What is the prostate

Prostate or prostate gland - is unpaired male genital organ, which is located in the lower part of the pelvis. Just above the prostate is the urinary bladder Urinary bladder - structure and function , Passes through the prostate urethra. The prostate is a glandular tissue, which pervades large number of excretory ducts, with basically the connective tissue.

The prostate contributes to the formation of sperm in the testicles under the influence of her secret becoming sperm motility, is the formation of sexual desire and orgasm. The prostate produces prostaglandins - biologically active substances that have a great impact on the entire body.

Causes

Prostate cancer occurs when breeding modified (atypical) of epithelial cells (covering the cells) of glandular and connective tissue of the prostate. The smaller the modified cells are similar to the original, the more malignant the tumor occurs.

Prostate cancer usually occurs after the age of 50 years against the backdrop of age hormonal changes: the change in hormone sensitive prostate tissue hormones begin to act as carcinogens (substances that contribute to the development of cancer).

A characteristic feature of prostate cancer is metastasis (the transfer of the cells at a distance of circulatory and lymphatic systems to the nearby and distant organs) in the skeletal system. Metastases usually affects the bones of the pelvis and lumbosacral spine. Less affected breast and cervical vertebrae, ribs, skull, femur neck. Quite often there are metastases in the pelvic and inguinal lymph nodes.

At the age of 50 may be a so-called latent (hidden) cancer, in which the latent period can last twenty years or more.

How is prostate cancer

Prostate cancer is a long time, asymptomatic. The initial stages can be identified in the course of routine inspection or accidentally, in the treatment of other diseases. Before the appearance of metastases in the patient's complaints mainly relate to urination disorders.

The most common symptoms are pain and violation of the sensitivity of different nature and intensity in the suprapubic and inguinal regions on the inner thighs, perineum, sacrum, rectum and vulva. Disturbed sexual function and urination (frequent painful urination, long, drop by drop, the expiration of urine, urinary retention, etc.). All these features increase as tumor growth.

In addition, there are signs of general illness: malaise, weakness, weight loss, sometimes - small temperature rises. Often the signs of cancer Fifteen signs of cancer that women ignore   due to tumor invasion into surrounding tissues and organs, as well as the development of metastases.

Diagnosis of prostate cancer

Suspected prostate cancer may have a urologist at the reception after the rectal (rectum) digital examination.

Another method of early detection of cancer is a blood test for PSA (prostate-spetsiifichesky antigen - a protein produced by the prostate). Increased PSA levels of more than 4 ng / ml. It is a signal for further examination.

Confirms the diagnosis through a wide arsenal of diagnostic methods, including radiology, X-ray, ultrasound and laboratory (biochemical and cytological - the study of cells) of the study. If necessary, a biopsy (tissue sampling by puncture of the tumor) followed by histological (tissue cells) study.

Treatment

The choice of methods of treatment and consistency of their application depends on the stage of the disease, the general condition of the patient and tumor sensitivity to a particular action.

In the initial stages in the absence of metastases Metastasis - danger everywhere   carried out radical (to the complete destruction of the tumor) operation - the tumor is removed along with the prostate gland, followed by treatment of hormonal preparations Hormonal treatments - not only contraceptives . Upon detection of metastases in lymph nodes are removed and castration.

In advanced cases, treatment begins with castration and hormone therapy. In case of reduction of the primary tumor and make removal of the prostate continues to hormone therapy.

Upon detection of distant metastases or a significant spread of cancer produce a castration, followed by hormone therapy. In these stages is a radiation therapy, in conjunction with the operation and as a separate treatment.

Prediction of prostate cancer depends on the stage of the disease, its histological structure (how the tumor cells differ from the cells of the prostate tissue), patient age (advanced cancer harder to occur in young men) and of the treatment.

Treatment of medullary thyroid cancer

Surgical methods

If the tumor is localized in one lobe of the thyroid gland, a doctor can prescribe the removal of only one lobe. If the tumor is large and pressed on the trachea and esophagus, the task of the operation - to remove all tumor tissue, and this usually requires total or subtotal thyroidectomy (sometimes quite lobectomy - removal of one lobe of the thyroid gland).

Most experts in the treatment of medullary thyroid cancer recommend a complete removal of the prostate. A less aggressive approach is possible for small tumors.

Patients with high-papillary or follicular thyroid cancer Follicular thyroid cancer: no one is safe   You may also need dissection of the lymph nodes in the neck and / or chest. This is an extensive operation, but it is prescribed to most patients with thyroid cancer.

• Partial lobectomy

Partial lobectomy - the removal of the thyroid lobe. For the treatment of medullary thyroid cancer surgery of this type is not practically used.

• Lobectomy

Lobectomy - the removal of thyroid lobe. Typically, it is the least invasive surgery, which can be used in the treatment of cancer. One lobe of the thyroid gland was removed if the tumor is very small and no metastases.

• Lobectomy and resection of the isthmus of the thyroid gland

During the operation, remove one lobe of the thyroid gland and isthmus (part of the gland, which connects two parts). Used to remove non-aggressive tumors are small.

• Subtotal thyroidectomy

Subtotal thyroidectomy involves removal of the entire "problem" of the thyroid gland with the isthmus and most of the other shares. It is also used to treat a relatively small tumors.

• Total thyroidectomy

As the name suggests, in the course of this operation, the thyroid gland is completely removed. Total thyroidectomy is most commonly used in the treatment of various types of medullary thyroid cancer.

Surgical Technique

The length of a standard incision, which is made in the neck for thyroid surgery - from 10 to 12.7 cm, although many surgeons today operate through incisions about 8 cm long.

Excision is in the lower part of the neck and the skin at this site usually heals very well.

Once the incision is made, the surgeon removes all of the thyroid gland, or a portion thereof. He observes the utmost caution so as not to hurt the laryngeal nerves that are located behind the thyroid gland and are responsible for the movement of the vocal cords. Nerve damage can lead to what would hoarse voice - usually temporary, but in some cases it becomes a permanent hoarseness. Generally, damage to the laryngeal nerve - a rare complication of total thyroidectomy (occurs in 1-2% of patients), but serious.

Another complication of thyroid surgery The thyroid gland - is responsible for your hormones   (although very rare) - hyperparathyroidism. It can develop in the case of damage to all four parathyroid glands located near the thyroid gland. The slightest chance of damage to these glands only exists in two types of operations - subtotal and total thyroidectomy. While the consequences of such injuries can be serious, that risk may outweigh the benefits that will thyroidectomy in medullary thyroid cancer.

Perfusion larynx and parathyroid glands is on the same blood vessels. During the operation, the surgeon is necessary to maintain the flow of blood to them; this is usually not a problem, but sometimes there are difficulties with this. In this case, the surgeon usually implant parathyroid glands in the neck muscle. There she survives well and soon starts to function normally.

What about radioactive iodine therapy?

In the treatment of most types of thyroid cancer using radioactive iodine, but the medullar cancer is not the case. Patients with other types of thyroid cancers, radioactive iodine is given after thyroidectomy to destroy the remaining cancer cells. The cells that produce thyroid hormones - the only ones capable of absorbing iodine including radioactive, so this kind of treatment is very effective.

However, the cells form tumors in medullary thyroid cancer, do not produce thyroid hormones. Patients with medullary thyroid cancer are malignant parafollicular cells. They are part of the thyroid gland, but do not produce thyroid hormones Thyroid hormones: mechanism of action and physiological effects Therefore they are not able to absorb iodine, and for this reason the radioactive iodine to them has no effect.

The effectiveness of the treatment of medullary thyroid cancer

The earlier diagnosed with medullary thyroid cancer, the more favorable prognosis. If the cancer is at the time of diagnosis had not spread to the lymph nodes, the chances of complete recovery are very high.

Most experts agree that the treatment of medullary thyroid cancer should be aggressive. Therefore, in most cases, treatment is elected by total thyroidectomy combined with lymph node dissection.

Aftercare

In addition to regular follow-up after treatment of all cancer patients who have had medullary thyroid cancer Thyroid cancer: it is curable Shall once a year to do chest X-ray and to donate blood for the analysis of the level of calcitonin. Since no one other cell in the body except parafollyakulyarnyh not produce this hormone, increase its level is an accurate indicator of recurrence of medullary thyroid cancer.

At best, during thyroidectomy it will remove all thyroid tissue and lymph nodes in the neck - then after the surgery calcitonin level is zero. In many cases, however, the blood will still contain calcitonin, but its level will be lower than before the surgery. When the level starts to rise, it will be a signal that the patient develops recurrent cancer.