Urogenital cancer. Kidney Cancer

What is Kidney Cancer?What is Kidney Cancer?
Seventh most common cancer and tenth mostSeventh most common cancer and tenth most
common cause of cancer death in mencommon cause of cancer death in men
A disease of the kidneys in which cells growA disease of the kidneys in which cells grow
uncontrollably and form a tumoruncontrollably and form a tumor
Several types of kidney cancers: renal cellSeveral types of kidney cancers: renal cell
carcinoma (85% of cases), transitional cellcarcinoma (85% of cases), transitional cell
carcinoma (10% to 15% of cases), sarcoma, andcarcinoma (10% to 15% of cases), sarcoma, and
Wilms tumorWilms tumor
Two most common cell types in kidney cancer:Two most common cell types in kidney cancer:
clear cell, caused by aclear cell, caused by a VHLVHL gene mutation, andgene mutation, and
papillary, caused by several genetic mutationspapillary, caused by several genetic mutations

What is the Function of the Kidneys?What is the Function of the Kidneys?
Two fist-sized organs located aboveTwo fist-sized organs located above
the waist on either side of the spinethe waist on either side of the spine
Filter blood and remove impurities,Filter blood and remove impurities,
excess minerals and salts, andexcess minerals and salts, and
surplus watersurplus water
Process 200 quarts of blood everyProcess 200 quarts of blood every
day to generate two quarts of urineday to generate two quarts of urine
Produce hormones to help controlProduce hormones to help control
blood pressure, red blood cellblood pressure, red blood cell
production, and other functionsproduction, and other functions
The human body can function withThe human body can function with
less than one complete kidneyless than one complete kidney

What are the Risk Factors for KidneyWhat are the Risk Factors for Kidney
Cancer?Cancer?
SmokingSmoking
Gender, race, and ageGender, race, and age
Nutrition and weightNutrition and weight
Hypertension (high blood pressure)Hypertension (high blood pressure)
Overuse of certain medicationsOveruse of certain medications
Exposure to cadmium (a metallic element)Exposure to cadmium (a metallic element)
Long-term dialysisLong-term dialysis
Genetic and hereditary risksGenetic and hereditary risks

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Kidney Cancer and Early DetectionKidney Cancer and Early Detection
No tests areNo tests are
recommended forrecommended for
screening the generalscreening the general
populationpopulation
People at high risk forPeople at high risk for
the disease maythe disease may
undergo regularundergo regular
computed tomographycomputed tomography
(CT or CAT) scans(CT or CAT) scans

What are the Symptoms of KidneyWhat are the Symptoms of Kidney
Cancer?Cancer?
Hematuria (blood in the urine)Hematuria (blood in the urine)
Pain, pressure, or a mass or lump in a person’sPain, pressure, or a mass or lump in a person’s
side, back, or testicleside, back, or testicle
Ankle and leg swellingAnkle and leg swelling
High blood pressure, anemia (low red blood cellHigh blood pressure, anemia (low red blood cell
count)count)
FatigueFatigue
Loss of appetite or unexplained weight lossLoss of appetite or unexplained weight loss
Recurrent fevers (not from cold, flu, or otherRecurrent fevers (not from cold, flu, or other
infections)infections)

How is Kidney Cancer Diagnosed?How is Kidney Cancer Diagnosed?
Diagnosis, including cell type, is confirmed withDiagnosis, including cell type, is confirmed with
a biopsya biopsy
Physical examinationPhysical examination
Blood and urine testsBlood and urine tests
Imaging tests, such as intravenous pyelogramImaging tests, such as intravenous pyelogram
(IVP) and CT scan(IVP) and CT scan

Stage I Kidney CancerStage I Kidney Cancer
The tumor is 7 cm orThe tumor is 7 cm or
smaller and is in thesmaller and is in the
kidney onlykidney only
Divided into Stage IaDivided into Stage Ia
(tumor is smaller than 4(tumor is smaller than 4
cm) and Stage Ib (tumorcm) and Stage Ib (tumor
is between 4 cm and 7is between 4 cm and 7
cm)cm)
The tumor has notThe tumor has not
invaded the lymphinvaded the lymph
nodes or distant organsnodes or distant organs

Stage II Kidney CancerStage II Kidney Cancer
The tumor is largerThe tumor is larger
than 7 cm and is in thethan 7 cm and is in the
kidney onlykidney only
The tumor has notThe tumor has not
invaded the lymphinvaded the lymph
nodes or distant organsnodes or distant organs

Stage III Kidney CancerStage III Kidney Cancer
The tumor of any size is located only in theThe tumor of any size is located only in the
kidney and has spread to regional lymph nodes,kidney and has spread to regional lymph nodes,
but not to other parts of the body, orbut not to other parts of the body, or
The tumor has spread into major veins or tissueThe tumor has spread into major veins or tissue
around the kidney, and possibly to regional lympharound the kidney, and possibly to regional lymph
nodes but not to other parts of the bodynodes but not to other parts of the body

Stage IV Kidney CancerStage IV Kidney Cancer
The tumor has spreadThe tumor has spread
beyond the envelope ofbeyond the envelope of
tissue surrounding thetissue surrounding the
kidney and extends intokidney and extends into
the adrenal gland on thethe adrenal gland on the
same side of the body,same side of the body,
possibly to lymphpossibly to lymph
nodes, but not to othernodes, but not to other
parts of the body, orparts of the body, or
to any other organto any other organ

Staging and PrognosisStaging and Prognosis
Cohen HT, McGovern FJ. NEJM. 2005;353:2477.Cohen HT, McGovern FJ. NEJM. 2005;353:2477.

How is Kidney Cancer Treated?How is Kidney Cancer Treated?
Treatment depends on stage of cancerTreatment depends on stage of cancer
More than one treatment may be usedMore than one treatment may be used
SurgerySurgery
Targeted therapyTargeted therapy
ImmunotherapyImmunotherapy
Radiation therapyRadiation therapy
ChemotherapyChemotherapy

Cancer Treatment: SurgeryCancer Treatment: Surgery
If the cancer has not metastasized (spread) beyond theIf the cancer has not metastasized (spread) beyond the
kidneys, surgery may be the only treatment necessarykidneys, surgery may be the only treatment necessary
Radical nephrectomy: Surgery to remove the tumor,Radical nephrectomy: Surgery to remove the tumor,
kidney, and surrounding tissues; affected lymph nodeskidney, and surrounding tissues; affected lymph nodes
may be removedmay be removed
Partial nephrectomy: Surgery to a remove a smallPartial nephrectomy: Surgery to a remove a small
tumor while saving as much of the kidney as possible.tumor while saving as much of the kidney as possible.
This is recommended for a stage I tumorThis is recommended for a stage I tumor
Laparoscopic surgery: Surgeon makes several smallLaparoscopic surgery: Surgeon makes several small
incisions in the abdomen instead of one large incisionincisions in the abdomen instead of one large incision
Radiofrequency ablation: use of needle inserted intoRadiofrequency ablation: use of needle inserted into
tumor to destroy the cancer with an electrical currenttumor to destroy the cancer with an electrical current
Cryoablation: Freezing cancer cellsCryoablation: Freezing cancer cells

Cancer Treatment: Targeted TherapyCancer Treatment: Targeted Therapy
Three approved drugs: sunitinib (Sutent),Three approved drugs: sunitinib (Sutent),
pazopanib (Votrient), and sorafenib (Nexavar);pazopanib (Votrient), and sorafenib (Nexavar);
these are anti-angiogenic drugs (starve the tumorthese are anti-angiogenic drugs (starve the tumor
by disrupting its blood supply)by disrupting its blood supply)
Another anti-angiogenic drug, bevacizumabAnother anti-angiogenic drug, bevacizumab
(Avastin), slows growth of metastatic renal(Avastin), slows growth of metastatic renal
carcinomacarcinoma
Other approved drug, temsirolimus (Torisol) andOther approved drug, temsirolimus (Torisol) and
everolimus (Afinitor) targets a different protein thateverolimus (Afinitor) targets a different protein that
controls tumor growth and blood vessel formationcontrols tumor growth and blood vessel formation

Cancer Treatment: ImmunotherapyCancer Treatment: Immunotherapy
Uses materials made by the body or in aUses materials made by the body or in a
laboratory to boost patients’ natural defenseslaboratory to boost patients’ natural defenses
against cancer (also called biologic therapy)against cancer (also called biologic therapy)
Kidney cancer, one of the few cancers that theKidney cancer, one of the few cancers that the
human body can fight, responds well tohuman body can fight, responds well to
immunotherapyimmunotherapy
Interleukin-2 (IL-2) is the most effective drugInterleukin-2 (IL-2) is the most effective drug
used against advanced kidney cancerused against advanced kidney cancer
Alpha-interferon is also used in the treatment ofAlpha-interferon is also used in the treatment of
advanced kidney canceradvanced kidney cancer

Cancer Treatment: Radiation TherapyCancer Treatment: Radiation Therapy
The use of high-energy x-rays to destroy cancer cellsThe use of high-energy x-rays to destroy cancer cells
Different types of delivery: external beam (outside theDifferent types of delivery: external beam (outside the
body) and internal beam (inside the body using implants)body) and internal beam (inside the body using implants)
Rarely use alone to treat kidney cancer and used only ifRarely use alone to treat kidney cancer and used only if
the patient cannot have surgerythe patient cannot have surgery
Most often used on metastases to help ease symptomsMost often used on metastases to help ease symptoms
A recent advance is stereotactic radiosurgery, designedA recent advance is stereotactic radiosurgery, designed
to optimize the dose of radiation therapy given to ato optimize the dose of radiation therapy given to a
specific area without damaging nearby tissuespecific area without damaging nearby tissue

Cancer Treatment: ChemotherapyCancer Treatment: Chemotherapy
Use of drugs to kill cancer cellsUse of drugs to kill cancer cells
Typical chemotherapy (use of drugs to killTypical chemotherapy (use of drugs to kill
cancer cells) not effective for treating most typescancer cells) not effective for treating most types
of kidney cancerof kidney cancer
Transitional cell kidney cancer and Wilms tumorTransitional cell kidney cancer and Wilms tumor
are more sensitive to chemotherapyare more sensitive to chemotherapy
New drugs and combinations of drugs are beingNew drugs and combinations of drugs are being
researchedresearched

What is Bladder Cancer?What is Bladder Cancer?
Fourth most common cancer among men andFourth most common cancer among men and
eighth most common cause of cancer death ineighth most common cause of cancer death in
menmen
A malignant (cancerous) tumor that begins in theA malignant (cancerous) tumor that begins in the
bladderbladder
Described as noninvasive (superficial) orDescribed as noninvasive (superficial) or
invasiveinvasive
Three main types of bladder cancer: urothelialThree main types of bladder cancer: urothelial
carcinoma (90% of cases), squamous cellcarcinoma (90% of cases), squamous cell
carcinoma (4%), and adenocarcinoma (2%)carcinoma (4%), and adenocarcinoma (2%)

What is the Function of the Bladder?What is the Function of the Bladder?
The bladder is anThe bladder is an
expandable, hollowexpandable, hollow
organ in the pelvisorgan in the pelvis
that stores urinethat stores urine
before it leaves thebefore it leaves the
body during urinationbody during urination
The bladder is part ofThe bladder is part of
the urinary tract,the urinary tract,
which is also made upwhich is also made up
of the kidneys,of the kidneys,
ureters, and urethraureters, and urethra

What are the Risk Factors for BladderWhat are the Risk Factors for Bladder
Cancer?Cancer?
Smoking (smokers are four to seven times moreSmoking (smokers are four to seven times more
likely to develop bladder cancer than nonsmokers)likely to develop bladder cancer than nonsmokers)
Age, gender, raceAge, gender, race
Exposure to chemicalsExposure to chemicals
Chronic bladder problemsChronic bladder problems
Cyclophosphamide (Cytoxan, Clafen, Neosar) useCyclophosphamide (Cytoxan, Clafen, Neosar) use
Personal historyPersonal history
Low fluid intakeLow fluid intake
Schistosomiasis (a parasitic disease)Schistosomiasis (a parasitic disease)

Bladder Cancer and Early DetectionBladder Cancer and Early Detection
No tests are recommended for screening theNo tests are recommended for screening the
general populationgeneral population
Most bladder cancer is diagnosed in people whoMost bladder cancer is diagnosed in people who
have symptomshave symptoms
The most common symptom is blood in theThe most common symptom is blood in the
urine, which can signal bladder cancer orurine, which can signal bladder cancer or
another noncancerous conditionanother noncancerous condition

What are the Symptoms of BladderWhat are the Symptoms of Bladder
Cancer?Cancer?
Blood in the urineBlood in the urine
Pain during urinationPain during urination
Frequent urinationFrequent urination
Feeling the need to urinate throughout the nightFeeling the need to urinate throughout the night
Feeling the need to urinate, but not being able toFeeling the need to urinate, but not being able to
pass urinepass urine
Symptoms of advanced bladder cancer maySymptoms of advanced bladder cancer may
include pain, change in bowel habits,include pain, change in bowel habits,
unexplained loss of appetite, and weight lossunexplained loss of appetite, and weight loss

How is Bladder Cancer Diagnosed?How is Bladder Cancer Diagnosed?
Cystoscopy (examination of the bladder with aCystoscopy (examination of the bladder with a
small tube)small tube)
Diagnosis is confirmed with a biopsyDiagnosis is confirmed with a biopsy
Urine tests (cytology)Urine tests (cytology)
Intravenous pyelogram (IVP)Intravenous pyelogram (IVP)
Computed tomography (CT or CAT) scanComputed tomography (CT or CAT) scan
Magnetic resonance imaging (MRI)Magnetic resonance imaging (MRI)

Stage 0 Bladder CancerStage 0 Bladder Cancer
The cancer is onlyThe cancer is only
found on thefound on the
surface of thesurface of the
inside lining of theinside lining of the
bladderbladder

Stage I Bladder CancerStage I Bladder Cancer
The cancer hasThe cancer has
grown through thegrown through the
inner lining of theinner lining of the
bladder to thebladder to the
connective tissueconnective tissue
layer but has notlayer but has not
spread to the thickspread to the thick
muscle wall of themuscle wall of the
bladderbladder

Stage II Bladder CancerStage II Bladder Cancer
spread into the thickspread into the thick
muscle wall of themuscle wall of the
bladder (invasivebladder (invasive
cancer) but not tocancer) but not to
the fatty tissuethe fatty tissue
surrounding thesurrounding the
bladderbladder

Stage III Bladder CancerStage III Bladder Cancer
spread to the fattyspread to the fatty
layer of tissuelayer of tissue
surrounding thesurrounding the
bladder and maybladder and may
have spread to thehave spread to the
prostate (men) orprostate (men) or
the uterus andthe uterus and
vagina (women)vagina (women)

Stage IV Bladder CancerStage IV Bladder Cancer
The cancer has spreadThe cancer has spread
through the bladder intothrough the bladder into
the walls of thethe walls of the
abdomen or pelvisabdomen or pelvis
and/or it has spread toand/or it has spread to
nearby lymph nodes.nearby lymph nodes.
The cancer also may beThe cancer also may be
found in other parts offound in other parts of
the body, such as thethe body, such as the
bones, liver, or lungsbones, liver, or lungs

How is Bladder Cancer Treated?How is Bladder Cancer Treated?
Treatment depends on the stage of the cancerTreatment depends on the stage of the cancer
SurgerySurgery
Chemotherapy (options include a combinationsChemotherapy (options include a combinations
of drugs)of drugs)
ImmunotherapyImmunotherapy

In early-stage cancer, the tumor is removed withIn early-stage cancer, the tumor is removed with
a laser or high-energy electricitya laser or high-energy electricity
Advanced cancer may require complete orAdvanced cancer may require complete or
partial removal of the bladder (cystectomy) andpartial removal of the bladder (cystectomy) and
nearby lymph nodes, tissues, and organsnearby lymph nodes, tissues, and organs
If the bladder is removed, a new way for theIf the bladder is removed, a new way for the
body to divert urine outside the body is madebody to divert urine outside the body is made
Cystectomy can cause impotence in men andCystectomy can cause impotence in men and
loss of sexual feeling and orgasm for men andloss of sexual feeling and orgasm for men and
women; these side effects are often treatablewomen; these side effects are often treatable

The use of high-energy x-rays to destroy cancerThe use of high-energy x-rays to destroy cancer
cellscells
External beam: outside the bodyExternal beam: outside the body
May be used to treat bladder cancer before orMay be used to treat bladder cancer before or
after surgeryafter surgery
Side effects may include fatigue, mild skinSide effects may include fatigue, mild skin
reactions, upset stomach, loose bowelreactions, upset stomach, loose bowel
movements, bladder irritation, and bleeding frommovements, bladder irritation, and bleeding from
the bladderthe bladder

Earlier stage cancers are more likely to be treated withEarlier stage cancers are more likely to be treated with
intravesical (local) chemotherapyintravesical (local) chemotherapy
Advanced cancers are more likely to be treated withAdvanced cancers are more likely to be treated with
systemic (whole body) chemotherapysystemic (whole body) chemotherapy
Standard systemic treatment is MVAC, a four-drugStandard systemic treatment is MVAC, a four-drug
combination: methotrexate (multiple brand names),combination: methotrexate (multiple brand names),
vinblastine (Velban), doxorubicin (Adriamycin), and cisplatinvinblastine (Velban), doxorubicin (Adriamycin), and cisplatin
(Platinol)(Platinol)
Gemcitabine (Gemzar), plus cisplatin, is as effective asGemcitabine (Gemzar), plus cisplatin, is as effective as
MVAC but with fewer side effectsMVAC but with fewer side effects
Other chemotherapy combinations are being tested inOther chemotherapy combinations are being tested in
clinical trialsclinical trials

Cancer Treatment: ImmunotherapyCancer Treatment: Immunotherapy
Uses materials made by the body or in aUses materials made by the body or in a
laboratory to boost patients’ natural defenseslaboratory to boost patients’ natural defenses
against canceragainst cancer
BCG (bacillus Calmette-Guerin) is the mostBCG (bacillus Calmette-Guerin) is the most
common immunotherapy drug for bladdercommon immunotherapy drug for bladder
cancer; it is given using intravesical therapycancer; it is given using intravesical therapy
BCG irritates the inside of the bladder, attractingBCG irritates the inside of the bladder, attracting
the patient’s immune cells to the bladder to fightthe patient’s immune cells to the bladder to fight
the tumorthe tumor

Prostate CancerProstate Cancer

What is Prostate Cancer?What is Prostate Cancer?
The most common type of cancer in men andThe most common type of cancer in men and
second most frequent cause of cancer-relatedsecond most frequent cause of cancer-related
death in mendeath in men
A malignant (cancerous) tumor that begins in theA malignant (cancerous) tumor that begins in the
prostate glandprostate gland
Some prostate cancers grow very slowly andSome prostate cancers grow very slowly and
may not cause problems for yearsmay not cause problems for years
Prostate cancer is somewhat unusual in thatProstate cancer is somewhat unusual in that
many men with advanced cancer respond tomany men with advanced cancer respond to
treatmenttreatment

What is the Function of the Prostate?What is the Function of the Prostate?
The prostate is a walnut-The prostate is a walnut-
sized gland located behindsized gland located behind
the base of the penis, in frontthe base of the penis, in front
of the rectum and below theof the rectum and below the
bladderbladder
It surrounds the urethra, theIt surrounds the urethra, the
tube-like channel that carriestube-like channel that carries
urine and semen through theurine and semen through the
penispenis
The primary function of theThe primary function of the
prostate is to produceprostate is to produce
seminal fluid, the liquid inseminal fluid, the liquid in
semen that protects,semen that protects,
supports, and helps transportsupports, and helps transport
spermsperm

What are the Risk Factors for ProstateWhat are the Risk Factors for Prostate
Cancer?Cancer?
AgeAge
Race/ethnicity (Black men at highest risk)Race/ethnicity (Black men at highest risk)
Family historyFamily history
DietDiet
HormonesHormones

Prostate Cancer and Early DetectionProstate Cancer and Early Detection
Prostate-specific antigen (PSA) testProstate-specific antigen (PSA) test
Digital rectal examination (DRE)Digital rectal examination (DRE)
Discuss screening with your doctorDiscuss screening with your doctor

What are the Symptoms of ProstateWhat are the Symptoms of Prostate
Cancer?Cancer?
Frequent urination, or weak or interrupted urineFrequent urination, or weak or interrupted urine
flowflow
Pain or burning during urination, or blood in thePain or burning during urination, or blood in the
urine or semenurine or semen
The urge to urinate frequently during the nightThe urge to urinate frequently during the night
Different symptoms if the cancer has spread: painDifferent symptoms if the cancer has spread: pain
in the back, weight loss, fatiguein the back, weight loss, fatigue
None of the symptoms are specific to prostateNone of the symptoms are specific to prostate
cancer, could be caused by an enlarged prostate, acancer, could be caused by an enlarged prostate, a
condition called benign prostate hyperplasia (BPH)condition called benign prostate hyperplasia (BPH)

How is Prostate Cancer Diagnosed?How is Prostate Cancer Diagnosed?
PSA testPSA test
DREDRE
Diagnosis is confirmed with a biopsyDiagnosis is confirmed with a biopsy
Transrectal ultrasound (TRUS)Transrectal ultrasound (TRUS)
Imaging tests can determine if the cancerImaging tests can determine if the cancer
has spreadhas spread

Stage I or Stage A Prostate CancerStage I or Stage A Prostate Cancer
Stage I cancer isStage I cancer is
found only in thefound only in the
prostate and usuallyprostate and usually
grows slowlygrows slowly

Stage II or Stage B Prostate CancerStage II or Stage B Prostate Cancer
Stage II cancer hasStage II cancer has
not spread beyondnot spread beyond
the prostate gland,the prostate gland,
but involves morebut involves more
than one part of thethan one part of the
prostate, and mayprostate, and may
tend to grow moretend to grow more
quicklyquickly

Stage III or Stage C Prostate CancerStage III or Stage C Prostate Cancer
Stage III cancer hasStage III cancer has
spread beyond thespread beyond the
outer layer of theouter layer of the
prostate into nearbyprostate into nearby
tissues or to thetissues or to the
seminal vesicles, theseminal vesicles, the
glands that helpglands that help
produce semenproduce semen

Stage IV or Stage D Prostate CancerStage IV or Stage D Prostate Cancer
Stage IV cancer hasStage IV cancer has
spread to otherspread to other
areas of the bodyareas of the body
such as the bladder,such as the bladder,
rectum, bone, liver,rectum, bone, liver,
lungs, or lymphlungs, or lymph
nodesnodes

How is Prostate Cancer Treated?How is Prostate Cancer Treated?
Active surveillance (watchful waiting) forActive surveillance (watchful waiting) for somesome
early-stage cancersearly-stage cancers
SurgerySurgery
Hormone therapyHormone therapy

Used to try to cure cancer before it spreadsUsed to try to cure cancer before it spreads
outside the prostateoutside the prostate
Usually the prostate and nearby lymph nodesUsually the prostate and nearby lymph nodes
are removedare removed
Urinary incontinence and sexual side effectsUrinary incontinence and sexual side effects
may result from surgery; these side effects aremay result from surgery; these side effects are
treatabletreatable
Cryosurgery (destroying cancer cells byCryosurgery (destroying cancer cells by
freezing) is still experimentalfreezing) is still experimental

cellscells
Used to try to cure disease or control symptomsUsed to try to cure disease or control symptoms
External-beam: outside the bodyExternal-beam: outside the body
Brachytherapy: the insertion of radioactiveBrachytherapy: the insertion of radioactive
pellets into the prostatepellets into the prostate
Intensity-modulated radiation therapy (IMRT):Intensity-modulated radiation therapy (IMRT):
small beams of radiation are aimed at a tumorsmall beams of radiation are aimed at a tumor
from many anglesfrom many angles
Side effects may include bowel and urinarySide effects may include bowel and urinary
problems, rash, and dry, reddened, or discoloredproblems, rash, and dry, reddened, or discolored
skinskin

Cancer Treatment: Hormone TherapyCancer Treatment: Hormone Therapy
Reduces level of male sex hormones to slowReduces level of male sex hormones to slow
growth of cancergrowth of cancer
Used to treat prostate cancer that has grownUsed to treat prostate cancer that has grown
after surgery and radiation therapy or to shrinkafter surgery and radiation therapy or to shrink
large tumors before surgery and radiationlarge tumors before surgery and radiation
therapytherapy
Can be done surgically or through medicationCan be done surgically or through medication
Hormone therapy may cause a variety of sideHormone therapy may cause a variety of side
effects, including a risk of metabolic syndromeeffects, including a risk of metabolic syndrome
More information can be found in theMore information can be found in the ASCOASCO
Patient Guide: Hormone Therapy for AdvancedPatient Guide: Hormone Therapy for Advanced
Prostate CancerProstate Cancer

No standard chemotherapy for prostate cancerNo standard chemotherapy for prostate cancer
Docetaxel (Taxotere) and prednisone help menDocetaxel (Taxotere) and prednisone help men
with advanced prostate cancer live longerwith advanced prostate cancer live longer
Other medications may help control symptomsOther medications may help control symptoms

What is Testicular Cancer?
A disease of one or both testicles in which cellsA disease of one or both testicles in which cells
grow uncontrollably and form a tumorgrow uncontrollably and form a tumor
Mainly develops in the sperm-producing cellsMainly develops in the sperm-producing cells
called germ cells; called germ cell tumorscalled germ cells; called germ cell tumors
Two types: seminoma and non-seminomaTwo types: seminoma and non-seminoma
Teratoma: type of non-seminoma that is unlikelyTeratoma: type of non-seminoma that is unlikely
to spread but can become cancerous if notto spread but can become cancerous if not
removedremoved

What is the Function of the Testicles?
Part of the malePart of the male
reproductive system,reproductive system,
also called the testesalso called the testes
or gonadsor gonads
Located under theLocated under the
penis in a sac-likepenis in a sac-like
pouch called thepouch called the
scrotumscrotum
Produce sperm andProduce sperm and
testosteronetestosterone

What are the Risk Factors for
Testicular Cancer?
AgeAge
Personal historyPersonal history
RaceRace
Cryptorchidism (undescended testicle)Cryptorchidism (undescended testicle)
Klinefelter’s syndromeKlinefelter’s syndrome
Human immunodeficiency virus (HIV)Human immunodeficiency virus (HIV)
infectioninfection

What are the Symptoms of TesticularWhat are the Symptoms of Testicular
Cancer?Cancer?
Painless lump or swelling on either testiclePainless lump or swelling on either testicle
Pain or discomfort in a testicle or the scrotumPain or discomfort in a testicle or the scrotum
Enlarged testicle or a change in the way it feelsEnlarged testicle or a change in the way it feels
Feeling of heaviness in the scrotumFeeling of heaviness in the scrotum
Dull ache in the lower abdomen or groinDull ache in the lower abdomen or groin
Buildup of fluid in the scrotumBuildup of fluid in the scrotum
Breast tenderness or growthBreast tenderness or growth
Lower back pain, shortness of breath, chestLower back pain, shortness of breath, chest
pain, and bloody phlegm may be symptoms ofpain, and bloody phlegm may be symptoms of
advanced canceradvanced cancer

Testicular Cancer and Early DetectionTesticular Cancer and Early Detection
Can often be detected earlyCan often be detected early
Many men find the cancer during a self-Many men find the cancer during a self-
examinationexamination
Some doctors recommend that men ages 15Some doctors recommend that men ages 15
to 55 perform a monthly self-examinationto 55 perform a monthly self-examination
Men who notice a lump, hardness,Men who notice a lump, hardness,
enlargement, pain or any other change inenlargement, pain or any other change in
one or both of their testicles should see theirone or both of their testicles should see their
doctor as soon as possibledoctor as soon as possible

How is Testicular Cancer Diagnosed?How is Testicular Cancer Diagnosed?
UltrasoundUltrasound
Blood tests/tumor markersBlood tests/tumor markers
Diagnosis is confirmed by surgically removing theDiagnosis is confirmed by surgically removing the
testicletesticle
Needle biopsy not used (except in very specificNeedle biopsy not used (except in very specific
situations)situations)
Surgical pathology testsSurgical pathology tests
X-rayX-ray

Stage 0 Testicular CancerStage 0 Testicular Cancer
Carcinoma in situCarcinoma in situ
Also called intratubular germ cell neoplasiaAlso called intratubular germ cell neoplasia

Stage I Testicular CancerStage I Testicular Cancer
Tumor is in the testicle only, the inner or outer membraneTumor is in the testicle only, the inner or outer membrane
surrounding the testicle, the spermatic cord (connects thesurrounding the testicle, the spermatic cord (connects the
testicle to the rest of the body), and/or the scrotumtesticle to the rest of the body), and/or the scrotum
Stage IA: cancer is only in the testicle, has not spread toStage IA: cancer is only in the testicle, has not spread to
lymph nodes or other areas, and serum markers are normallymph nodes or other areas, and serum markers are normal
Stage IB: cancer is outside the testicle or has spread toStage IB: cancer is outside the testicle or has spread to
blood or lymphatic vessels in the testicle, but there is noblood or lymphatic vessels in the testicle, but there is no
spread to lymph nodes or other areas, and serum markersspread to lymph nodes or other areas, and serum markers
are normalare normal
Stage IS: imaging tests show that the cancer has not spreadStage IS: imaging tests show that the cancer has not spread
to lymph nodes or other areas but serum markers remainto lymph nodes or other areas but serum markers remain
above normal levels after the cancerous testicle has beenabove normal levels after the cancerous testicle has been
removedremoved

Stage II Testicular CancerStage II Testicular Cancer
Cancer has spread to lymph nodes in the back of theCancer has spread to lymph nodes in the back of the
abdomen (retroperitoneum), but not lymph nodes in otherabdomen (retroperitoneum), but not lymph nodes in other
parts of the bodyparts of the body
Stage IIA: cancer has spread to 1 to 5 lymph nodes, none ofStage IIA: cancer has spread to 1 to 5 lymph nodes, none of
which are larger than 2 centimeters (cm), and serum markerwhich are larger than 2 centimeters (cm), and serum marker
levels are normal or slightly elevatedlevels are normal or slightly elevated
Stage IIB: cancer has spread to regional lymph nodes, oneStage IIB: cancer has spread to regional lymph nodes, one
of which is greater than 2 cm but none are greater thanof which is greater than 2 cm but none are greater than
5cm; or cancer has spread to more than 5 lymph nodes with5cm; or cancer has spread to more than 5 lymph nodes with
none greater than 5cm. Serum markers are normal ornone greater than 5cm. Serum markers are normal or
slightly elevatedslightly elevated
Stage IIC: cancer has spread to at least 1 lymph node thatStage IIC: cancer has spread to at least 1 lymph node that
is larger than 5cm, and serum marker levels are normal oris larger than 5cm, and serum marker levels are normal or
slightly elevatedslightly elevated

Stage III Testicular CancerStage III Testicular Cancer
Stage IIIA: cancer has spread to distant lymph nodes or theStage IIIA: cancer has spread to distant lymph nodes or the
lungs, and serum marker levels are normal or slightlylungs, and serum marker levels are normal or slightly
elevatedelevated
Stage IIIB: cancer has spread to any lymph nodes and/orStage IIIB: cancer has spread to any lymph nodes and/or
the lungs but not to other organs, and serum marker levelsthe lungs but not to other organs, and serum marker levels
are substantially elevatedare substantially elevated
Stage IIIC: Either or both of the followingStage IIIC: Either or both of the following
– Serum marker levels are highly elevated, and cancer hasSerum marker levels are highly elevated, and cancer has
spread to at least 1 lymph node or organspread to at least 1 lymph node or organ
– Cancer has spread to an organ other than the lungsCancer has spread to an organ other than the lungs

Advanced Testicular Cancer:Advanced Testicular Cancer:
Risk Group ClassificationRisk Group Classification
Used if cancer has spread to lymph nodes or otherUsed if cancer has spread to lymph nodes or other
organs to predict the effectiveness of treatmentorgans to predict the effectiveness of treatment
Based on tumor location, tumor spread, and serumBased on tumor location, tumor spread, and serum
marker levelsmarker levels
Divided into 3 groups for both seminoma and non-Divided into 3 groups for both seminoma and non-
seminomaseminoma
– Good riskGood risk
– Intermediate riskIntermediate risk
– Poor riskPoor risk
Patients with poor-risk cancer still have about a 50%Patients with poor-risk cancer still have about a 50%
chance of successful treatmentchance of successful treatment

How is Testicular Cancer Treated?How is Testicular Cancer Treated?
Treatment depends on stage of cancer and theTreatment depends on stage of cancer and the
type of tumortype of tumor
SurgerySurgery
Active surveillanceActive surveillance
Patients should talk with their doctor aboutPatients should talk with their doctor about
whether treatment plan could affect sexualwhether treatment plan could affect sexual
function and fertility before treatment beginsfunction and fertility before treatment begins

Cancer Treatment:Cancer Treatment:
Surgery – Radical inguinal orchiectomySurgery – Radical inguinal orchiectomy
Removal of affected testicleRemoval of affected testicle
Typically part of both diagnosis and treatmentTypically part of both diagnosis and treatment
Most men are still able to have children after theMost men are still able to have children after the
removal of one testicleremoval of one testicle
Removal of one testicle is very unlikely to affect aRemoval of one testicle is very unlikely to affect a
man’s ability to have a normal erection and orgasmman’s ability to have a normal erection and orgasm
(men with sexual problems after surgery should(men with sexual problems after surgery should
have their testosterone level checked)have their testosterone level checked)
Some men may choose to have an artificial testicleSome men may choose to have an artificial testicle
implantedimplanted

Cancer Treatment:Cancer Treatment:
Surgery – Bilateral orchiectomySurgery – Bilateral orchiectomy
Removal of both testiclesRemoval of both testicles
While uncommon, some men may develop cancerWhile uncommon, some men may develop cancer
in both testicles at the same timein both testicles at the same time
After bilateral surgery, a man will no longer produceAfter bilateral surgery, a man will no longer produce
sperm or testosterone and will not be able tosperm or testosterone and will not be able to
biologically produce childrenbiologically produce children
Some men choose to store sperm in a sperm bankSome men choose to store sperm in a sperm bank
prior to surgeryprior to surgery
Testosterone hormone replacement therapy will beTestosterone hormone replacement therapy will be
neededneeded

Cancer Treatment: Surgery –Cancer Treatment: Surgery –
Retroperitoneal lymph node dissection (RPLND)Retroperitoneal lymph node dissection (RPLND)
Removal of the retroperitoneal lymph nodes thatRemoval of the retroperitoneal lymph nodes that
lie at the back of the abdomenlie at the back of the abdomen
Performed in two situations:Performed in two situations:
– Men with a stage I or IIa non-seminomaMen with a stage I or IIa non-seminoma
– Men who have retroperitoneal tumorsMen who have retroperitoneal tumors
remaining after completing chemotherapy forremaining after completing chemotherapy for
advanced stage canceradvanced stage cancer

cellscells
Usually external-beam radiation therapyUsually external-beam radiation therapy
More effective for seminoma than non-seminomaMore effective for seminoma than non-seminoma
Used for stage I, IIa, or IIb seminomasUsed for stage I, IIa, or IIb seminomas
Side effects include fatigue, mild skin reactions,Side effects include fatigue, mild skin reactions,
upset stomach, and loose bowel movements,upset stomach, and loose bowel movements,
peptic ulcers, cardiovascular disease, andpeptic ulcers, cardiovascular disease, and
secondary cancerssecondary cancers
Can cause problems with sperm production; theCan cause problems with sperm production; the
remaining testicle needs to be shielded if the manremaining testicle needs to be shielded if the man
wishes to preserve fertilitywishes to preserve fertility

The drugs bleomycin (Blenoxane), etoposideThe drugs bleomycin (Blenoxane), etoposide
(VePesid, Etopophos, Lastet), and cisplatin(VePesid, Etopophos, Lastet), and cisplatin
(Platinol) are a commonly used combination(Platinol) are a commonly used combination
called BEPcalled BEP
Side effects may include fatigue, infection,Side effects may include fatigue, infection,
nausea and vomiting, hearing loss, skin marks,nausea and vomiting, hearing loss, skin marks,
numbness and tingling, loss of hair, lungnumbness and tingling, loss of hair, lung
damage, kidney damage, cardiovasculardamage, kidney damage, cardiovascular
disease, and secondary cancersdisease, and secondary cancers

Cervical CancerCervical Cancer

What is Cervical Cancer?What is Cervical Cancer?
An estimated 500 000 women diagnosed in the world everyAn estimated 500 000 women diagnosed in the world every
yearyear
A disease of the cervix in which cells grow uncontrollablyA disease of the cervix in which cells grow uncontrollably
and form a tumorand form a tumor
Develops from precancerous changes in the cells (calledDevelops from precancerous changes in the cells (called
dysplasia)dysplasia)
When found early, these cells can be removed withoutWhen found early, these cells can be removed without
damaging the healthy tissuedamaging the healthy tissue
When precancerous changes become true cancer cells andWhen precancerous changes become true cancer cells and
spread deeper into the cervix, it is called cervical cancerspread deeper into the cervix, it is called cervical cancer
Most are squamous cell carcinoma, which begins in theMost are squamous cell carcinoma, which begins in the
cells on the surface of the cervixcells on the surface of the cervix

What is the Function of the Cervix?What is the Function of the Cervix?
The cervix is theThe cervix is the
lower, narrow part oflower, narrow part of
the uterusthe uterus
It connects the uterusIt connects the uterus
to the vagina, formingto the vagina, forming
the birth canalthe birth canal

What are the Risk Factors for CervicalWhat are the Risk Factors for Cervical
Cancer?Cancer?
Human papillomavirus (HPV) infectionHuman papillomavirus (HPV) infection
Immune system deficiencyImmune system deficiency
HerpesHerpes
SmokingSmoking
AgeAge
RaceRace
Oral contraceptivesOral contraceptives
Exposure to diethylstilbestrol (DES)Exposure to diethylstilbestrol (DES)

What Can ReduceWhat Can Reduce
the Risk of Cervical Cancer?the Risk of Cervical Cancer?
Having yearly pelvic examination and Pap testHaving yearly pelvic examination and Pap test
Delaying first sexual intercourse until the late teens orDelaying first sexual intercourse until the late teens or
olderolder
Limiting the number of sex partnersLimiting the number of sex partners
Avoiding sexual intercourse with people who have hadAvoiding sexual intercourse with people who have had
multiple partnersmultiple partners
Avoiding sexual intercourse with people obviouslyAvoiding sexual intercourse with people obviously
infected with genital warts or other sexually transmittedinfected with genital warts or other sexually transmitted
diseasesdiseases
Using condomsUsing condoms
Quitting smokingQuitting smoking

What are the SymptomsWhat are the Symptoms
of Cervical Cancer?of Cervical Cancer?
Blood spots or light bleeding between or afterBlood spots or light bleeding between or after
periodsperiods
Menstrual bleeding that is longer and heavier thanMenstrual bleeding that is longer and heavier than
usualusual
Bleeding after intercourse, douching, or pelvicBleeding after intercourse, douching, or pelvic
examinationexamination
Pain during sexual intercoursePain during sexual intercourse
Bleeding after menopauseBleeding after menopause
Increased vaginal dischargeIncreased vaginal discharge
Most symptoms do not appear until the cancer hasMost symptoms do not appear until the cancer has
spreadspread

How is Cervical Cancer Diagnosed?How is Cervical Cancer Diagnosed?
Pap testPap test
Pelvic examinationPelvic examination
ColposcopyColposcopy
BiopsyBiopsy
Other tests are used to determineOther tests are used to determine
if the cancer has spreadif the cancer has spread
CystoscopyCystoscopy
Proctoscopy (sigmoidoscopy)Proctoscopy (sigmoidoscopy)
LaparoscopyLaparoscopy
X-rayX-ray
Computed tomography (CT orComputed tomography (CT or
CAT) scanCAT) scan
Magnetic resonance imagingMagnetic resonance imaging
(MRI)(MRI)
Positron emission tomographyPositron emission tomography
(PET) scan(PET) scan

Stage 0 Cervical CancerStage 0 Cervical Cancer
Carcinoma in situ; not considered an invasiveCarcinoma in situ; not considered an invasive
cancercancer
Found only in the first layer of cells lining theFound only in the first layer of cells lining the
cervixcervix
Cancer has not spread to deeper tissueCancer has not spread to deeper tissue

Stage I Cervical CancerStage I Cervical Cancer
Cancer has spread deeper in the cervix, but isCancer has spread deeper in the cervix, but is
still only in the cervix/uterusstill only in the cervix/uterus
It has not spread to lymph nodes or other partsIt has not spread to lymph nodes or other parts
of the bodyof the body

Stage II Cervical CancerStage II Cervical Cancer
Cancer has spread to areas near the cervix, butCancer has spread to areas near the cervix, but
is still in the pelvic areais still in the pelvic area
It has not spread to lymph nodes or other partsIt has not spread to lymph nodes or other parts

Stage III Cervical CancerStage III Cervical Cancer
Stage III is divided into 2 groupsStage III is divided into 2 groups
Stage IIIa: cancer has spread to the lower part ofStage IIIa: cancer has spread to the lower part of
the vagina but not to other parts of the bodythe vagina but not to other parts of the body
Stage IIIb: cancer may have spread to the pelvicStage IIIb: cancer may have spread to the pelvic
wall and lymph nodes but not to other parts ofwall and lymph nodes but not to other parts of
the bodythe body

Stage IV Cervical CancerStage IV Cervical Cancer
Stage IV is divided into 2 groupsStage IV is divided into 2 groups
Stage IVa: cancer has spread to the bladder orStage IVa: cancer has spread to the bladder or
rectum and may or may not have spread to therectum and may or may not have spread to the
lymph nodes; it has not spread to other parts oflymph nodes; it has not spread to other parts of
the bodythe body
Stage IVb: cancer has spread to other parts ofStage IVb: cancer has spread to other parts of
the bodythe body

How is Cervical Cancer Treated?How is Cervical Cancer Treated?
Treatment depends on stage of cancer, tumorTreatment depends on stage of cancer, tumor
size, the woman’s age, her health, and hersize, the woman’s age, her health, and her
desire to have childrendesire to have children
SurgerySurgery
Clinical trialsClinical trials

Conization: removal of a cone-shaped piece of tissue fromConization: removal of a cone-shaped piece of tissue from
the cervixthe cervix
Hysterectomy:Hysterectomy:
– Simple hysterectomy: removal of the uterus and cervixSimple hysterectomy: removal of the uterus and cervix
– Radical hysterectomy: removal of the uterus, cervix,Radical hysterectomy: removal of the uterus, cervix,
upper vagina, tissue around the cervix, and pelvicupper vagina, tissue around the cervix, and pelvic
lymph nodeslymph nodes
– Both ovaries and fallopian tubes may also be removedBoth ovaries and fallopian tubes may also be removed
at same timeat same time
Radical trachelectomy: removal of the cervix, leaving theRadical trachelectomy: removal of the cervix, leaving the
uterus intactuterus intact
If the cancer has spread, the lower colon, rectum, orIf the cancer has spread, the lower colon, rectum, or
bladder may also be removedbladder may also be removed
Reconstruction of vagina may be possibleReconstruction of vagina may be possible

The use of high-energy x-rays to destroy cancer cellsThe use of high-energy x-rays to destroy cancer cells
External-beam radiation therapy is most commonExternal-beam radiation therapy is most common
Brachytherapy: radiation therapy using implantsBrachytherapy: radiation therapy using implants
Side effects may include fatigue, mild skin reactions, upsetSide effects may include fatigue, mild skin reactions, upset
stomach, and loose bowel movementsstomach, and loose bowel movements
Brachytherapy may cause abdominal pain and bowelBrachytherapy may cause abdominal pain and bowel
obstructionobstruction

Most drugs for cervical cancer are given intravenously (IV)Most drugs for cervical cancer are given intravenously (IV)
Side effects may include fatigue, infection, nausea andSide effects may include fatigue, infection, nausea and
vomiting, loss of appetite, and diarrheavomiting, loss of appetite, and diarrhea
Other side effects may include infertility, prematureOther side effects may include infertility, premature
menopause, and kidney damagemenopause, and kidney damage

What is Uterine Cancer?What is Uterine Cancer?
Most common cancer of the female reproductiveMost common cancer of the female reproductive
systemsystem
Fourth most common cancer and eighth mostFourth most common cancer and eighth most
common cause of cancer death in womencommon cause of cancer death in women
A disease in which cells in the uterus begin toA disease in which cells in the uterus begin to
change, grow uncontrollably, and form a malignantchange, grow uncontrollably, and form a malignant
(cancerous) tumor(cancerous) tumor
Two major types: adenocarcinoma (95% of cases)Two major types: adenocarcinoma (95% of cases)
and sarcoma (2% to 4% of cases)and sarcoma (2% to 4% of cases)
Other, less common types include: carcinosarcomaOther, less common types include: carcinosarcoma
and endometrial stromal sarcomaand endometrial stromal sarcoma

What is the Function of the Uterus?What is the Function of the Uterus?
Pear-shaped, hollow, andPear-shaped, hollow, and
located in a woman’slocated in a woman’s
pelvis between thepelvis between the
bladder and rectumbladder and rectum
Also known as the womb,Also known as the womb,
where a baby growswhere a baby grows
during pregnancyduring pregnancy
Made up of threeMade up of three
sections: cervix (lower),sections: cervix (lower),
corpus (middle), andcorpus (middle), and
fundus (top)fundus (top)
The inside of the uterusThe inside of the uterus
has two tissue layers:has two tissue layers:
endometrium (inner) andendometrium (inner) and
myometrium (outermyometrium (outer

What are the Risk Factors for UterineWhat are the Risk Factors for Uterine
Cancer?Cancer?
Age (most often occurs in women over age 50 afterAge (most often occurs in women over age 50 after
menopause)menopause)
ObesityObesity
RaceRace
GeneticsGenetics
Other health conditions and cancersOther health conditions and cancers
Tamoxifen (Nolvadex) use (drug used to prevent andTamoxifen (Nolvadex) use (drug used to prevent and
treat breast cancer)treat breast cancer)
Radiation therapy to the pelvisRadiation therapy to the pelvis
Estrogen exposure and/or imbalanceEstrogen exposure and/or imbalance
DietDiet

Uterine Cancer PreventionUterine Cancer Prevention
Birth control pillsBirth control pills
Assessing uterine cancer risk before consideringAssessing uterine cancer risk before considering
hormone replacement therapy (HRT)hormone replacement therapy (HRT)
Maintaining a healthy weightMaintaining a healthy weight
If diabetic, maintaining good self-careIf diabetic, maintaining good self-care

What are the Symptoms of UterineWhat are the Symptoms of Uterine
Cancer?Cancer?
Unusual vaginal bleeding, spotting, or discharge,Unusual vaginal bleeding, spotting, or discharge,
particularly during or after menopauseparticularly during or after menopause
Difficulty or pain when urinatingDifficulty or pain when urinating
Pain during sexual intercoursePain during sexual intercourse
Pain in pelvic areaPain in pelvic area

How is Uterine Cancer Diagnosed?How is Uterine Cancer Diagnosed?
Pelvic examPelvic exam
Transvaginal ultrasound: a test that uses soundTransvaginal ultrasound: a test that uses sound
waves to produce images of the uteruswaves to produce images of the uterus
Endometrial biopsy or a dilation & curettageEndometrial biopsy or a dilation & curettage
(D&C): removes tissue samples from the uterus(D&C): removes tissue samples from the uterus
to check for cancerous cellsto check for cancerous cells
Imaging tests to find out if cancer has spreadImaging tests to find out if cancer has spread

Stage 0 Uterine CancerStage 0 Uterine Cancer
Known as “cancer in situ,” meaning the cancer isKnown as “cancer in situ,” meaning the cancer is
in only one layer of cells and has not spreadin only one layer of cells and has not spread

Stage I Uterine CancerStage I Uterine Cancer
The cancer is foundThe cancer is found
only in the uterus andonly in the uterus and
has not spread tohas not spread to
other parts of theother parts of the
bodybody
Treatment optionsTreatment options
include surgery,include surgery,
surgery and radiationsurgery and radiation
therapy, and hormonetherapy, and hormone
therapytherapy

Stage II Uterine CancerStage II Uterine Cancer
from the uterus to thefrom the uterus to the
cervixcervix
include surgery andinclude surgery and
radiation therapyradiation therapy

Stage III Uterine CancerStage III Uterine Cancer
spread beyond thespread beyond the
uterus, but it is stilluterus, but it is still
only in the pelvic areaonly in the pelvic area
include surgeryinclude surgery
followed by radiationfollowed by radiation
therapy and/ortherapy and/or
chemotherapy, or achemotherapy, or a
clinical trialclinical trial

Stage IV Uterine CancerStage IV Uterine Cancer
The cancer has spread toThe cancer has spread to
the mucosa (innerthe mucosa (inner
surface) of the bladder orsurface) of the bladder or
rectum, and/or to therectum, and/or to the
lymph nodes in the groin,lymph nodes in the groin,
and/or to distant organsand/or to distant organs
Treatment options includeTreatment options include
surgery, radiationsurgery, radiation
therapy, hormonetherapy, hormone
therapy, andtherapy, and
chemotherapy, or achemotherapy, or a
clinical trialclinical trial

How is Uterine Cancer Treated?How is Uterine Cancer Treated?
SurgerySurgery
Hormone therapyHormone therapy

First line of treatmentFirst line of treatment
Type of surgery depends on the extent of the cancerType of surgery depends on the extent of the cancer
– Simple hysterectomy: removal of the body of the uterusSimple hysterectomy: removal of the body of the uterus
and cervixand cervix
– Radical hysterectomy: removal of the uterus, cervix,Radical hysterectomy: removal of the uterus, cervix,
upper vagina, and nearby tissueupper vagina, and nearby tissue
– Bilateral salpingo-oophorectomy: removal of fallopianBilateral salpingo-oophorectomy: removal of fallopian
tubes and ovariestubes and ovaries
– May be performed as traditional surgery or byMay be performed as traditional surgery or by
laparoscopylaparoscopy
After a hysterectomy, a woman cannot have childrenAfter a hysterectomy, a woman cannot have children
Removal of the ovaries results in premature menopauseRemoval of the ovaries results in premature menopause

cellscells
Usually given after surgeryUsually given after surgery
External-beam: outside the bodyExternal-beam: outside the body
Brachytherapy : delivers radiation directly to theBrachytherapy : delivers radiation directly to the
tumortumor
reactions, upset stomach, and loose bowelreactions, upset stomach, and loose bowel
movementsmovements

Drugs used to kill cancer cells (options mayDrugs used to kill cancer cells (options may
include a combination of drugs)include a combination of drugs)
Used to destroy remaining cancer after surgery,Used to destroy remaining cancer after surgery,
slow tumor growth, or reduce side effectsslow tumor growth, or reduce side effects
Potential side effects include fatigue, hair loss,Potential side effects include fatigue, hair loss,
risk of infection, neuropathy, and othersrisk of infection, neuropathy, and others

Cancer Treatment: Hormone TherapyCancer Treatment: Hormone Therapy
Slows the growth of uterine cancer cellsSlows the growth of uterine cancer cells
Primary treatment is progesterone, a sexPrimary treatment is progesterone, a sex
hormonehormone
May be used for women who cannot haveMay be used for women who cannot have
surgery or radiation therapysurgery or radiation therapy
Side effects include fluid retention, appetiteSide effects include fluid retention, appetite
increase, weight gain, and changes in theincrease, weight gain, and changes in the
menstrual cyclemenstrual cycle

What is Ovarian Cancer?What is Ovarian Cancer?
Ninth most common type of cancer and fifthNinth most common type of cancer and fifth
most frequent cause of cancer-related death inmost frequent cause of cancer-related death in
womenwomen
A disease in which ovarian cells growA disease in which ovarian cells grow
uncontrollably and form a tumoruncontrollably and form a tumor
85% to 90% of cases begin in cells on the outer85% to 90% of cases begin in cells on the outer
surface of the ovary, called epithelial carcinomasurface of the ovary, called epithelial carcinoma

What is theWhat is the
Function of theFunction of the
Ovaries?Ovaries?
Every woman has twoEvery woman has two
ovariesovaries
Almond-shaped glandsAlmond-shaped glands
that contain the germ cellsthat contain the germ cells
or eggsor eggs
During monthly ovulation,During monthly ovulation,
an egg is released froman egg is released from
an ovary and travels toan ovary and travels to
the uterus through thethe uterus through the
fallopian tubefallopian tube
Primary source ofPrimary source of
estrogen andestrogen and
progesterone, theprogesterone, the
hormones that influencehormones that influence
breast growth, bodybreast growth, body
shape, and body hair, andshape, and body hair, and
regulate the menstrualregulate the menstrual
cycle and pregnancycycle and pregnancy

What are the Risk Factors for OvarianWhat are the Risk Factors for Ovarian
Cancer?Cancer?
AgeAge
GeneticsGenetics
EthnicityEthnicity
Reproductive historyReproductive history
HormonesHormones
ObesityObesity
Behavioral and social factorsBehavioral and social factors

Hereditary Ovarian Cancer: HBOCHereditary Ovarian Cancer: HBOC
Hereditary breast and ovarian cancer (HBOC) isHereditary breast and ovarian cancer (HBOC) is
caused by a mutation incaused by a mutation in BRCA1BRCA1 andand BRCA2BRCA2
genesgenes
Women with HBOC have a 15% to 40% lifetimeWomen with HBOC have a 15% to 40% lifetime
risk of ovarian cancerrisk of ovarian cancer
Women with HBOC should have increasedWomen with HBOC should have increased
screening for ovarian cancerscreening for ovarian cancer
Screening options include pelvic examinations,Screening options include pelvic examinations,
ultrasound, and a CA-125 blood testultrasound, and a CA-125 blood test
Genetic testing is availableGenetic testing is available

Ovarian Cancer and Early DetectionOvarian Cancer and Early Detection
Certain factors may reduce a woman's risk ofCertain factors may reduce a woman's risk of
developing ovarian cancerdeveloping ovarian cancer
Taking birth control pills for more than 5 yearsTaking birth control pills for more than 5 years
BreastfeedingBreastfeeding
PregnancyPregnancy
A hysterectomy or a tubal ligationA hysterectomy or a tubal ligation
Women with strong family histories of ovarianWomen with strong family histories of ovarian
cancer may consider a risk-reducing salpingo-cancer may consider a risk-reducing salpingo-
oophorectomy (removal of both ovaries andoophorectomy (removal of both ovaries and
fallopian tubes)fallopian tubes)

What are the Symptoms of OvarianWhat are the Symptoms of Ovarian
Cancer?Cancer?
More commonMore common
symptomssymptoms
BloatingBloating
Pelvic or abdominalPelvic or abdominal
painpain
Difficulty eating orDifficulty eating or
feeling full quicklyfeeling full quickly
Urinary symptomsUrinary symptoms
(urgency or(urgency or
frequency)frequency)
Other symptomsOther symptoms
FatigueFatigue
IndigestionIndigestion
Back painBack pain
Pain with intercoursePain with intercourse
ConstipationConstipation
MenstrualMenstrual
irregularitiesirregularities

How is Ovarian Cancer Diagnosed?How is Ovarian Cancer Diagnosed?
A biopsy is rarely done as a separate procedureA biopsy is rarely done as a separate procedure
Diagnosis is confirmed with an analysis of tumorDiagnosis is confirmed with an analysis of tumor
tissuetissue
Pelvic examinationPelvic examination
Transvaginal ultrasoundTransvaginal ultrasound
CA-125 blood testCA-125 blood test
Lower gastrointestinal (GI) seriesLower gastrointestinal (GI) series
Positron emission tomography (PET) scanPositron emission tomography (PET) scan
X-rayX-ray

Stage IA Ovarian CancerStage IA Ovarian Cancer
Tumor isTumor is
encapsulated andencapsulated and
limited to one ovarylimited to one ovary
No spread to lymphNo spread to lymph
nodes or other partsnodes or other parts

Stage IB Ovarian CancerStage IB Ovarian Cancer
Cancer isCancer is
encapsulated andencapsulated and
located in bothlocated in both
ovariesovaries
nodes or the rest ofnodes or the rest of
the bodythe body

Stage IC Ovarian CancerStage IC Ovarian Cancer
Cancer is in bothCancer is in both
ovaries with aovaries with a
ruptured capsuleruptured capsule
There is spread toThere is spread to
ovarian surface orovarian surface or
malignant cells in themalignant cells in the
abdominal fluidabdominal fluid

Stage IIA Ovarian CancerStage IIA Ovarian Cancer
Cancer is in one orCancer is in one or
both ovaries and hasboth ovaries and has
spread to the pelvisspread to the pelvis
Cancer has spreadCancer has spread
to the uterus orto the uterus or
fallopian tubesfallopian tubes

Stage IIB Ovarian CancerStage IIB Ovarian Cancer
to other pelvic tissueto other pelvic tissue

Stage IIC Ovarian CancerStage IIC Ovarian Cancer
to pelvic areato pelvic area
Cancer is sheddingCancer is shedding
cancer cells into thecancer cells into the

Stage IIIA Ovarian CancerStage IIIA Ovarian Cancer
both ovaries, theboth ovaries, the
pelvis, and haspelvis, and has
spread to thespread to the
peritoneumperitoneum
microscopicallymicroscopically
throughout the pelvisthroughout the pelvis

Stage IIIB Ovarian CancerStage IIIB Ovarian Cancer
to other pelvic tissueto other pelvic tissue

Stage IIIC Ovarian CancerStage IIIC Ovarian Cancer
to pelvic areato pelvic area
Cancer is sheddingCancer is shedding
cancer cells into thecancer cells into the

Stage IV Ovarian CancerStage IV Ovarian Cancer
to distant organsto distant organs
Treatment includesTreatment includes
surgery andsurgery and
chemotherapychemotherapy

How is Ovarian Cancer Treated?How is Ovarian Cancer Treated?
SurgerySurgery

Primary treatmentPrimary treatment
Removal of ovaries, fallopian tubes, the uterus, and/orRemoval of ovaries, fallopian tubes, the uterus, and/or
the omentum, the thin tissue covering the stomach andthe omentum, the thin tissue covering the stomach and
large intestinelarge intestine
Lymph nodes, tissue samples, and fluid from theLymph nodes, tissue samples, and fluid from the
abdomen may be removed to determine if the cancerabdomen may be removed to determine if the cancer
has spreadhas spread
It may be possible to remove only one ovary andIt may be possible to remove only one ovary and
fallopian tubefallopian tube
Surgery may cause short-term pain and tenderness orSurgery may cause short-term pain and tenderness or
difficulty emptying the bladderdifficulty emptying the bladder
Women may have menopausal symptoms, including hotWomen may have menopausal symptoms, including hot
flashes and vaginal dryness if both ovaries are removedflashes and vaginal dryness if both ovaries are removed

Given to destroy cancer remaining after surgery,Given to destroy cancer remaining after surgery,
slow tumor growth, or reduce side effectsslow tumor growth, or reduce side effects
A combination of drugs is often usedA combination of drugs is often used

Types of ChemotherapyTypes of Chemotherapy
Most drugs used to treat ovarian cancer are givenMost drugs used to treat ovarian cancer are given
intravenously (IV) or intraperitoneally (IP)intravenously (IV) or intraperitoneally (IP)
Either injected into a vein or through a catheterEither injected into a vein or through a catheter
Women with advanced ovarian cancer may have aWomen with advanced ovarian cancer may have a
combination of IV and IP chemotherapycombination of IV and IP chemotherapy
Side effects may include fatigue, risk of infection,Side effects may include fatigue, risk of infection,
nausea and vomiting, loss of appetite, and diarrheanausea and vomiting, loss of appetite, and diarrhea

cellscells
Different methods of deliveryDifferent methods of delivery
Radiation treatment is not usually used to treatRadiation treatment is not usually used to treat
ovarian cancer, but may be used to relieve sideovarian cancer, but may be used to relieve side
effects of progressive cancer, such as tumor growtheffects of progressive cancer, such as tumor growth
in the pelvic areain the pelvic area
reactions, upset stomach, and loose bowelreactions, upset stomach, and loose bowel
movementsmovements
Doctors may advise their patients not to have sexualDoctors may advise their patients not to have sexual
intercourse during radiation therapyintercourse during radiation therapy

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