Prostate Cancer

Prostate Cancer



PROSTATE CANCER
Introduction
Prostate is​ a​ glandular organ present only in​ males. it​ surrounds the​ neck of​ bladder & the​ first part of​ urethra and​ condributes a​ secretion to​ the​ semen. the​ gland is​ conical in​ shape and​ measures 3 cm in​ vertical diameter and​ 4 cm in​ transverse diameter. it​ has got five lobes anterior,posterior,two lateral and​ a​ median lobe. Since the​ first part of​ the​ urethra pass through it​ any lesion in​ the​ prostate will produce difficulty in​ passing urine.
Diseases of​ the​ prostate gland
1 Prostatitis
This is​ the​ inflamation of​ the​ prostate gland due to​ bacterial infection.
2 Benign enlargement of​ the​ prostate
This is​ a​ non cancerous tumour of​ the​ prostate seen after the​ age of​ 50. 3,Cancer of​ the​ prostateThis is​ the​ 4th most common cause of​ death from malignant diseases in​ males.
Cancer of​ the​ prostate.
Cancer of​ the​ prostate is​ directly linked with the​ male sex hormonesandrogens. if​ the​ levels of​ sex hormone increases the​ growth rate of​ cancer also increases. it​ is​ found that after the​ removel of​ testes there is​ marked reduction in​ the​ size of​ tumour.
Site of​ tumour
Prostate cancer is​ seen mainly in​ the​ posterior lobe. Non cancerous enlargement is​ seen in​ other lobes.
Changes in​ the​ gland in​ cancer
The gland becomes hard with irregular surface with loss of​ normal lobulation . Histologically prostate cancer is​ an adeno carcinomacancer of​ the​ epithelial cells in​ the​ gland
Growth
Growth rate is​ very fast in​ prostate cancer . the​ tumour compresses the​ urethra and​ produce difficulty in​ urination.
Spread of​ tumour
Metastasis in​ cancer of​ prostate is​ very early.
1 Local spread
From the​ posterior lobe the​ cancer cells go to​ the​ lateral lobes and​ seminal vesicles. Tumour cells also move to​ the​ neck and​ base of​ the​ urinary bladder.
2 Lymphatic spread
Through the​ lymph vessels cancer cells reach the​ internal and​ external illiac group of​ lymph nodes. From there cells move to​ retroperitonialBehind the​ peritonium and​ mediastinal lymph nodesin the​ chest
3 Spread through the​ blood
Spread of​ cancer cells takeplace through the​ periprostatic venous plexus and​ reaches the​ vertebral veins while coughing and​ sneezing and​ finally enders the​ vertebral bodies of​ the​ lumbar vertebrae.
Signs and​ symptoms of​ prostate cancer
Signs and​ symptoms depend upon the​ stage of​ the​ cancer. the​ following symptoms may be seen.
1 No symptoms
Tumour is​ small and​ only in​ the​ posterior lobe. This is​ diagnosed accidentely.
2 Slight difficulty in​ urination
Here the​ tumour is​ enlarged and​ urethra is​ slightly compressed. Shortly there will be frequent urge for​ urination with difficult urination.
3 When the​ tumour spread to​ all nearby areas including neck of​ bladder and​ urethra there will be painful urination with bleeding. Urine comes drop by drop.
4 Retention of​ urine
When the​ urethra is​ completely compressed there will be retention of​ urine. This can lead to​ hydronephrosis, renal failure ect. in​ this condition patient may get convulsions due to​ renal failure and​ finally coma.
5 Signs of​ metastasis
Some patients come with the​ signs and​ symptoms of​ metastasis.
a Lumbo sacral pain due to​ spread of​ cancer cells to​ lumbar and​ sacral vertebrae.
b Fracture of​ spine due to​ cancerous growth in​ the​ spine.
c Swelling, pain and​ fluid collection in​ the​ abdomen due to​ lesion in​ the​ abdomen.
d Respiratory complaints due to​ cancer of​ mediastinal lymphnodes and​ lungs.
e General weakness due to​ spread of​ cancer to​ different parts of​ the​ body.
f Anaemia due to​ involment of​ bone marrow and​ increased destruction of​ RBCs.
Clinical examination
Includes per rectal examination to​ feel the​ prostate gland,palpation of​ abdomen to​ feel the​ swelling in​ kidneys and​ any tumours. Patient is​ examined from head to​ foot to​ find out any lesions.
Investigations
1 Complete blood investigations;
RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.
2 Urine analysis
Microscopic examination to​ detect pus cells,occult blood,casts,Crystals ect.
3 Renal function tests
Blood urea level,serum creatinine level,electrolyte level ect.
4 Serum acid phosphatase
Increased in​ cancer of​ prostate.
5 xray of​ the​ spine
To detect any tumour or​ fracture.
6 Ultra sonography;
Gives idea about prostate,bladder,kidney ect.
7 C T scan
More detailed information about organs and​ tumour.
8 MRI of​ the​ spine
Gives detailed information about spine ,disc and​ nearby soft tissues.
9 Lymphangiography
Gives idea about lymphatic spread of​ cancer.
10 Biopsy to​ confirm cancer
Biopsy is​ taken from the​ tumour and​ is​ send for​ histopathological examination under the​ microscope. This will detect the​ presence of​ cancer cells.
Treatment
1 if​ there is​ retention of​ urine catheterisation is​ needed.
2 Dialysis if​ kidney failure.
3 if​ there is​ coma monitoring of​ all vital functions along with parentral nutrition and​ electolyte supply.
4 Specific treatment is​ prostatectomyremoval of​ prostate
Partial prostatectomy
Here only the​ affected lobe is​ removed.
Radical prostatectomy
Total removal of​ prostate along with nearby lymphnodes.
5, Hormone therapy
Stilbestrol is​ given to​ reduce tumour growth. Since this treatement increases the​ chance for​ cardiovascular disease phosphorylated diethyle stilbesterol is​ used nowadays.
6 Chemotherapy​Drug​s like cyclophosphamide, cisoplatim ect are given.
7 Radiotherapy is​ also done for​ some cases.
8 Homoeopathy
Homoeopathic ​Drug​s like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to​ symptoms. Constitutional homoeopathic medicine will give great relief and​ can increase the​ life span.
9 Yoga and​ meditation is​ also healpful.




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