Chapter 10 Reproductive System Conditions: Introduction Function and structure, female reproductive system (Fig. 10.1): Ovaries Produce hormones, eggs Oviducts (aka, Fallopian tubes, uterine tubes) Fimbriae Site of fertilization Uterus Endometrium Shed with menses Cervix Vagina

Function and structure, female reproductive system (Fig. 10.1):

Ovaries

Produce hormones, eggs

Oviducts (aka, Fallopian tubes, uterine tubes)

Fimbriae

Site of fertilization

Uterus

Endometrium

Shed with menses

Cervix

Vagina

Chapter 10: Reproductive System Conditions: Introduction, cont. Function and structure, male reproductive system (Fig. 10.2): Testes Manufacture sperm Hormones Epididymis Sperm mature here Vas deferens Carries sperm into abdomen Prostate gland Urethra Shared by the urinary system

Function and structure, male reproductive system (Fig. 10.2):

Testes

Manufacture sperm

Hormones

Epididymis

Sperm mature here

Vas deferens

Carries sperm into abdomen

Prostate gland

Urethra

Shared by the urinary system

Cervical Cancer Growth of malignant cells in the lining of the cervix Incidence: 16,000 diagnoses of invasive cervical cancer/year 4× as many with precancerous cellular changes 4,000 deaths/year Average age at diagnosis: 28 years

Growth of malignant cells in the lining of the cervix

Incidence:

16,000 diagnoses of invasive cervical cancer/year

4× as many with precancerous cellular changes

4,000 deaths/year

Average age at diagnosis: 28 years

Cervical Cancer, cont. Related to viral infection with human papilloma virus (HPV) Cervical warts Many types of HPV; not all cause invasive cervical cancer Sexually transmitted disease; not prevented with condom use

Related to viral infection with human papilloma virus (HPV)

Cervical warts

Many types of HPV; not all cause invasive cervical cancer

Sexually transmitted disease; not prevented with condom use

Cervical Cancer, cont. Infection with HPV causes changes in cervical lining: dysplasia Can be low-risk or high-risk variety Low-risk problems are self-limiting High-risk problems may develop into cervical cancer Other factors in cervical cancer: Smoking Being a DES daughter Coinfection with genital herpes Having limited access to health care

Infection with HPV causes changes in cervical lining: dysplasia

Can be low-risk or high-risk variety

Low-risk problems are self-limiting

High-risk problems may develop into cervical cancer

Other factors in cervical cancer:

Smoking

Being a DES daughter

Coinfection with genital herpes

Having limited access to health care

Cervical Cancer, cont. Signs and symptoms Usually none until cancer is advanced Bleeding or spotting between menses, vaginal discharge, abdominal or pelvic pain Diagnosis: Papanicolaou test (Pap test) Pap test has brought rates of cervical cancer down by 74% since 1955

Signs and symptoms

Usually none until cancer is advanced

Bleeding or spotting between menses, vaginal discharge, abdominal or pelvic pain

Diagnosis:

Papanicolaou test (Pap test)

Pap test has brought rates of cervical cancer down by 74% since 1955

Cervical Cancer, cont. Treatment: Depends on stage Cryotherapy LEEP ( loop electrosurgical excision procedure ) Partial/full hysterectomy Exenteration Radiation, chemotherapy Massage? Fine in the context of treated cervical dysplasia For more advanced forms of cervical cancer, work with health care team for maximum benefit and minimum risk

Treatment:

Depends on stage

Cryotherapy

LEEP ( loop electrosurgical excision procedure )

Partial/full hysterectomy

Exenteration

Radiation, chemotherapy

Massage?

Fine in the context of treated cervical dysplasia

For more advanced forms of cervical cancer, work with health care team for maximum benefit and minimum risk

Dysmenorrhea Painful menstrual periods Incidence: 40% women have painful periods regularly 10% are incapacitated 1–3 days /month Primary vs. secondary: Primary: free-standing problem (usually begins soon after menarche) Secondary: symptom or complication of some other disorder

Painful menstrual periods

Incidence:

40% women have painful periods regularly

10% are incapacitated 1–3 days /month

Primary vs. secondary:

Primary: free-standing problem (usually begins soon after menarche)

Secondary: symptom or complication of some other disorder

Dysmenorrhea, cont. Causes of primary dysmenorrhea: Prostaglandins Inflammatory chemicals rise before period starts Pain–spasm cycle Ischemia, pain, reinforce uterine spasm Ligament irritation Uterus pulls on uterine ligament at sacrum, can contribute to low back pain

Causes of primary dysmenorrhea:

Prostaglandins

Inflammatory chemicals rise before period starts

Pain–spasm cycle

Ischemia, pain, reinforce uterine spasm

Ligament irritation

Uterus pulls on uterine ligament at sacrum, can contribute to low back pain

Dysmenorrhea, cont. Causes of secondary dysmenorrhea: Endometriosis Fibroid tumors Ovarian cysts Pelvic inflammatory disease, STDs Pelvic adhesions, scar from surgery

Causes of secondary dysmenorrhea:

Endometriosis

Fibroid tumors

Ovarian cysts

Pelvic inflammatory disease, STDs

Pelvic adhesions, scar from surgery

Dysmenorrhea, cont. Signs and symptoms: Dull ache or sharp pains in abdomen, pelvis, low back Usually happen early in menses; may persist through whole period Headaches, nausea, vomiting, diarrhea, constipation may also occur Diagnosis: Need to consider underlying disorders Laparoscopy, ultrasound, culture for infectious agents

Signs and symptoms:

Dull ache or sharp pains in abdomen, pelvis, low back

Usually happen early in menses; may persist through whole period

Headaches, nausea, vomiting, diarrhea, constipation may also occur

Diagnosis:

Need to consider underlying disorders

Laparoscopy, ultrasound, culture for infectious agents

Dysmenorrhea, cont. Treatment: Painkillers to inhibit prostaglandins Nutritional assistance Exercise, stretching Low-dose birth control pills Surgery or medication to deal with underlying causes Massage? Avoid abdomen, pelvis during menstruation Get information about possible underlying disorders Otherwise massage is probably safe, effective, and very welcome Parasympathetic balance Pelvic adhesions?

Treatment:

Painkillers to inhibit prostaglandins

Nutritional assistance

Exercise, stretching

Low-dose birth control pills

Surgery or medication to deal with underlying causes

Massage?

Avoid abdomen, pelvis during menstruation

Get information about possible underlying disorders

Otherwise massage is probably safe, effective, and very welcome

Parasympathetic balance

Pelvic adhesions?

Endometriosis Establishment of endometrial cells outside the uterus Incidence: Estimates: 5 million women in US Cannot be diagnosed without surgery Most diagnosed between 20 and 45 years of age Mostly in women with heavy periods that last <28 days

Establishment of endometrial cells outside the uterus

Incidence:

Estimates: 5 million women in US

Cannot be diagnosed without surgery

Most diagnosed between 20 and 45 years of age

Mostly in women with heavy periods that last <28 days

Endometriosis, cont. How do endometrial cells escape? Retrograde backflow through uterine tubes? Circulatory, lymphatic dissemination? Most women have some cells in peritoneal fluid during menstruation; not all have endometriosis

How do endometrial cells escape?

Retrograde backflow through uterine tubes?

Circulatory, lymphatic dissemination?

Most women have some cells in peritoneal fluid during menstruation; not all have endometriosis

Endometriosis, cont. Factors in endometriosis: Low killer T-cells, natural killer cells High suppressor T-cells High macrophages: stimulate proliferation, inflammation High prostaglandins Excessive inflammation, pain sensitivity

Factors in endometriosis:

Low killer T-cells, natural killer cells

High suppressor T-cells

High macrophages: stimulate proliferation, inflammation

High prostaglandins

Excessive inflammation, pain sensitivity

Endometriosis, cont. Endometrial growths get established on… Uterus, uterine tubes, ovaries, bladder, colon (Fig. 10.3) May interfere with fertility May escape abdomen Body attempts to encyst growths Growths are sensitive to hormonal cycles: Grow during proliferative phase Degenerate during menstruation Cannot exit body; stimulates inflammatory response, more scar

Endometrial growths get established on…

Uterus, uterine tubes, ovaries, bladder, colon (Fig. 10.3)

May interfere with fertility

May escape abdomen

Body attempts to encyst growths

Growths are sensitive to hormonal cycles:

Grow during proliferative phase

Degenerate during menstruation

Cannot exit body; stimulates inflammatory response, more scar

Endometriosis, cont. Causes: Genetic potential Exposure to dioxins Other environmental estrogens Signs and symptoms: Infertility Dysmenorrhea Spotting between periods Complications: Scar tissue Ectopic pregnancy Infertility Anemia

Causes:

Genetic potential

Exposure to dioxins

Other environmental estrogens

Signs and symptoms:

Infertility

Dysmenorrhea

Spotting between periods

Complications:

Scar tissue

Ectopic pregnancy

Infertility

Anemia

Endometriosis, cont. Diagnosis: Laparoscopic surgery Treatment: Goals: Relieve pain, stop progression, prevent new growths, maintain/restore fertility NSAIDs, birth control pills, laparoscopic surgery to remove growths, reduce adhesions

Diagnosis:

Laparoscopic surgery

Treatment:

Goals:

Relieve pain, stop progression, prevent new growths, maintain/restore fertility

NSAIDs, birth control pills, laparoscopic surgery to remove growths, reduce adhesions

Endometriosis, cont. Massage? Endometriosis can cause displacement of pelvic organs: deep abdominal/pelvic work is contraindicated (Risk of bruising ovary) Work elsewhere is highly appropriate and called for

Massage?

Endometriosis can cause displacement of pelvic organs: deep abdominal/pelvic work is contraindicated

(Risk of bruising ovary)

Work elsewhere is highly appropriate and called for

Fibroid tumors Benign tumors in muscular wall of uterus Also called leiomyomas Incidence: Diagnosed in 20% of fertile women May be present in up to 80% fertile women More common in African American women than others Disappear after menopause (estrogen sensitive)

Benign tumors in muscular wall of uterus

Also called leiomyomas

Incidence:

Diagnosed in 20% of fertile women

May be present in up to 80% fertile women

More common in African American women than others

Disappear after menopause (estrogen sensitive)

Fibroid Tumors, cont. Combination of genetic, hormonal, environmental factors Classified by location (Fig. 10.4): Submucosal Close to endometrium Intramural Within muscular wall Subserosal Superficial to the muscular wall; deep to serous covering of uterus

Combination of genetic, hormonal, environmental factors

Classified by location (Fig. 10.4):

Submucosal

Close to endometrium

Intramural

Within muscular wall

Subserosal

Superficial to the muscular wall; deep to serous covering of uterus

Fibroid Tumors, cont. Signs and symptoms: Usually silent May grow enough to… Interfere with pregnancy Put pressure on other structures May cause heavy bleeding during menses Complications: Anemia, infertility, interrupted pregnancy, necrosis of twisted tumor

Signs and symptoms:

Usually silent

May grow enough to…

Interfere with pregnancy

Put pressure on other structures

May cause heavy bleeding during menses

Complications:

Anemia, infertility, interrupted pregnancy, necrosis of twisted tumor

Fibroid Tumors, cont. Treatment: Hormone therapy, interruption of blood supply, partial or total hysterectomy 170,000-300,000 hysterectomies/year Massage? If a person knows she has them, deep abdominal work should be conducted with caution (displacement of pelvic organs) Otherwise, massage has no particular impact: can improve quality of life, if not status of fibroid tumors

Treatment:

Hormone therapy, interruption of blood supply, partial or total hysterectomy

170,000-300,000 hysterectomies/year

Massage?

If a person knows she has them, deep abdominal work should be conducted with caution (displacement of pelvic organs)

Otherwise, massage has no particular impact: can improve quality of life, if not status of fibroid tumors

Breast Cancer Development of malignant tumors in the epithelial or connective tissue of the breast Incidence: 216,000 diagnoses in women/year 1,450 diagnoses in men/year 60,000 cases of “noninvasive” (in situ) /year 40,000 deaths/year women; 500 deaths/year men 77% of patients are > 50 years at diagnosis 1:8 women will have breast cancer 2 million people in the United States have had breast cancer

Development of malignant tumors in the epithelial or connective tissue of the breast

Incidence:

216,000 diagnoses in women/year

1,450 diagnoses in men/year

60,000 cases of “noninvasive” (in situ) /year

40,000 deaths/year women; 500 deaths/year men

77% of patients are > 50 years at diagnosis

1:8 women will have breast cancer

2 million people in the United States have had breast cancer

Breast Cancer, cont. Types of breast cancer: Ductal carcinoma Most common: 70%–80% diagnoses Lobular 5%–10% of all diagnoses; higher risk of appearing in both breasts Other types: 10%–15% of all diagnoses Inflammatory breast cancer, Paget’s disease of the breast, medullary breast cancer (affects connective tissue)

Types of breast cancer:

Ductal carcinoma

Most common: 70%–80% diagnoses

Lobular

5%–10% of all diagnoses; higher risk of appearing in both breasts

Other types:

10%–15% of all diagnoses

Inflammatory breast cancer, Paget’s disease of the breast, medullary breast cancer (affects connective tissue)

Breast Cancer, cont. Growth pattern: In situ growths, which may or may not become aggressive Several years to reach 1 cm in diameter Metastasis through lymph 30%–40% have cells in axillary lymph nodes at diagnosis Goes from nodes to liver, lung, brain Each tumor may have different types of cells in it

Growth pattern:

In situ growths, which may or may not become aggressive

Several years to reach 1 cm in diameter

Metastasis through lymph

30%–40% have cells in axillary lymph nodes at diagnosis

Goes from nodes to liver, lung, brain

Each tumor may have different types of cells in it

Breast Cancer, cont. Risk factors: No dependable risk profile Statistical prevalence among… Early menarche, late menopause, no or few children Obesity 2+ alcoholic drinks/day History of proliferative breast disease Genetic predisposition BRCA 1, 2 account for <10% of all cases Age

Risk factors:

No dependable risk profile

Statistical prevalence among…

Early menarche, late menopause, no or few children

Obesity

2+ alcoholic drinks/day

History of proliferative breast disease

Genetic predisposition

BRCA 1, 2 account for <10% of all cases

Age

Breast Cancer, cont. Signs and symptoms: Often none Hard, thickened areas with self exam Advanced cases: Asymmetrical breast growth, “orange peel” skin; inverted nipples with discharge Symptoms of metastasis: bone pain, weight loss, spinal cord compression, swelling in arms

Signs and symptoms:

Often none

Hard, thickened areas with self exam

Advanced cases:

Asymmetrical breast growth, “orange peel” skin; inverted nipples with discharge

Symptoms of metastasis: bone pain, weight loss, spinal cord compression, swelling in arms

Breast Cancer, cont. Diagnosis: Self-examination, clinical examination, mammogram (Fig. 10.5) Ultrasound, biopsy Tracking sentinel lymph node, if possible Treatment: Surgery Lumpectomy, partial, radical mastectomy Radiation External or with implanted pellets

Diagnosis:

Self-examination, clinical examination, mammogram (Fig. 10.5)

Ultrasound, biopsy

Tracking sentinel lymph node, if possible

Treatment:

Surgery

Lumpectomy, partial, radical mastectomy

Radiation

External or with implanted pellets

Breast Cancer, cont. Chemotherapy Toxic drugs Hormone therapy To bind up receptors on potential cancer cells Prognosis: Survivors must be constantly vigilant 5-year survival rate: 83% 10-year survival rate: 65% 15-year survival rate: 56%

Chemotherapy

Toxic drugs

Hormone therapy

To bind up receptors on potential cancer cells

Prognosis:

Survivors must be constantly vigilant

5-year survival rate: 83%

10-year survival rate: 65%

15-year survival rate: 56%

Breast Cancer, cont. Massage? Avoid tumor sites, obviously Work with health care team to achieve best benefit, minimal risks Base decisions on what treatment(s) the client must undergo Risks with each option Infection, blood clots, toxicity, lymphedema, etc… Benefits: better tolerance of treatments, less pain, better sleep, appetite, immune system function, etc…

Massage?

Avoid tumor sites, obviously

Work with health care team to achieve best benefit, minimal risks

Base decisions on what treatment(s) the client must undergo

Risks with each option

Infection, blood clots, toxicity, lymphedema, etc…

Benefits: better tolerance of treatments, less pain, better sleep, appetite, immune system function, etc…

Ovarian Cancer Growth of malignant cells in the ovaries Incidence: 25,000 diagnoses/year 1:60–70 women 15,000 deaths/year

Growth of malignant cells in the ovaries

Incidence:

25,000 diagnoses/year

1:60–70 women

15,000 deaths/year

Ovarian Cancer, cont. Types of ovarian tumors: Germ cells Stromal cells Epithelial cells (adenocarcinomas) These are most common: 90% of cases Several categories of adenocarcinomas Metastasis through… Peritoneal fluid Direct extension to nearby structures Lymph, blood flow

Types of ovarian tumors:

Germ cells

Stromal cells

Epithelial cells (adenocarcinomas)

These are most common: 90% of cases

Several categories of adenocarcinomas

Metastasis through…

Peritoneal fluid

Direct extension to nearby structures

Lymph, blood flow

Ovarian Cancer, cont. Risk factors: Familial history 1 st degree relative has 50% chance of developing ovarian cancer 2 nd degree relative, or relative with breast cancer, has greater than normal risk Reproductive history Most common in women who never had any interruption in menses (childbearing, birth control pills), or multiple miscarriages Health history: History of breast or colon cancer, breast cancer genes Estrogen replacement therapy Other: Radiation, use of talc on genitals, high-fat diet, age

Risk factors:

Familial history

1 st degree relative has 50% chance of developing ovarian cancer

2 nd degree relative, or relative with breast cancer, has greater than normal risk

Reproductive history

Most common in women who never had any interruption in menses (childbearing, birth control pills), or multiple miscarriages

Health history:

History of breast or colon cancer, breast cancer genes

Estrogen replacement therapy

Other:

Radiation, use of talc on genitals, high-fat diet, age

Ovarian Cancer, cont. Signs and symptoms: None, or very subtle in early stages In later stages, looks like ovarian cyst, other nonthreatening problems: Heavy feeling in pelvis, bloating, nausea, diarrhea/constipation, weight gain or loss, ascites… Diagnosis: Pelvic examination, CT scan, ultrasound, laparoscopy… Difficult to identify early

Signs and symptoms:

None, or very subtle in early stages

In later stages, looks like ovarian cyst, other nonthreatening problems:

Heavy feeling in pelvis, bloating, nausea, diarrhea/constipation, weight gain or loss, ascites…

Diagnosis:

Pelvic examination, CT scan, ultrasound, laparoscopy…

Difficult to identify early

Ovarian Cancer, cont. Prognosis: Found in Stage I or II only 25% of cases Five-year survival rate is 50% Treatment: Surgery, chemotherapy Massage? As with other cancers, work with health care team for best benefits, minimal risks

Prognosis:

Found in Stage I or II only 25% of cases

Five-year survival rate is 50%

Treatment:

Surgery, chemotherapy

Massage?

As with other cancers, work with health care team for best benefits, minimal risks

Ovarian Cysts Any variety of cysts that grow on ovaries (Fig. 10.6) Functional cysts related to hormonal imbalance Incidence: 30% women with regular menstrual cycle will have at least one 50% women with irregular cycles will have at least one Cysts found in premenarchal or postmenopausal patients have higher risk of being malignant

Any variety of cysts that grow on ovaries (Fig. 10.6)

Functional cysts related to hormonal imbalance

Incidence:

30% women with regular menstrual cycle will have at least one

50% women with irregular cycles will have at least one

Cysts found in premenarchal or postmenopausal patients have higher risk of being malignant

Ovarian Cysts, cont. Types of cysts: Follicular cysts: Follicle does not rupture completely; blister forms over ovum; most common Corpus luteum cysts: Blister forms over site of egg release; blocks hormonal release; look like pregnancy; may bleed into peritoneal space Polycystic ovaries (Fig. 10.7): Also called Stein-Leventhal syndrome; enlarged ovaries with multiple small cysts; hormone disruption causes symptoms; linked to metabolic syndrome Other cysts: Dermoid, benign tumors, endometrial cysts

Types of cysts:

Follicular cysts:

Follicle does not rupture completely; blister forms over ovum; most common

Corpus luteum cysts:

Blister forms over site of egg release; blocks hormonal release; look like pregnancy; may bleed into peritoneal space

Polycystic ovaries (Fig. 10.7):

Also called Stein-Leventhal syndrome; enlarged ovaries with multiple small cysts; hormone disruption causes symptoms; linked to metabolic syndrome

Other cysts:

Dermoid, benign tumors, endometrial cysts

Ovarian Cysts, cont. Signs and symptoms: Dull ache in lower abdomen Hormonal symptoms: Looks/feels like early pregnancy, hair growth, obesity, acne… Complications: Depends largely on size: pressure on other structures; bleeding with rupture, can mimic advanced ovarian cancer

Signs and symptoms:

Dull ache in lower abdomen

Hormonal symptoms:

Looks/feels like early pregnancy, hair growth, obesity, acne…

Complications:

Depends largely on size: pressure on other structures; bleeding with rupture, can mimic advanced ovarian cancer

Ovarian Cysts, cont. Diagnosis: May be found during pelvic examination Ultrasound, biopsy through laparoscopy Treatment: Oral contraceptives: give ovaries time to resolve Aspiration Oophorectomy, hysterectomy if risk of cancer is high Massage? At least a local contraindication; displacement of pelvic contents Massage elsewhere is probably appropriate

Diagnosis:

May be found during pelvic examination

Ultrasound, biopsy through laparoscopy

Treatment:

Oral contraceptives: give ovaries time to resolve

Aspiration

Oophorectomy, hysterectomy if risk of cancer is high

Massage?

At least a local contraindication; displacement of pelvic contents

Massage elsewhere is probably appropriate

Benign Prostatic Hyperplasia Prostate of mature men becomes enlarged Not synonymous with prostate cancer Incidence: 50% men > 60 years 70% men > 70 years, and so on

Prostate of mature men becomes enlarged

Not synonymous with prostate cancer

Incidence:

50% men > 60 years

70% men > 70 years, and so on

Benign Prostatic Hyperplasia, cont. Unclear why some men’s prostates enlarge;others do not Dihydrotestosterone? Endogenous estrogens? Enlarged prostate can exert pressure on urethra, leading to symptoms and problems (Fig. 10.8): Urinary tract infection pyelonephritis

Unclear why some men’s prostates enlarge;others do not

Dihydrotestosterone?

Endogenous estrogens?

Enlarged prostate can exert pressure on urethra, leading to symptoms and problems (Fig. 10.8):

Urinary tract infection

pyelonephritis

Benign Prostatic Hyperplasia, cont. Signs and symptoms: Difficulties with urination: Weak flow, difficulty initiating urination, leakage, dribbling Not usually pelvic pain—distinguishes from prostatitis Diagnosis: Palpation through wall of rectum Typically deep, smooth nodules, not hard, superficial growths—distinguishes from prostate cancer PSA test (helps to rule out prostate cancer)

Signs and symptoms:

Difficulties with urination:

Weak flow, difficulty initiating urination, leakage, dribbling

Not usually pelvic pain—distinguishes from prostatitis

Diagnosis:

Palpation through wall of rectum

Typically deep, smooth nodules, not hard, superficial growths—distinguishes from prostate cancer

PSA test (helps to rule out prostate cancer)

Benign Prostatic Hyperplasia, cont. Treatment: Monitor for growth Medications to slow growth, relax smooth muscle tissue Surgery to remove part or all of prostate Tissue is always examined for prostate cancer; comes up positive 10% of time Massage? No particular impact on prostate growth Can certainly improve the quality of life of the person with BPH, if not improving the situation directly

Treatment:

Monitor for growth

Medications to slow growth, relax smooth muscle tissue

Surgery to remove part or all of prostate

Tissue is always examined for prostate cancer; comes up positive 10% of time

Massage?

No particular impact on prostate growth

Can certainly improve the quality of life of the person with BPH, if not improving the situation directly

Prostate Cancer Growth of malignant cells in the prostate gland Incidence: 212,000 diagnoses/year, 29,000 deaths/year Lifetime risk is 1:10 Incidence rises with age Rare before age 40 Precancerous changes found in 25% of men >50 Precancerous changes found in 50% of men >80 Average age at diagnosis: 70–72 years old African Americans 2× more likely to have it; 2× more likely to die of it

Growth of malignant cells in the prostate gland

Incidence:

212,000 diagnoses/year, 29,000 deaths/year

Lifetime risk is 1:10

Incidence rises with age

Rare before age 40

Precancerous changes found in 25% of men >50

Precancerous changes found in 50% of men >80

Average age at diagnosis: 70–72 years old

African Americans 2× more likely to have it; 2× more likely to die of it

Prostate Cancer, cont. Causes unclear Oncogenes activated Tumor-suppressor genes inhibited Absence of enzyme that neutralizes free radicals Related to testosterone Does not occur in men who have been castrated High-fat diets increase risk Genetic link: higher incidence within families

Causes unclear

Oncogenes activated

Tumor-suppressor genes inhibited

Absence of enzyme that neutralizes free radicals

Related to testosterone

Does not occur in men who have been castrated

High-fat diets increase risk

Genetic link: higher incidence within families

Prostate Cancer, cont. Signs and symptoms: Pressure on urethra Looks like BPH: difficulty with urination Risk of urinary tract infection, kidney infection Also pain with ejaculation, difficulty maintaining an erection, blood in urine Low back pain may develop if tumor puts pressure on other structures, nerve roots

Signs and symptoms:

Pressure on urethra

Looks like BPH: difficulty with urination

Risk of urinary tract infection, kidney infection

Also pain with ejaculation, difficulty maintaining an erection, blood in urine

Low back pain may develop if tumor puts pressure on other structures, nerve roots

Prostate Cancer, cont. Diagnosis: Digital rectal examination finds hard, superficial nodules Blood test for PSA (prostate-specific antigen) Not definitive, but indicative Free vs. attached PSA: attached indicated higher risk of cancer Ultrasound, biopsy Early detection is possible 5-year survival rate for early detection approaches 100%

Diagnosis:

Digital rectal examination finds hard, superficial nodules

Blood test for PSA (prostate-specific antigen)

Not definitive, but indicative

Free vs. attached PSA: attached indicated higher risk of cancer

Ultrasound, biopsy

Early detection is possible

5-year survival rate for early detection approaches 100%

Prostate Cancer, cont. Treatment: Radiation, surgery, hormone therapy For slow-growing forms, some elderly patients may opt not to treat it at all Massage? As with other forms of cancer, work with health care team for best benefit, minimal risk Elderly clients may elect not to treat prostate cancer; discuss risks of metastasis with primary health care provider (risks are probably minimal) Massage can improve quality of life for people undergoing great challenges

Treatment:

Radiation, surgery, hormone therapy

For slow-growing forms, some elderly patients may opt not to treat it at all

Massage?

As with other forms of cancer, work with health care team for best benefit, minimal risk

Elderly clients may elect not to treat prostate cancer; discuss risks of metastasis with primary health care provider (risks are probably minimal)

Massage can improve quality of life for people undergoing great challenges

Prostatitis Prostate becomes enlarged, inflamed, and often painful Not synonymous with benign prostatic hyperplasia Incidence: 2 million doctor visits/year 10%–50% of men 20–70 years old will have symptoms at least once Most common urologic problem in men < 50 years old

Prostate becomes enlarged, inflamed, and often painful

Not synonymous with benign prostatic hyperplasia

Incidence:

2 million doctor visits/year

10%–50% of men 20–70 years old will have symptoms at least once

Most common urologic problem in men < 50 years old

Prostatitis, cont. Prostate anatomy: Walnut-sized gland that surround urethra, distal to urinary bladder Channels on a horizontal plane drain seminal fluid into urethra during ejaculation Fluid can stagnate, even crystallize (prostate stones) Bladder reflux can introduce caustic material into delicate environment

Prostate anatomy:

Walnut-sized gland that surround urethra, distal to urinary bladder

Channels on a horizontal plane drain seminal fluid into urethra during ejaculation

Fluid can stagnate, even crystallize (prostate stones)

Bladder reflux can introduce caustic material into delicate environment

Prostatitis, cont. Types of prostatitis: Type 1: Acute bacterial prostatitis :acute infection E. Coli, Klebsiella —often part of sexually transmitted disease Type 2: Chronic bacterial prostatitis :recurrent infection of the prostate Type 3: Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS): prostate enlargement with no demonstrable infection Most common version (90%); could be referral from trigger points in perineal muscle

Types of prostatitis:

Type 1: Acute bacterial prostatitis :acute infection

E. Coli, Klebsiella —often part of sexually transmitted disease

Type 2: Chronic bacterial prostatitis :recurrent infection of the prostate

Type 3: Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS): prostate enlargement with no demonstrable infection

Most common version (90%); could be referral from trigger points in perineal muscle

Prostatitis, cont. Type 3: subtypes: Inflammatory chronic pelvic pain syndrome: white blood cells are found in the semen, expressed prostatic secretions, or urine Noninflammatory chronic pelvic pain syndrome: white cells are not found in semen, expressed prostatic secretions, and urine Type 4: Asymptomatic inflammatory prostatitis (AIP): no subjective symptoms, but white blood cells are found in prostate secretions

Type 3: subtypes:

Inflammatory chronic pelvic pain syndrome: white blood cells are found in the semen, expressed prostatic secretions, or urine

Noninflammatory chronic pelvic pain syndrome: white cells are not found in semen, expressed prostatic secretions, and urine

Type 4: Asymptomatic inflammatory prostatitis (AIP): no subjective symptoms, but white blood cells are found in prostate secretions

Prostatitis, cont. Signs and symptoms: Acute prostatitis looks like urinary tract infection: Pain, burning, frequent urination, low back pain, pain in groin, perineum, testes, penis Penile discharge, fever Prostate is extremely painful on palpation CCPS has no fever or discharge; prostate is only mildly painful on palpation

Signs and symptoms:

Acute prostatitis looks like urinary tract infection:

Pain, burning, frequent urination, low back pain, pain in groin, perineum, testes, penis

Penile discharge, fever

Prostate is extremely painful on palpation

CCPS has no fever or discharge; prostate is only mildly painful on palpation

Prostatitis, cont. Complication: Urethral obstruction: medical emergency Diagnosis: Rule out BPH, prostate cancer Urine analyzed for signs of infection With and without prostate massage through the rectum Semen may be analyzed

Complication:

Urethral obstruction: medical emergency

Diagnosis:

Rule out BPH, prostate cancer

Urine analyzed for signs of infection

With and without prostate massage through the rectum

Semen may be analyzed

Prostatitis, cont. Treatment: Types 1 and 2: antibiotics May take long course for type 2 CPPD: antibiotics may be prescribed “just in case”; smooth muscle relaxants, frequent ejaculation, sitz baths, biofeedback: coping skills rather than “cures” Massage? Massage is contraindicated in the presence of acute infection Otherwise, massage may be a helpful tool for someone dealing with a difficult, stubborn, painful, long-term problem

Treatment:

Types 1 and 2: antibiotics

May take long course for type 2

CPPD: antibiotics may be prescribed “just in case”; smooth muscle relaxants, frequent ejaculation, sitz baths, biofeedback: coping skills rather than “cures”

Massage?

Massage is contraindicated in the presence of acute infection

Otherwise, massage may be a helpful tool for someone dealing with a difficult, stubborn, painful, long-term problem

Testicular Cancer Growth of malignant cells in the testicles Incidence: 7,500 diagnoses/year 400 deaths/year Caucasians > other races, 8:1 Leading cause of cancer in men 15–35 years old Rates climbed 51% 1973–1995

Growth of malignant cells in the testicles

Incidence:

7,500 diagnoses/year

400 deaths/year

Caucasians > other races, 8:1

Leading cause of cancer in men 15–35 years old

Rates climbed 51% 1973–1995

Testicular Cancer, cont. Only reliable risk factor: Men born with cryptorchidism (undescended testicle) have slightly higher risk Types of testicular cancer: Stromal cell tumors: <5% of all diagnoses Sertoli cell tumors Leydig cell tumors

Only reliable risk factor:

Men born with cryptorchidism (undescended testicle) have slightly higher risk

Types of testicular cancer:

Stromal cell tumors: <5% of all diagnoses

Sertoli cell tumors

Leydig cell tumors

Testicular Cancer, cont. Germ cell tumors Seminomas 40%–45% of all diagnoses Slow-growing, sensitive to radiation Non-seminomas Embryonic carcinomas Yolk sac tumors Teratomas Choriocarcinoma (especially aggressive)

Germ cell tumors

Seminomas

40%–45% of all diagnoses

Slow-growing, sensitive to radiation

Non-seminomas

Embryonic carcinomas

Yolk sac tumors

Teratomas

Choriocarcinoma (especially aggressive)

Testicular Cancer, cont. Signs and symptoms: Painless lump on testicle, dull ache in pelvis or groin, tender breasts Symptoms that last 2 weeks + should be investigated immediately Diagnosis: Rule out infection or injury Ultrasound, blood tests Orchiectomy (usually through abdomen to avoid risk of spreading cells) Examination of inguinal lymph nodes for staging

Signs and symptoms:

Painless lump on testicle, dull ache in pelvis or groin, tender breasts

Symptoms that last 2 weeks + should be investigated immediately

Diagnosis:

Rule out infection or injury

Ultrasound, blood tests

Orchiectomy (usually through abdomen to avoid risk of spreading cells)

Examination of inguinal lymph nodes for staging

Testicular Cancer, cont. Treatment: Depends on type of cancer Removal of affected tissue Seminomas are sensitive to radiation Non-seminomas treated with chemotherapy Survival rates are generally good Massage? Accommodate for risks of chemotherapy, radiation Can improve tolerance to treatment stresses Work with health care team for best benefits, minimal risks

Treatment:

Depends on type of cancer

Removal of affected tissue

Seminomas are sensitive to radiation

Non-seminomas treated with chemotherapy

Survival rates are generally good

Massage?

Accommodate for risks of chemotherapy, radiation

Can improve tolerance to treatment stresses

Work with health care team for best benefits, minimal risks

Menopause The moment the ovaries stop secreting enough hormones to maintain a menstrual cycle Perimenopause is term for symptoms leading up to menopause Incidence: All women go through it if they live long enough Average age at onset is 47.5; completion at 51.4 40 million women in the United States are postmenopausal By 2020, 46 million will be postmenopausal

The moment the ovaries stop secreting enough hormones to maintain a menstrual cycle

Perimenopause is term for symptoms leading up to menopause

Incidence:

All women go through it if they live long enough

Average age at onset is 47.5; completion at 51.4

40 million women in the United States are postmenopausal

By 2020, 46 million will be postmenopausal

Menopause, cont. Hormones from ovaries work to establish menstrual cycle, other functions: Bone density Estrogen inhibits osteoclasts; progesterone stimulates osteoblasts Cardiovascular health Mechanism for influence on triglycerides, LDLs not understood; HRT does not work in the way it was assumed Protection from some types of cancer High estrogen associated with low colorectal cancer, increased risk of breast, ovarian cancer Central nervous system function Hormones influence mood, depression, cognitive function

Hormones from ovaries work to establish menstrual cycle, other functions:

Bone density

Estrogen inhibits osteoclasts; progesterone stimulates osteoblasts

Cardiovascular health

Mechanism for influence on triglycerides, LDLs not understood; HRT does not work in the way it was assumed

Protection from some types of cancer

High estrogen associated with low colorectal cancer, increased risk of breast, ovarian cancer

Central nervous system function

Hormones influence mood, depression, cognitive function

Menopause, cont. As ovaries lose function, hormonal ratios shift Estrogen, progesterone continue to be made in fat cells, but in wider difference Environmental estrogens tip the scales too Signs and symptoms: Not identified until a full year after last menstrual cycle Symptoms brought about by changing hormone levels (perimenopause): hot flashes, night sweats, insomnia, mood swings, confusion, short-term memory loss, poor concentration, bone thinning, increased risk of heart disease

As ovaries lose function, hormonal ratios shift

Estrogen, progesterone continue to be made in fat cells, but in wider difference

Environmental estrogens tip the scales too

Signs and symptoms:

Not identified until a full year after last menstrual cycle

Symptoms brought about by changing hormone levels (perimenopause):

hot flashes, night sweats, insomnia, mood swings, confusion, short-term memory loss, poor concentration, bone thinning, increased risk of heart disease

Menopause, cont. Treatment: By symptoms Hormone replacement therapy (HRT) Combinations of estrogen and progesterone, depending on history of hysterectomy Actually increases risk of heart disease, some cancers if used for more than 2 years Topical applications of hormone (progesterone) cream

Treatment:

By symptoms

Hormone replacement therapy (HRT)

Combinations of estrogen and progesterone, depending on history of hysterectomy

Actually increases risk of heart disease, some cancers if used for more than 2 years

Topical applications of hormone (progesterone) cream

Menopause, cont. Massage? No contraindications if osteoporosis, heart disease are ruled out Can be supportive, nurturing, affirming activity during a time of shifting self-perception

Massage?

No contraindications if osteoporosis, heart disease are ruled out

Can be supportive, nurturing, affirming activity during a time of shifting self-perception

Menopause, cont. Hormone replacement therapy Women’s Health Initiative studied 160,000+ women on HRT to gather statistics about osteoporosis, cardiovascular disease 37 % Decreased Colorectal cancer 33 % Decreased Hip fractures 105 % Increased Dementia 111 % Increased Blood clot: leg or lung 41 % Increased Stroke 26 % Increased Breast cancer 29% Increased Heart attack

Hormone replacement therapy

Women’s Health Initiative studied 160,000+ women on HRT to gather statistics about osteoporosis, cardiovascular disease

Sexually Transmitted Diseases, cont. Syphilis ( Treponema pallidum ) Approximately 32,000 diagnoses/year (recent decrease) Spirochetal bacterial infection Spread through intimate contact (stages I and II) and from mother–child Travels through blood, affects other tissues, including CNS Increases risk of HIV transmission Signs and symptoms (3 stages): Primary: chancre (open ulcer); may be in vaginal canal Secondary: rash, often on hands or feet Tertiary: (only 1/3 go this far): bacteria affect bones, joints, blood vessels, brain Treatment: Single dose of penicillin

Syphilis ( Treponema pallidum )

Approximately 32,000 diagnoses/year (recent decrease)

Spirochetal bacterial infection

Spread through intimate contact (stages I and II) and from mother–child

Travels through blood, affects other tissues, including CNS

Increases risk of HIV transmission

Signs and symptoms (3 stages):

Primary: chancre (open ulcer); may be in vaginal canal

Secondary: rash, often on hands or feet

Tertiary: (only 1/3 go this far): bacteria affect bones, joints, blood vessels, brain

Treatment:

Single dose of penicillin

Sexually Transmitted Diseases, cont. Other STDs: Nongonococcal urethritis : can be chlamydia, or related to other agents; treatable with antibiotics Molluscum contagiosus virus : not always sexually transmitted, but can be an STD; appears on external genitalia, anus; treated with topical medication or cryotherapy Genital warts ( condylomata acuminata ): from human papilloma virus; can lead to cervical cancer

Other STDs:

Nongonococcal urethritis : can be chlamydia, or related to other agents; treatable with antibiotics

Molluscum contagiosus virus : not always sexually transmitted, but can be an STD; appears on external genitalia, anus; treated with topical medication or cryotherapy

Genital warts ( condylomata acuminata ): from human papilloma virus; can lead to cervical cancer

Sexually Transmitted Diseases, cont. Massage? Some STDs are spread by skin-to-skin contact (warts, syphilis, molluscum contagiosum); undiagnosed lesions contraindicate massage, and open lesions require the use of standard precautions Most STDs are treated quickly and effectively with antibiotics; massage can be postponed until then Clients with a history of STDs but no current infection are good candidates for massage

Massage?

Some STDs are spread by skin-to-skin contact (warts, syphilis, molluscum contagiosum); undiagnosed lesions contraindicate massage, and open lesions require the use of standard precautions

Most STDs are treated quickly and effectively with antibiotics; massage can be postponed until then

Clients with a history of STDs but no current infection are good candidates for massage