TRUS) Needle biopsy MRI CT  TNM Staging -Prostate T-stage: T1a - incidental histologic finding in 5% or less of tissue resected T1b - incidental histologic finding in more than 5% of tissue resected T1c – identified only by needle biopsy (e.g., because of elevated PSA) T2a - involves one half of one lobe or less T2b - involves more than one half of one lobe but not both lobes T2c - involves both lobes T3a – extra-capsular extension (unilateral or bilateral) T3b - invades seminal vesicles T4 - fixed or invades adjacent structures other than seminal vesicles: bladder neck, rectum, levator muscles, and/or pelvic wall  TNM Staging -Prostate (cont) N-stage: Nx – Nodes not assessed N0 – no evidence of nodal spread N1 – evidence of nodal spread M-stage: M0 – no spread outside of the pelvis M1a – spread to non-regional lymph nodes M1b – spread to bone M1c - other sites Regional lymph nodes: pelvic, hypogastric, obturator, iliac (internal, external), sacral Distant lymph nodes: aortic, common iliac, inguinal (deep), inguinal (superficial, femoral), supraclavicular, cervical, scalene, retroperitoneal TNM Staging -Prostate (cont) Overall stage: I - T1a N0 G1 II - T1a /G2-4, T1b-1c, T2 III - T3 N0 IV - T4, N1, M1 Grading G1 - well differentiated (Gleason 2-4) G2 - moderately differentiated (Gleason 5-6) G3-4 - poorly differentiated (Gleason 7- 10) Gleason Score – what is it? Multiple samples. Add 2 highest scores together. Spread of Prostate Cancer Lymph nodes in the pelvis Lymph nodes outside the pelvis Bones Prostate Management The Rectum Bowel cancer statistics Prevention  Existing bowel disease Polyps Ulcerative colitis Crohn’s Disease Aetiology (granulomatous colitis/regional enteritis) of Rectal Smoking, obesity, limited Cancer exercise Diet Genetic – screening programmes Epidemiology of Colo-Rectal Cancer Bowel Cancer Incidence by age Bowel Cancer Incidence by Anatomical Site Bowel Cancer Incidence Projections  Adenocarcinoma = 90- Rectal 95% Mucinous – 6% of Cancer adenocarcinomas (goblet cells) Histology Signet Ring - rare Other much rarer types include: Leiomyosarcoma Lymphoma Melanoma SCC  Signs and symptoms Some patients will be asymptomatic and their cancers will be detected by FOB testing Rectal bleeding (and sometimes associated anaemia) Change in bowel habit Sensation of incomplete emptying of rectum Fatigue Weight loss Pelvic pain, particularly on passing stools More advanced disease – may also present with bowel obstruction, vomiting, peritonitis, ascites, hydronephrosis Investigatio ns FOB test History and examination, including DRE FBC Colonoscopy Chest x-ray CEA assay (Carcino- embryonic antigen) CT MRI Pet/CT Rectal Grading The grades of bowel cancer cells are from 1 to 4: Low grade – slow growing Grade 1- well differentiated, the cells look most like normal cells Grade 2 – moderately differentiated – the cells look a bit like normal cells High grade – fast growing Grade 3 – poorly differentiated, the cells look very abnormal Grade 4 – undifferentiated, the cells look completely different from normal cells TNM staging Spread of Rectal Cancer Local invasion Transcoelomic Lymphatic Blood borne spread to lungs and liver Management of Rectal Cancer T1-2, N0: treat with primary surgery. If N+ or pT3 on pathology then adjuvant chemo- RT T3 or N+: treat with pre-op chemo-RT to debulk, followed by surgery, then adjuvant chemo Metastatic (solitary resectable liver mets): chemo-RT or chemo alone, followed by resection of rectal tumour and mets Non- resectable metastatic disease: Chemotherapy with localised radiotherapy Chemotherapy 5FU (+ Leucovorin) Capecitabine Oxaliplatin Monoclonal antibodies (Avastin, Cetuximab) Bone and brain metastases Commonest primary cancers metastasizing to: Bone Brain Prostate Breast Lung Metastases signs and symptoms In groups discuss the common signs and symptoms for bone, spine, lung and brain mets Session outline Review Aetiology, Signs and epidemiolog Histology, symptoms, y, Staging, Investigatio Treatment grading, ns, and survival spread,