15. Testicular cancer
• Causes of testicular cancer
• Some factors that may increase risk of testicular
cancer include:
• undescended testicle (when an infant)
• family history (having a father or brother who has
had testicular cancer)
• personal history – if you have had cancer in one
testicle you are more likely to develop cancer in
the other testicle
• infertility
16. • Physical features – people born with
Hypospadias, which causes the urethra to
open on the underside of the penis, are at an
increased risk of testicular cancer
• Cannabis use – there is some evidence
linking regular cannabis use to the
development of testicular cancer
• Intersex variations - risk is higher in people
with some intersex variations, such as partial
androgen insensitivity syndrome
17.
18.
19.
20. TNM stages
The stage of a cancer tells you how big it is
and how far it has spread. It helps your
doctor decide which treatment you need.
Doctors use a staging system called TNM
(Tumour, Node, Metastasis).
•T describes the size of the tumour
•N describes whether there are any cancer
cells in the lymph nodes
•M describes whether the cancer has
spread to a different part of the body
Doctors may also use a number staging
system for kidney cancer.
21. T stages
The T stage describes the size of the tumour.
There are 4 stages, T1 to T4.
T0 means there is no evidence of a primary tumour in
the kidney.
T1 is divided into T1a and T1b:
•T1a means the tumour is less than 4cm across, and
is completely inside the kidney
•T1b means the tumour is between 4 to 7cm across,
and is completely inside the kidney
T2 is divided into T2a and T2b:
•T2a means the tumour is between 7 to 10cm across,
and is completely inside the kidney
•T2b means the tumour is more than 10cm across, but
is still completely inside the kidney
T3 is divided into T3a, T3b, and T3c:
22. •T3a means the tumour has grown into nearby tissues or
veins, but is still inside the layer of connective tissue called
Gerota's fascia
•T3b means the tumour has grown into the vena cava, but
is below the diaphragm (sheet of muscle between the lungs
and tummy)
•T3c means the tumour has grown into the vena cava
above the diaphragm (sheet of muscle between the lungs
and tummy), or has grown into the wall of the vena cava
T4 means the cancer has spread further than the tissues
around the kidney
23. •T3a means the tumour has grown into
nearby tissues or veins, but is still inside
the layer of connective tissue called
Gerota's fascia
•T3b means the tumour has grown into the
vena cava, but is below the diaphragm
(sheet of muscle between the lungs and
tummy)
•T3c means the tumour has grown into the
vena cava above the diaphragm (sheet of
muscle between the lungs and tummy), or
has grown into the wall of the vena cava
T4 means the cancer has spread further
than the tissues around the kidney
24. N stages
The N stage describes whether the cancer
has spread to the lymph nodes.
NX means lymph nodes cannot be
assessed
N0 means there are no cancer cells in the
lymph nodes
N1 means there are cancer cells in one or
more lymph nodes
Doctors often call lymph nodes that contain
cancer positive lymph nodes.
The lymph nodes nearest to the kidney
include the paraaortic, renal hilar and caval
lymph nodes.
25. M stages
The M stages describe whether the cancer has
spread to a different part of the body
(metastases).
M0 means the cancer has not spread to another
part of the body
M1 means the cancer has spread to another part
of the body
If your cancer has spread, you have advanced
kidney cancer.
26. Surgery is the main treatment.
If your cancer is smaller than 3cm and you
are older or unwell, your doctor might
suggest you have no treatment at first.
They will monitor you closely. They might
call this active surveillance.
If you can't have surgery, you might have:
•freezing therapy (cryotherapy)
•radio wave treatment (RFA)
•radiotherapy
•blocking the blood supply to the cancer
(arterial embolisation
27. TNM staging for prostate cancer
The TNM system is a way of staging
prostate cancer. It stands for Tumour,
Node, Metastasis. Staging means
describing the size of the cancer and how
far it has grown.
Doctors in the UK now use a tool called the
Cambridge Prognostic Group (CPG) to
divide prostate cancer into 5 groups. The
CPG uses information about:
•the T stage from the TNM staging
•Grade Groups or Gleason score
•Prostate specific antigen (PSA) level
28.
29.
30. Node (N)
Node (N) describes whether the cancer has spread
to the lymph nodes.
N is split into N0 and N1.
N0 means that the nearby lymph nodes don’t
contain cancer cells
N1 means there are cancer cells in lymph nodes
near the prostate
31. Metastasis (M)
Metastasis (M) describes whether the
cancer has spread to a different part of the
body.
There are 2 M stages – M0 and M1.
M0 means the cancer hasn’t spread to
other parts of your body.
M1 means the cancer has spread to other
parts of the body outside the pelvis . It is
split into M1a, M1b and M1c.
M1a means there are cancer cells in lymph
nodes outside the pelvis
M1b means there are cancer cells in the
bone
M1c means there are cancer cells in other
parts of the body such as the lungs
32. Treatment
The TNM stage helps your doctor recommend
if you need treatment and the type of
treatment you need. Doctors also consider
the following things:
•what the cancer cells look like under the
microscope. This is the Grade Group
•your PSA blood test level
If your cancer has not spread then the Grade
Group, PSA and TNM stage is combined to
divide your cancer into one of the 5
Cambridge Prognostic Groups (CPGs).
Doctors also consider other factors when
recommending the best treatment for you:
•how much cancer there is. This is based on
the number of biopsy samples that had
cancer divided by the number of biopsies
taken
•your age and general health
•whether you have an increased chance of
having aggressive cancer based on
any gene changes you might have
•how you feel about what the treatments
involve and the side effects
33. If you decide to have treatment this might
include:
•surgery to remove your prostate
•external beam radiotherapy
•internal radiotherapy (brachytherapy)
•hormone therapy alone or in combination
with radiotherapy
•chemotherapy
•symptom control treatment
•high frequency ultrasound therapy (HIFU)
as part of a clinical trial
•cryotherapy as part of a clinical trial
34. Stages of bladder cancer
The TNM staging system is the most
common way that doctors stage bladder
cancer. TNM stands for Tumour, Node,
Metastasis.
Doctors may also use a number staging
system, but this is less common for bladder
cancer.
Your doctor may use other terms to
describe your bladder cancer stage. These
include:
•non muscle invasive bladder cancer
•invasive or muscle invasive bladder
cancer
•metastatic bladder cancer
35. TNM staging
This is the most common way that doctors
stage bladder cancer. TNM stands for
Tumour, Node, Metastasis.
Tumour (T)
Tumour describes the size of the tumour.
There are several T stages:
CIS or Tis means very early, high
grade cancer cells are only in the
innermost layer of the bladder lining.
Ta means the cancer is just in the
innermost layer of the bladder lining.
T1 means the cancer has started to grow
into the connective tissue beneath the
bladder lining.
T2 means the cancer has grown through
the connective tissue into the muscle. It is
divided into T2a and T2b.
•T2a means the cancer has grown into the
superficial muscle
•T2b means the cancer has grown into the
deeper muscle
36. means the cancer has grown through the
muscle into the fat layer. It is split into T3a
and T3b.
•T3a means the cancer in the fat layer can
only be seen under a microscope
(microscopic invasion)
•T3b means the cancer in the fat layer can
be seen on tests, or felt by your doctor
during an examination under anaesthetic
(macroscopic invasion)
T4 means the cancer has spread outside
the bladder. It is split into T4a and T4b.
•T4a means the cancer has spread to
the prostate, womb (uterus) or vagina
•T4b means the cancer has spread to the
wall of the pelvis or tummy (abdomen)
37.
38. Node (N)
Node in TNM means your lymph nodes. These are a network of
glands throughout the body, for example in your armpits, neck and
groin. They drain away waste fluid, waste products and damaged
cells, and contain cells that fight infection.
Cancer cells can enter the lymphatic system and travel around the
body.
There are 4 lymph node (N) stages in bladder cancer - N0 to N3:
•N0 means there are no cancer cells in any lymph nodes
•N1 means there are cancer cells in one lymph node in the pelvis
(between your hip bones)
•N2 means there are cancer cells in more than one lymph node in the
pelvis
•N3 means there are cancer cells in one or more lymph node just
outside the pelvis
39. Number stages
There is another staging system for
bladder cancer which is not used often. It
has 5 main stages, numbered from stage 0
to stage 4. Stage 0 is the earliest cancer
and stage 4 is the most advanced.
Stage 0
The cancer is just in the inner layer of the
bladder lining (stage 0a) OR there are very
early, high grade cancer cells only in the
inner layer of the bladder lining (stage 0is).
Stage 1
The cancer has started to grow into the
connective tissue beneath the bladder
lining.
Stage 2
The cancer has grown through the
connective tissue layer into the muscle of
the bladder wall.
Stage 3
The cancer has grown through the muscle
into the fat layer and may have spread to
the prostate, womb or vagina. It might also
have spread to nearby lymph nodes.
Stage 4
