Topic for Histopathology of Genitourinary Cancers
According to the research conducted professional essay writer in 2015 Canadian Cancer Statistics, the overall, age-adjusted, mortality rates for all cancers combined have not significantly changed in the last 30 years. This is despite billions and billions of dollars spent on research to develop effective therapies. Global cancer statistics reveal that genitourinary cancers represented approximately 10.4% of new cancers diagnosed worldwide in 2005 (Vogelzang 2006 318). These cancers occur in approximately 300,000 patients within the United States each year, and prostate cancer is now the most common malignancy and second leading cause of cancer death in U.S. men. Recognizing these facts within the confines of essay editing, practicing physicians require an essential understanding of the diagnosis and treatment of these diseases. In this study, the study includes the current management of prostate, bladder, renal, and testicular neoplasm.
Within help writing an essay was disclose that genitourinary cancer is most commonly diagnosed cancer in American men and is among the most common cancers diagnosed in many developed countries. The classic risk factors for this cancer are older age, African-American racial group, and family history of cancer. Nonetheless, the wide variation in incident rates among countries and the increases in genitourinary cancer rates in groups that have migrated from countries that have low rates to those countries with high rates strongly suggest the importance of environmental and etiological factors in the line of progressive mortality ratings for the past 30 years.
Histopathology of Genitourinary Cancers
Genitourinary Cancer
Genitourinary cancers include testis, bladder, renal, and prostate cancers. The incidence, presenting symptoms, and prognoses for these cancers vary widely. Testis cancer is rare but curable in all stages. Approximately 7,500 cases of testis cancer will be diagnosed in the US in 2002 with only 400 men dying of the disease (American Cancer Society, 2002). Cancers of the genitourinary system are frequent malignancies and affect a large portion of the United States’ population (Vogelzang 2006 318). Testicular cancer is the most common cancer in men 15 to 35 years old, with an incidence of 3:100,000 men. Prostate cancer is second only to lung cancer as a cause of cancer deaths in men and is the most common cancer in them (Syzf 2001 404). Bladder cancer is the least common malignancy among the malignancies of the genitourinary tract, accounting for 4% of the new cancers diagnosed annually in the United States, producing nearly 12,000 deaths annually. Testicular cancer is a relatively uncommon malignancy, with approximately 8,960 new cases predicted to be diagnosed in 2004. However, the disease is the most common solid tumor malignancy in males between the ages of 15 and 35 years of age. The worldwide incidence of testicular cancer has doubled in the past 40 years (Syzf 2001 404). The highest incidence rates of testicular cancer occur in North America, Scandinavia, Germany, and New Zealand (Vogelzang 2006 318). Testicular cancer occurs four to five times more frequently in white males than in African American males (Vogelzang 2006 319). More than 50% of testicular cancer cases are diagnosed at an early stage. Although more than 90% of individuals with testicular cancer achieve a 5-year survival, the American Cancer Society (ACS) estimates that 360 males will die from the disease in 2004.
The Difficulty of Cancer
The incidence of genitourinary cancer had somehow changed during the course of time; however, the reduction of mortality ratings have yet to consider its decreasing state. At some point, researchers have pointed out that the little change in the mortality of Genitourinary cancer cases are mainly due to varying environmental and etiological changes occurring in the illness state. Such problems are considered as the rationale for the progressive yet continuously increasing mortality ratings of Genitourinary cancer cases. There are few early symptoms of testis cancer (Vogelzang 2006 319). Men typically present with a testicular mass as their first symptom (Droller 2001 489). Genitourinary cases have always been handled in appropriate staging, although sometimes the problem resides in this initial area. Staging includes assessment of regional lymph nodes and measurement of certain biochemical markers in the blood (Syzf 2001 404). Patients with no evidence of spread to the regional lymph nodes may be cured with surgery; however, misdiagnosis sometimes occur, which further degrades the conditions of such cases. Those with more advanced stage II or III disease are likely to be given additional chemotherapy or radiation. Tumor markers measured in the blood are often elevated in testis cancer and may be sensitive measures of therapy effectiveness (Droller 2001 489). Patients with testis cancer are often diagnosed at a young age and may be partially or completely infertile by the time of diagnosis. These men should be counseled that chemotherapy should further decrease their ability to father children (Syzf 2001 405).
On the aspect of etiological origin of the problem, most testicular cancers are derived from germ cell elements. A common histological scheme distinguishes pure seminomas from nonseminomatous germ cell tumors, which include embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumors, Leydig cell tumors, and gonadoblastoma. Among bladder cancers, approximately 95% are transitional cell carcinomas, 3% are squamous cell carcinomas, and the remainder are adenocarcinomas (Droller 2001 489). Risk factors for testicular cancer include cryptorchidism, genetics, and personal history of testicular cancer. The most significant risk factor is cryptorchidism undescended testicle (Waxman 2002 236). Males with a history of cryptorchidism have a 30- to 40-fold increased risk for testicular cancer. Successful orchiopexy, performed before the patient is 6 years of age, reduces the risk of testicular cancer (Droller 2001 490). However, data do not support a decreased risk for the disease when orchiopexy is performed in adults. Scientists continue to study the role of genetics in the development of testicular cancer. Such occurrence creates higher possibility for cancer progression; hence, increasing the rates of mortality conditions. The incidence of testicular cancer is greater in individuals with Klinefelter’s syndrome, Down’s syndrome, and testicular feminization, although the exact mechanisms of risk are unknown (Waxman 2002 236). In addition, sans of men with a history of testicular cancer have a four times greater risk of developing testicular cancer, and male siblings of individuals with testicular cancer have a 10 times greater risk of developing the disease (Droller 2001 490). The incidence of bilateral testicular cancer is I %—2%. However, a personal history of unilateral testicular cancer results in a 500 times greater chance of development of the disease in the contralateral testicle (Waxman 2002 236).
Staging is critical in the initial management of bladder cancers. The presence or absence of distal metastases can be documented by a physical examination, a CT scan of the chest, abdomen, and pelvis, and a radionuclide bone scan (Syzf 2001 406). The utility of bone scan is increased if the patient has bone pain or an elevated alkaline phosphatase level (Waxman 2002 236). Most cases of testicular cancer can be diagnosed at an early stage because early symptoms lead men to seek medical attention. Unfortunately, however, some testicular cancers may not cause symptoms until after reaching an advanced stage (Droller 2001 491). Most health care providers agree that examination of a man’s testicles should be part of a general physical examination. The ACS recommends a testicular examination as part of a periodic checkup. The ACS advises men to be aware of testicular cancer and to seek prompt medical evaluation if a mass is found (Waxman 2002 237). Because regular testicular self-examinations have not been studied enough to show a reduction in the death rate from this cancer, the ACS does not recommend regular testicular self-examinations for men without specific testicular cancer risk factors. However, some health care professionals think that not noticing masses promptly is an important factor in delaying treatment, and they recommend that all men perform monthly testicular self-examinations after puberty (Droller 2001 491). The choice of whether a monthly self-examination is to be performed should be made by each man. Signs and symptoms of testicular cancer include a lump, swelling, dull ache, heaviness, and pain in the scrotum (Waxman 2002 238). The most common presenting symptom is a mass in the scrotum that the individual or sexual partner discovers. In Contrast to the findings on breast self- examination, 95% of all masses of the testicle are malignant (Syzf 2001 406). Less common symptoms of testicular cancer include oligospermia. Often diagnosed as a component of an infertility evaluation, breast tenderness may also be present. Symptoms of chronic cough, shortness of breast, chest pain, and hemoptysis are characteristic of spread of the disease to the lungs. Other common sites of metastases include the live; brain, and bone (Droller 2001 491).
Genitourinary cancer metastases to the brain are rare. Germinal testicular cancer most commonly metastasizes to the brain, with an incidence ranging from 2 to 15% in clinical series4 and up to 40% in post-mortem autopsy studies (Waxman 2002 156). Furthermore, the development of isolated relapse of testicular cancer in the brain, although rare, has been well described in the literature (Dannenber et. al., 2003 184). The reported rate of brain metastases from urothelial cancer ranges from 1-12%. Yet, recent improvements in systemic therapy have allowed for increased survival and an apparent increase in the diagnosis of brain metastases in patients with advanced bladder cancer (Waxman 2002 156). Finally, the incidence of prostatic cancer meta stases to the brain is the lowest among genitourinary tumors and ranges from 0.2% in clinical studies to 1% in autopsy studies. The majority of brain metastases from genitourinary tumors are asymptomatic. When they become symptomatic, presentations include symptoms and signs of increased intracranial pressure, including headaches and papilledema, as well as symptoms and signs of cortical compression and irritation, such as seizures and focal neurological finding (Syzf 2001 407).
The diagnosis of testicular cancer is based on a combination of physical examination findings, laboratory tests, radiographic tests, and orchiectomy for tissue diagnosis. Orchiectomy is the recommended surgical procedure for obtaining a tissue diagnosis because fine-needle biopsy increases the risk of metastases. Physical examination should include an evaluation of the testicles, lymph nodes, and breast (because hormonally active testicular cancers can cause breast enlargement). Laboratory tests include beta-human chorionic gonadotropin levels and alpha fetoprotein markers. Radiographic tests include chest x-ray study and computed tomography of the abdomen and chest to determine the presence of distant metastases (Waxman 2002 157).
Alternative Approaches to Reduce Mortality
The treatment methods for genitourinary cases are continuously being developed in order to provide the best possible intervention in reducing mortality ratings of the disease. The increasing incidence of genitourinary cancer can be attributed to widespread screening using prostate-specific antigen (PSA), CT Scan, and other diagnostic procedures (Warmkessel 2005 268). For example, the increasing use of the assay in the late 1980s, coupled with the ease of transrectal prostatic biopsies using spring-loaded devices and transrectal ultrasonography, caused an “explosion” in prostatic cancer detection probably peaking in 1996, and greater public awareness of the disease has also contributed in this rapid increase in detection. The American Cancer Society recommends annual digital rectal examination in combination with PSA testing for prostatic cancer screening beginning at age 50 years, or at a younger age for African-Americans or those with a family history of the disease. Retrospective analysis has suggested that biannual PSA testing may be an acceptable screening interval when the initial PSA level is less than 2 ng/mL (Warmkessel 2005 269). Families with an altered HPCI gene exhibit more advanced stage and younger age at diagnosis, thus supporting initiation of annual screening at age 40 years in susceptible families. The cause of prostatic cancer is unknown, although racial, genetic, and dietary factors have been implicated (Waxman 2002 157). Approximately 9% of prostatic cancers can be attributed to inherited mutations in prostatic cancer—susceptibility genes. A major susceptibility locus for prostatic cancer has been mapped Lo chromosome I q and has been designated HPC1 (hereditary prostate cancer I). No research has yet linked aging to mutations of this gene. Recent evidence suggests that a CAG repeat polymorphism in the androgen receptor gene confers risk for prostatic cancer, with fewer repeats in the germ line associated with an increased likelihood of des eloping the disease (Waxman 2002 159). Bladder cancer treatment is best divided into the treatment of superficial and muscle-invasive disease. Superficial disease includes those tumors, which are noninvasive or invade only sub-epithelial tissue (Syzf 2001 409).
New treatments are being discovered in hope of reducing the mortality of genitourinary cancers. The treatment of testicular cancer is one of the few solid cancers In adults that may be successfully cured even In the presence of metastases (Warmkessel 2005 269). This has only been achievable in the last 40 years, since the introduction of csspl4itifl chemotherapy. Cisplatin was discovered serendipitously by Barnett Rosenberg, a physicist at Michigan State University, in 1965. He studied the effects of electric currents on E. Colli using platinum electrodes in a water bath and found that they stopped dividing but not growing, leading to bacteria up to 300 times longer than normal (Waxman 2002 159). This was found to be due to cisplatin, a product from the platinum electrodes, which was interfering with DNA replication. The genitourinary tract is one of the most frequent sites of cancer in men and includes prostate cancer, which has emerged as the most common tumor in men. COX-2 inhibitors and other NSAIDS are very promising for the prevention and treatment of genitourinary cancers (Dannenber et. al., 2003 192). Selective COX-inhibitor, non-selective-COX-inhibitor and non-COX-inhibitor NSAIDs have all shown activity against bladder and prostate cancers, which implicates, where COX-2 over-expression is clear, and in prostate carcinogenesis (Waxman 2002 238).
Another research currently occurring involves the utilization of different compounds to alleviate the cancer condition, such as in the case of one of the types of genitourinary cancer – bladder cancer. The majority of transitional cell carcinomas of the bladder present as superficial turnouts. After resection by diathermy at cystoscopy, approximately 60% of these wilt recur (Warmkessel 2005 269). The recurrence rate is greater where there are multiple turnouts, associated carcinoma in site or poorly differentiated tumours (Waxman 2002 159). The outlook is best for solitary tumours, tumours with good histology and tumours without invasion of the lamina propria. The recommendation for follow-up is slightly controversial but, in most practices, cystoscopv is performed three-monthly until the patient is tumour free and thereafter six-monthly for two years then yearly for three years (Syzf 2001 401). If turnouts arc poorly controlled by cystoscopic diathermy but remain superficial, agents may be instilled into the bladder to try and control the disease. There are a number of different compounds used, including BCG, interferon, thiotepa, adriamcyin, mitomycin C. mitozantrone and epodyl (Dannenber et. al., 2003 192). The consensus view is that diathermy and intravesical chemotherapy present the progression of superficial to locally advanced or metastatic disease in 40% of cases, However, overall, approximately 10% of patients with superficial turnouts develop invasive disease (Waxman 2002 161).
Clinical results have shown that combinations of chemotherapy or radiotherapy with NSAIDCOX-2 inhibitors are more effective in treating bladder and prostate cancers than is either modality alone. Therefore, these agents may be most effective when combined with other treatment modalities or agents. This concept will require further evaluation in clinical trials (Syzf 2001 401). The only reported completed NSAID study in prostate cancer indicated that a non-COX-inhibiting NSAID (Waxman 2002 161). sulindac sulfone, was active in preventing PSA progression in patients with D, prostate cancer (elevated PSA in absence of clinically detectable prostate cancer). The selective COX.2 inhibitor, celecoxib, is a very promising NSAID currently being tested in an NCI-sponsored phase Ill prevention trial in the bladder and in a pharmacodynamic trial in preprostatectomy patients. A large number of preclinical and clinical NSAID studies are underway in bladder, prostate, skin, esophageal, pancreatic, breast, lung and cervical cancers (Warmkessel 2005 268). These studies are addressing many unanswered questions, such as what are the best type (selective or non-selective COX inhibitors or non-COX inhibitors) dose and duration of NSAIDs. Future studies likely will focus on NSAID mechanisms and combinations for both treating and preventing genitourinary cancers (Dannenber et. al., 2003 194). These current treatments are being developed continuously in order to further facilitate significant cure methodology for such genitourinary cancer patients (Warmkessel 2005 268).
Conclusion
Genitourinary (or urogenital) cancers are cancers of the organs concerned with reproduction and the production and excretion of urine. For the past 30 years, the mortality ratings of genitourinary cases have not changed significantly in spite of the technological advancements and research procedures done. The primary problems attributed to the reason why such cancer is hard to treat are coinciding in etiological rationale and environmental causations. Nevertheless, in spite of these mortality conditions, there are studies that provides alternative routes of alleviating the said condition. These studies are addressing many unanswered questions, such as what are the best type (selective or non-selective COX inhibitors or non-COX inhibitors) dose and duration of NSAIDs. Future studies likely will focus on NSAID mechanisms and combinations for both treating and preventing genitourinary cancers.
Works Cited:
Dannenberg etal, Andrew J. Cox-2: A New Target for Cancer Prevention and Treatment. Karger Publishers, 2003.
Droller, Michael J. Bladder Cancer: Current Diagnosis and Treatment. Humana Press, 2001.
Szyf, Moshe. DNA Methylation and Cancer Therapy. Springer, 2005.
Vogelzang, Nicholas. Comprehensive Textbook of Genitourinary Oncology. Lippincott Williams & Wilkins, 2006.
Warmkessel, Jeanne. Contemporary Issues in Prostate Cancer: A Nursing Perspective. Jones & Bartlett Publishing, 2005.
Waxman, Jonathan. Treatment Options in Urological Cancer. Blackwell Publishing, 2002.
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