Alpha-feto-protein (commonly elevated even during early stages)
Treatment of early stage is surgery
Cure rate >75 % for tumors <2cm
Severe cirrhosis or small liver Ca may benefit from liver transplant
Not proven benefit from chemotherapy or radiation
Most common cancer in women
Second leading cause of death in women after lung cancer, in the US
In 2005 - 213,000 women were Dx with invasive breast cancer
40,000 women died of Breast Ca
Breast cancer in men is rare, but it happens
First-term pregnancy after 25 years of age
Prolonged Use of exogenous estrogen
Exposure to ionizing radiation
Cancer - susceptibility genes
BRCA1 and BRCA2
Present in Only 5-10% of patients with breast cancer
Personal or family hx of male breast Ca
Family Hx of ovarian Ca
Should be offered counseling / genetic testing
Yearly mammograms are recommended starting at age 40 .
A clinical breast exam should be part of a periodic health exam, about every three years for women in their 20s and 30s , and every year for women 40 and older.
Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.
Breast Cancer types
• Earliest form of the disease, ductal carcinoma in situ (DCIS), solely in the milk ducts.
The most common type of breast cancer , Invasive ductal carcinoma (IDC), develops from DCIS, spreads through the duct walls, and invades the breast tissue.
Invasive lobular carcinoma originates in the milk glands and accounts for 10 - 15% of invasive breast cancers
Less common Breast Cancer types
Paget's disease of the nipple:
originates in the milk ducts and spreads to the skin of the nipple
tends to spread quickly
Erythema and edema of the overlying skin
Underlying aggressive ductal carcinoma
lump that feels different than the surrounding breast tissue
Lumps found in lymph nodes located in the armpits
changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge,ulceration
Symptoms of Inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange peel texture to the skin referred to as peau d'orange .
Paget's disease of the breast . eczematoid skin changes, redness , mild flaking of the nipple skin. As advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain, discharge from the nipple. Approximately half of women diagnosed with Paget's also have a lump in the breast
Disproportionate breast size
Disproportionate breast size may occur as a result of:
Surgery and/or radiation
Breast feeding on one side only
Rapidly growing tumors
Breast puckering secondary to a small, superficial cancer close to the skin, became apparent in this 65 year old woman on a visit to her doctor when she was asked to raise her arms during the clinical breast examination.
Dimpling may be associated with inflammatory cancer. It may also be seen after surgery
"accessory" breast tissue
Extra breast tissue or "accessory" breast tissue is not abnormal. It may be unsightly and some women consult with plastic surgeons if they feel awkward in tank tops or other sleeveless garments
Nipple Inversion: This woman noted an inverted nipple since she was a teenager. This is longstanding and no further work-up is required.
Xeroradiograph that demonstrates a cancer behind the nipple pulling the nipple in. Xeroradiography has been replaced by mammography.
Inverted nipple (the discoloration is due to a needle biopsy
Bloody discharge needs to be investigated.
Please consult your physician
Ulceration of breast skin
This represents a breast cancer that has eroded the skin and caused a small ulcer.
This represents a recurrence of breast cancer after a lumpectomy and radiation therapy. Breast cancer can recur after a lumpectomy or after a mastectomy.
More common sites of metastasis include bone, liver, lung and brain
Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills.
Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms
Breast cancer diagnosed most often through screening mammogram
Fewer than 10% patients have metastasis at Dx
Requires removal of the primary tumor and ipsilateral axillary lymph node
If tumor more than 5cm with + lymph nodes include:
CT of the abdomen
For smaller tumors, no need for above unless they have bone pain-sign of metastasis
Small breast tumor- lumpectomy+radiation
Large tumor or two or more-mastectomy
Women who had previous radiation-mastectomy
Chemotherapy may allow breast conservation
Preoperative hormone therapy in frail patients with hormone receptors pos.tumors
Adjuvant therapy with chemo.and hormones improve relapse free and over all survival
Trastuzumab -monoclonal antibody
Patients with metastasis:
Better prognosis in women with hormone responsive disease and lymph node metastasis only. No liver,bone or CNS
Biphosphonates IV to alleviate pain from bone metastases and the risk of fractures
DCIS - lumpectomy, followed by radiation therapy or mastectomy
Tamoxifen: estrogen agonist
800-900 new cases each year in the US
Age 15-34 yo, most common
90% cure rates, 100% if it has not metastasize
Unusual lump in a testicle should be checked immediatelly
Most common advanced symptom is bone pain(vertebrae , pelvis and ribs)
If spinal cord compression-leg weakness, urinary and fecal incontinence
Risk factors:age, genetics, race,diet, life style
Digital rectal exam:feeling for irregularities or bumps
Prostate specific antigen (PSA)
Elevated in BPH and Prostatitis, after ejaculation, catheterization
Only diagnostic test - Biopsy
Early stage:prostatectomy,radiation therapy
Late stage:hormone therapy and/or radiation therapy
External beam radiation therapy and brachytherapy
Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society
The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.
Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45.
For men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.
Less common in women than in men
One fifth of the affected patients will dye
Most common risk factor is cigarette smoking
Other factors: exposure to chemicals, parasites and medications such as Cytoxan
Most common :transitional cell carcinoma
Most common presentation - gross hematuria
Bladder irritation or spasms
When beyond the bladder : leg swelling, pelvic pain, compression nerves in the pelvic plexus
Tumors are divided into superficial, invasive and metastatic
Direct imaging and Biopsy to determine depth of invasion - prognosis - treatment
Cystoscopy the most important Dx tool to determine if wall of the bladder has been affected
CT and MRI for nodal involvement and Metastaisis
TURB transurethral resection of the bladder
Cytoscopy :every three months for monitoring and resections if required
Also use of immunomodulators instilled in the bladder:Interferon, mitoxantrone, every week for 6 weeks , then do cytoscopy
Tumors invading the muscle:
If not through the bladder wall - radical cystectomy
A pouch is created from the small intestine to store and expel urine
Other approaches possible-with bladder preservation + chemotherapy