Методички онкология / 5 курс / САРС / 10 простата
.docMINISTRY OF HEALTH OF UKRAINE
Kharkiv National Medical University
Approved
on the methodical meeting Department of Oncology
Head of Department
MD, professor Starikov VI
'28"August 2011
A methodical DEVELOPMENT
For independent work of students
Course 5
Faculty of Medicine (specialty "General Medicine", "Pediatrics", "Prophylactic medicine")
Study Subject: Oncology
Module number 1
Content module № 3
Subject: № 10 Cancer of the prostate
number of training hours -5
Kharkiv November 2011
Topic.
Malignant tumors of the prostate in the structure of cancer in men occupy 8-12%; abandonment process limits the possibility of effective treatment. Weather in common unfavorable stages. Appropriate Oncology cautious and careful onkosposterezhennya for patients with precancerous diseases of the prostate. The problem of prostate cancer remains an important and unexplored until the end.
Overall objective: to be able to diagnose and treat cancer tumors peredmыhurovoъ
Know:
1. Epidemiology, etiologic factors for prostate cancer.
2. Pathological anatomy, classification of the stages of prostate cancer.
3. Clinical signs and diagnosis of prostate cancer.
4. Methods of modern special treat prostate cancer.
Be able to:
1. Conduct review of a patient with prostate tumor.
2. Absorb the history and make its analysis.
3. Palpable peripheral lymph nodes.
4. Carry out rectal examination.
5. Work plan and examination of the patient, based on a survey of the patient, formulate clinical diagnosis and treatment plan in case of prostate cancer.
Contents of training
Theoretical questions to topics that must learn studentyi: 1. Clinical symptoms of prostate cancer. 2. Diagnosis of tumors prostate. 3. Classification of tumors prostate. 4. Question metastasis 5. Epidemiology of tumors Prostate cancer incidence and mortality in these pa prostate etiological factors and Precancer disease pathogenesis. 6. The principles and tactics of treatment of tumors prostate cancer, and long-term results of treatment of prostate cancer, diagnosis and treatment of recurrences and metastases. 7. Predisposing factors and precancerous conditions, prevention. 8. Examination of disability, prognosis, rehabilitation patients
Among malignant diseases in men with prostate cancer is 8-12%. The greatest incidence in Northern Europe and North America (30-50 per 100,000 population) etiology - not fully understood. Etazhn bind with high content of androgens. Macroscopically, prostate cancer has the form of small units measuring 1 - 1.5 cm, placed under the capsule in the peripheral regions of the prostate. While growth may take the entire gland and move into surrounding tissue.
There are histological forms of prostate cancer:
Adenokartsinoma - 70%
a) tubular (svitloklitynna, temnoklitynna).
b) slyzoutvoryuyucha - 2% krybroznyy cancer - 10%, undifferentiated carcinoma - 16%, squamous cell carcinoma - 2% other.
Tubular adenokartsinoma characterized by a benign course, and slyzoutvoryuyucha krybroznyy cancer unfavorable course.
Early symptoms of prostate cancer is not, is only finger study by prophylactic examinations. In 80% of cases sposteriahyutsya urinary disorders similar to benign prostate. Pain in the perineum, the anus, and buttocks may be caused germination capsule gland.
Metastasis lymphogenous in l / nodes and hematogenous bone in the pelvis and spine.
Palpable gland, which initially may be normal size, then may increase. Unit prostate dense, looks like a cone, facing the tip into the lumen of the rectum. With further growth of prostate tumors in a real infiltrate.
Percutaneous biopsy performed transrectal or perineal access. Transrectal ultrasound conducting research. CT is used for 3-4 stage. Lymphography shows in 70-80% of cases of metastatic lymph nodes. 90-95% of patients appear in the later stages and is inoperable. Apply surgery, radiation therapy, hormone-and chemotherapy.
At T 1.2 perform radical prostatectomy with the seminal vesicles, fiber and neck of the bladder (the operation is possible in 5-8% of patients). When N 1 - castration and estrogenoterapii, often used THT. At T 3 conduct remote THT on prostate, castration and estrogenoterapii. At T 4 or M 1 - the same treatment. Estrogenoterapii start with large doses within 1-1,5 months. Then, a maintenance therapy. Sinestrol intramuscularly 80 mg or 500 mg honvanu (fosfestrolu) in / every day.
In hormonorezystentnyh - 10-20% of prostate tumors - used methotrexate, cisplatin, 5-fluorouracil, cyclophosphamide, adriamycin, vinblastine, DTIK. Results from monochemotherapy almost like and from chemotherapy.
Weather. 5-year survival in the early stages after radical surgery - 80% after THT - 80%, hormone therapy - 45-65% in the late stages of the 5-year survival rate - 10-30%.
Literature Summary:
1. Bilynsky BT Oncology. Lviv, 1998.
2. Bilynsky BT Oncology. Lviv, 1992.
3. Peterson BE CANCER. Moscow: Medicine, 1980.
4. Slynchak SM CANCER. Kiev, 1989.
5. Trapeznikov NN CANCER. Moscow: Medicine, 1981.
6. Lecture material
Further Reading:
Danyэl-Beck K. Fundamentals of Oncology. Moscow: Medicine, 1973. - 215 p.
Clinical CANCER. Moscow: Medicine, 1971. V.2. - 440 p.
Marynbah EB Zlokachestvennыe tumor predstatelnoy cancer. Moscow: Medicine, 1967.
CANCER. Dictionary-Handbook. Kasyanenko IV, Pinchuk VG, Myasoedov DV and Dr. K.: Scientific Thought, 1992.
Quiz:
1. Clinical symptoms of prostate cancer. 2. Diagnosis of tumors prostate. 3. Classification of tumors prostate. 4. Question metastasis 5. Epidemiology of tumors Prostate cancer incidence and mortality in these pa prostate etiological factors and Precancer disease pathogenesis. 6. The principles and tactics of treatment of tumors prostate cancer, and long-term results of treatment of prostate cancer, diagnosis and treatment of recurrences and metastases. 7. Predisposing factors and precancerous conditions, prevention. 8. Examination of disability, prognosis, rehabilitation patients
Situational tasks (correct answers are marked *)
Task 1. Patient complains of pain in the perineum pulling. After completing routine prophylactic examinations ill directed to consult an oncologist. A rectal examination in the right piece of prostate formation of 1x1 cm, dense, hilly. Mizhdolova furrow pronounced. Your preliminary diagnosis? A. Prostatitis; B. Tuberculosis of the prostate; C. Prostate cancer * D. Adenoma of the prostate; E. Sclerosis of the prostate.
Task 2. Patient in '73, pale, complains of poor urination, pain in the abdomen, in the perineum and sacrum, blood in the urine. During rectal palpation revealed nodular, very dense tumor in both pieces of the prostate. What data speak in favor of a malignant tumor prostate? A. Pallor, anemia. B. Pain in the perineum and sacrum. * C. Poor urination. D. Danny palpation of the prostate. E. Blood sechy.
Problem 3. Patient F., 48 years complains of frequent painful urination, pain in the perineum, buttocks and back, periodically increased body temperature. During rectal palpation determined enlarged prostate tuhoelastychnoyi consistency. How much research will be the best? A. Common blood and urine tests, ultrasound of kidney, retrograde pyelography. B. Common blood and urine tests, ultrasound of the bladder, intravenous pyelography. C. Common blood and urine tests, blood chemistry, ultrasound of the kidneys and bladder, intravenous pyelography. D. CT of the pelvis, the urine on the microflora. * E. CT of the pelvis. Ultrasound bladder, survey abdominal radiography.
Problem 4. The patient complains of '73 poor urination, pain in the abdomen. During rectal palpation revealed nodular, very dense tumor in both pieces of the prostate. Diagnosis - prostate cancer. What tactics further management of the patient? A. Hospitalization in the surgical department for epitsystostomiyi. B. Hospitalization in the surgical department for adenomektomy. C. Hospitalization in the therapy department for symptomatic treatment. D. Refer to an oncologist. * E. Observation surgeon.
Problem 5. Patient S., 64 years had sought a urologist with complaints of frequent small meals sechospuskannya that arise also at night. Other complaints there. Above symptoms gradually increased over several years. Palpable prostate is enlarged due to the formation of elastic to 5 cm in diameter, rolling. When ultrasound is defined node with indistinct contours to 4.5 cm in diameter. When needle biopsy - elements proliferating epithelium. Assumptions diagnosis - prostate adenoma. What symptoms can differentiate the diagnosis from another prostate pathology? A. Polakiuriya, nocturia, which continued growing slowly, no other complaints. * B. Data palpation. C. Data ultrasound. D. These puncture. E. Dimensions node.
tests (Correct answers are marked *)
Test number 1 Patient 83 years. Complains of poor urination, flabby jet. Diagnosis: prostate cancer stage II. Your treatment strategy? A. Perform ultrasound prostate, send an oncologist. B. Perform ultrasound and CT of the pelvis, to send to the surgeon. C. Set urethral catheter assign antibiotic, send an oncologist. * D. Set urethral catheter, antibiotic assign, direct them to the surgeon. E. Approve symptomatic therapy, after relief of dispatch to an oncologist.
Test number 2. Patients enrolled in the admissions department with symptoms of urinary tract obstruction. Sick 3 months if any unpleasant feeling in the suprapubic area weakened force jet during sechospuskannya. Symptoms grew and before having severe pain in the suprapubic area, resorting to sechospuskannya. What diagnostic tactics surgeon? A. Plain radiographs of the lumbar area, ultrasound of the kidneys. W. Finger study rectal ultrasound of the bladder and prostate, general clinical blood tests. * C. Ultrasound bladder and kidney, ascending urography. D. CT of the pelvis. E. Only the blood and urine.
Test number 3. Patient in '73, pale, complains of poor urination, pain in the abdomen, in the perineum and sacrum, blood in the urine. During rectal palpation revealed nodular, very dense tumor in both pieces of the prostate. What is the preliminary diagnosis? A. Chronic prostatitis B. Prostate Cancer * C. Cancer of the rectum D. Adenoma of prostate E. Bladder tumors
Test number 4.
Patient K., '52, was diagnosed with prostate cancer III. What treatment is.
A. chemotherapy and estrogenoterapii B. gamma therapy for prostate, castration and estrogenoterapii *
C. gamma therapy for prostate and castration D. prostatectomy, gamma-therapy to the prostate bed E. prostatectomy, gamma-therapy estrogenoterapii
Methodological development was by MD, assistant Muzhychuk O.