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Reproductive Cancers

Reproductive Cancers

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Cancer's overall effect1 in 3 people in the U.S., and kills 1 in 5; higher incidence in males versus females;
tumoran overgrown, solid mass of cells; benign tumors are often arranged in an orderly fashion and are encapsulated within connective tissue (do not move from primary site)
cancerous cells: structural and functional abnormalitieslack of differentiation
cancerous cells: uncontrolled growth rateand lack of normal death-inducing signals required for apoptosis; production of growth factors; angiogenesis via angiogenic factors
cancerous cells: metastasiscells that break away from a primary tumor and enter the blood or lymph to establish new cancers in bone marrow, gut, lymph nodes ... ; malignant tumors
cancerous cells: angiogenesisblood supply to solid tumors (potential for angiostatin, endostatin and thalidomide??)
Incidence of breast cancernew 210,000 deaths 50,000
Incidence of ovarian cancernew 26,600 deaths 14,500
Incidence of vaginal cancgerrare
Incidence of prostate cancernew 317,000 ideathsn 41,400
Incidence of testicular cancernew 7,400 deaths 370
Incidence of penile cancerrare
Breast cancer frequency10% of women in the U.S. will develop breast cancer at some point in their life. ~210,000 new cases will develop this year; 46,000 deaths. 26% of
duct carcinomaBreast cancer - (epithelial lining), 90% of
carcinomas of the alveolar lobulesBreast cancer - 2nd most prevalent
cancers that have spreadless common
spread of cancer to bone or other parts ofalso uncommon
early menarche (puberty)increases risk of Breast cancer
weight gain in adults (>18>45 lbs, breast cancer risk increased x 2; due to E conversion from body fat)
post-menopausal obesityincreases risk of Breast cancer
post-menopausal ERTincreases risk of Breast cancer (but risk/benefit ratio?)
mutations of the BRCA1 gene (chromosome 17);inheritance results in a 90% lifetime risk of developing breast cancer
lactation, early menopause/oopherectomydecreases risk of Breast cancer
breast implantsdon't effect risk of breast cancer
abortion in middle-aged womenincreased risk of breast cancer
Early detection of breast lumpsimportant for biopsy to determine benign (e.g., fibroadenomas) vs. malignant!
fibroadenomasbenine tumor
Herceptinan antibody directed against E receptor; not a cure vs. breast cancer
Tamoxifen(estrogen analogs) may reduce the risk but not in all women! (raloxifene [tamoxifen], to treat osteoporosis)
Vitamin D(exposure to sunlight) a preventative measure?
Breast Cancer in MenThe disease appears similar in both sexes, but is uncommon in males (1% vs. incidence in women; 0.2% of all malignancies in men)
The male breastsimilar to the preadolescent girl; drugs (cardiovascular, digitalis; high blood pressure, reserpine) may have estrogen-like effects.
Breast Cancer Risk Factors in men:age - rare before age 35, ethnicity - Jewish males of European ancestry, geography - Egyptian males represent 6% of all male breast cancers; Zambian males account for 15% (E from parasite infection? from malnutrition?), testicular disorders - abnormal estrogen profilces
Ovarian cancerfourth leading cancer and cause of cancer-, 5 year survival rates: early treatment, 90% (but only 23% of cases detected); overall rate, 42%, 90% of ovarian cancers are of epithelial cell origin; rest include granulosa, theca, stromal, germ cell cancers (relatively rare)
Ovarian cancer increased riskwomen over 60; use of fertility drugs (x 2.5); women without children; women diagnosed with breast, intestinal, rectal cancer; mutated BRCA1 and -2 genes - 50% reduction in incidence by use of oral contraceptives!!!
Ovarian cancer decreased riskassociated with use of oral contraceptives; increased parity; early first pregnancy, early menopause
Ovarian cancer treatmentno proven early detection benefit to serum tests or ultrasound, surgical oophorectomy plus hysterectomy, radiation, chemotherapy (e.g., paclitaxel, cisplatin)
Cervical cancer occurenceIn 1996, 15,700 cases, 4,900 deaths; cervical neoplasia a precondition to cervical cancer; screened for by the Pap test (cervical scrapings to evaluate histology)
Cervical cancer and assoc. with HPVinfection with human papilloma virus (HPV) found in 90% of cervical cancers
increased rick of Cervical cancerrisk with multiple partners, early first intercourse
Uterine (endometrial) cancercritical role of estrogen
Uterine (endometrial) cancer increased riskdecreased by early age of menopause, increasing parity, use of oral contraceptives (containing progesterone)
Uterine (endometrial) cancer decreased riskincreased by obesity in pre- and post-menopausal women (25-50 lbs, 3-fold increase), ERT in post-menopausal women, PCO syndrome
increased rick of the rare Vaginal cancerwomen whose mothers were given DES during pregnancy
Vaginal cancer treatmentsurgery (including laser surgery), chemotherapy, radiation
DESdiethystilbestrol, used to prevent miscarrages, but caused cancers and miscarrages
Prostate cancermost prevalent cancer in men (U.S., 1:11); second leading cause of cancer deaths (after lung cancer). In 1996, 317,000 men were diagnosed with prostate cancer (vs. 182,000 women with breast cancer), >40,000 die each year.
Risk factors of Prostate cancernone confirmed
ethnic influence on Prostate cancerhigher in African-American men, and older men (average age of diagnosis, 65);
genetic influence on Prostate cancer10% of cases may be inherited; Recent studies have begun to identify the gene responsible for inherited forms of prostate cancer, and have thus far localized the gene to chromosome 1
hormonal influence on Prostate cancerincreased risk with androgen replacement therapy or DHEA?
Prostate cancer symptomsoften asymptomatic in earliest stages; by the time it is diagnosed, it is often metastatic (50-60% of diagnosed cases), symptoms may include urinary problems, but this may also be due to enlarged prostate; rectal examination, transrectal ultrasoundsymptoms may include urinary problems, but this may also be due to enlarged prostate; rectal examination, transrectal ultrasound
Prostate cancer detectionprostate-specific antigen (PSA) in serum, but only a ‘marker’; other tumor-specific antigens??, rectal exam + PSA can detect 85% of cancers, early detection results in 90% cure rate!
Prostate cancer Treatmentnone - elderly males (common in Sweden) , chemo, radiation, hormone therapy , removal of prostrate
hormone therapy for prostrate cancerto reduce androgen (DHT) levels (also orchiectomy) 80% successful, but not curative, as after 2-3 years cancers will begin to grow again ; tumors are androgen-independent
removal of prostatefairly standard, especially when cancer is localized to prostate; but may result in impotence due to removal of nerves that lead to the penis, and incontinence
Penile cancerrare and highly curable; epidermal cancers only; predisposition for men not circumsized at birth, screening by self-examination (lumps), treatment with chemo- /radio-therapy, biopsy
freq of Testicular cancerOnly 1% of cancers in men; 7,400 diagnoses, 370 deaths; mostly found in young men (ages 20-34); increased risk in white vs African American (by 4.5-fold)
survival of Testicular cancer96% are of germ cell origin, but prognosis is good (5-year survival, 92%), even with advanced stages (5-year survival, 70%)
screening testicular cancerscreening by self-examination for lump; 26-56% of patients are first diagnosed with epididymititis, testicular trauma, hydrocele, or other benign disorders; tumor-specific antigens not useful in early screening
testicular cancer treatmenttreatment by radiation therapy or chemotherapy (followed by bone marrow transplantation) or surgery


Fran Larkin

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