Other Lymphoproliferative Disorders Involving the Testis

Testicular Lymphoproliferative Disorders in Childhood The testis is involved in approximately 5 of childhood lymphomas, most commonly in disseminated Burkitt lymphoma, an aggressive mature B-cell lymphoma associated in all cases with translocation of the MYC gene. 43 . With modern combination chemotherapy protocols, testicular involvement at diagnosis does not appear to confer a worse prognosis 43 . The testis is also not infrequently involved during the course of precursor B- or T-cell ALL...

Angiogenesis Inhibitors Used in Clinical Trials to Treat Renal Cell Carcinoma

TNP-470 is a fumagillin analogue and is one of the first angiogenesis inhibitors to undergo clinical testing. Fumagillin was originally isolated from Aspergillus fumigatus contaminating endothelial cell cultures 78 and is a potent inhibitor of endothelial growth in vitro and in vivo. A number of analogues of fumagillin were synthesized, and TNP-470 was selected as the least toxic compound with the greatest antian-giogenic effect 78 . A phase II trial of TNP-470 was carried out in 33 patients...

Primary Renal Synovial Sarcomas

Synovial sarcoma of the kidney is characterized by a specific morphology and specific cytogenetic characteristics 14 . It consists of spindle cells and frequently has large cysts. Many cases show local recurrence after nephrectomy. Most cases are diagnosed between the ages of 20 and 50 years. Microscopically, tumors are characterized by monomorphic plump spindle cells (Fig. 25.4). The cysts are lined by mitotically inactive epithelial cells without striking cellular atypia. The tumors have been...

Three Dimensional Conformal Radiotherapy 3DCRT

Conventional radiotherapy is delivered using rectangular-shaped treatment fields, which inevitably encompass large volumes of normal tissues as well as the required target volume. The major focus over the last decade has been the development of conformal radiotherapy techniques, which allow delivery of irregularly shaped fields that conform more closely to the tumor target while reducing the radiation to the dose-limiting normal tissues. Shaping of fields can be achieved in one of two ways by...

Rhabdomyosarcoma of the Bladder

Rhabdomyosarcoma of the bladder is a rare malignant mesenchymal neoplasm composed of tumor cells that recapitulate the morphological features of skeletal muscle. Most commonly seen in childhood and adolescence, the majority of these tumors are of the embryonal subtype in the bladder (and are also known as sarcoma botryoides). In contrast, the alveolar subtype, carrying a distinct chromosomal translocation (t2 13), is most commonly seen in the deep soft tissues and rarely arises in the bladder.

Quality of Life and Psychosexual Issues

These issues, unfortunately, have been entirely neglected in most reports on penile cancer. This is surprising considering the possible major psychosexual impact of a penectomy. There are only a few small, mostly retrospective studies evaluating the quality of life and psychosexual issues (2,88,89). The expected quality of life, particularly sexual functions after treatment, should be specifically discussed with the patient. It is an expansive concept that involves vast and profound evaluation....

Carcinoma in Situ CIS

Carcinoma in situ is defined as a flat (nonpapil-lary) high-grade transitional cell carcinoma that has not penetrated the basement membrane of the epithelium. Such lesions are considered distinct entities from papillary (pTa pT1) tumors, with profound implications for prognosis. Clinically, CIS can be divided into diffuse (velvety erythematous elevations) or focal (thickened Treatment Options in Superficial (pTA pT1 CIS) Bladder Cancer Fig. 13.1. Suggested surveillance protocols for newly...

Viral Methods

Viruses have evolved to be efficient in introducing their DNA into host cells, where it is converted into protein product and hence are obvious methods of gene delivery for therapy. There are clearly drawbacks in terms of toxicity, both from the viruses themselves and due to the immunogenicity of viral antigens. The vector in most bladder cancer gene therapy experiments has been the adenovirus, and this will be discussed in some detail. There are many other DNA virus types that have been used...

Inguinal Orchidectomy Timing of Orchidectomy

Inguinal orchidectomy is the first step in the management and staging of most patients presenting with testicular cancer. Certainly, well patients presenting with a solid testicular mass, the most common presentation, should undergo inguinal orchidectomy as soon as possible followed by radiological staging and referral to an oncologist. In the less common situation of an ill patient with metastases typical of a germ cell tumor and elevated b-human chorionic gonadotropin (bHCG), a-fetoprotein...

Complications of Ilioinguinal Lymphadenectomy

Although perioperative mortality consequent to ilioinguinal lymphadenectomy is rare, the morbidity of the procedure is quite significant. Skin flap or edge necrosis and wound breakdown along with persistent lymphorrhea are the commonest early complications reported in up to 80 of patients 65,66 . This may lead to pro The Clinical Management of Penile Cancer longed hospitalization or may require secondary reconstruction with skin grafts or pedicled flaps. Routine transposition of the sartorius...

Phimosis and Balanitis Xerotica Obliterans

Phimosis has been reported to be present in 44 to 85 of men with penile SCC 7 . Balanitis xerotica obliterans (BXO) of the penis is a well-recognized inflammatory dermatosis that causes atrophic and sclerotic changes this may lead to secondary problems with phimosis and meatal strictures. The association of SCC arising on a background of BXO has not been examined as fully in males as has lichen sclerosus for vulvar SCC in females. It is known that about 40 of penile SCC also have histological...

There Should Be an Acceptable Screening Instrument for the Disease

The advent of PSA testing in the late 1980s as a simple blood test to indicate the possibility of prostate cancer has revolutionized its diagnosis. Although the triad of PSA, digital rectal examination (DRE), and transrectal ultrasound (TRUS) and biopsies remain conventional in confirming the diagnosis and staging the disease 19 , it is now accepted that neither DRE nor TRUS should be included in a screening context for prostate cancer. In the absence of the disease, serum PSA concentrations...

Adjuvant Therapy

The only curative treatment for renal cell carcinoma is complete surgical excision of the primary lesion. As stated earlier, 20 to 30 of patients who initially present with localized disease subsequently relapse after nephrectomy, usually with metastatic disease . Thus there is a need for an effective adjuvant therapy. Three large randomized trials totaling 250 patients have compared adjuvant interferon with observation in resected Robson stages II (perinephric fat involved) and III (tumor...

Standard External Beam Radiotherapy EBRT

Scan Bladder Cancer

Radical EBRT is an alternative to radical prostatectomy for patients with early, organ-confined prostate cancer (T1-2, N0, M0) and can also be used for patients with nonmetastatic locally advanced disease (T3-T4) where surgery is inappropriate. The primary tumor is assessed by digital rectal examination, cystoscopy, and transrectal ultrasound (TRUS). Staging of systemic disease usually comprises bone scanning and pelvic lymph node imaging (with computed tomography CT or magnetic resonance...

References

Cancer Facts and Figures 2004. Atlanta American Cancer Society, 2004. 2. AIHW and AACR. AIHW National Mortality Database, Australia's Health 2004, AIHW. 3. Majeed A, Babb P, Jones J, Quinn M. Trends in prostate cancer incidence, mortality and survival in England and Wales 1971-1998. BJU Int 2000 85(9) 1058-1062. 4. Dijkman GA, Debruyne FM. Epidemiology of prostate cancer. Eur Urol 1996 30(3) 281-295. Urological Cancers Science and Treatment 5. Parkin DM, Pisani P,...

Pdo In Carcinoma Of Breast

Chemotherapy for renal cell carcinoma. Semin Oncol 2000 27(2) 177-16. 2. Fishman M, Antonia S. Novel therapies for renal cell carcinoma an update. Expert Opin Investig Drugs 2003 12(4) 593-609. 3. Rini BL,Vogezang NJ, Dumas MC, Wade JL, Taber DA, Stadlet WM. Phase II trial of weekly intravenous gemcitabine with continuous infusion fluorouracil in patients with metastatic renal cell cancer. J Clin Oncol 2000 18(12) 2419-2426. 4. Ryan CW, Vogezang NJ, Stadler WM. A phase II trial of...

Treatment Options in G3pT1 Disease

G3pT1 forms the watershed of therapeutic intervention, with advocates of conservative and radical intervention equally persuaded in their Treatment Options in Superficial (pWpT1 CIS) Bladder Cancer differing interpretation of the available data. The historical series suggest that untreated G3pTl has a recurrence rate between 70 and 80 , and progression rates ranging from 29 to as high as 50 74 . In Birch and Harland's 75 review, 40 of G3pTl cases followed beyond 24 months developed...

Biochemotherapy

The lack of cross-resistance, nonoverlapping toxicity, and potential synergy between chemotherapy and biological therapy has led to several trials combining cytokines and chemotherapeutic agents so-called bio-chemotherapy in metastatic renal cell carcinoma. One rationale for this approach is that by causing cytotoxicity chemotherapy will release tumor antigens, which are processed by IFN-a-stimulated antigen-presenting cells that in turn activate IL-2-stimulated CTLs. The counterargument would...

Nkx31

Two separate sites on chromosome 8 8p23 and 8p12-22 have shown chromosomal deletions or allelic loss most frequently in prostate cancer 9 . Nkx3-1 maps to 8p21 and has been proposed as a tumor suppressor. NFK3-1 is Urological Cancers Science and Treatment expressed in normal prostate epithelium and is decrease in prostate tumor cells 21 .In addition, Bhatia-Gaur et al. 21 have suggested that loss of a single allele may be linked to a predisposition to prostate cancer.

Contributors

Abel, ChM, FRCS Department of Surgery Faculty of Medicine Hammersmith Hospital Campus Imperial College London London, UK Chris M. Bacon, MB ChB, PhD, BMedSci Department of Histopathology Royal Free and University College Medical School London, UK Dean F. Bajorin, MD Division of Solid Tumor Oncology Department of Medicine Memorial Hospital for Cancer and Allied Diseases Memorial Sloan-Kettering Cancer Center New York, NY, USA Carsten Bokemeyer, MD Department of Hematology Oncology...

Risk of Recurrence and Progression in Superficial Transitional Cell Carcinoma

Key issues in the clinical management of superficial bladder cancer are the provision of adequate disease monitoring after resection of a primary tumor and prediction of the risk of recurrence and progression to invasive disease. Accurate assessment of risk of recurrence could allow less frequent monitoring by cystoscopy and if urine-based analyses could be used, this would reduce costs and the cystoscopy-associated morbidity and anxiety suffered by patients. A wide range of molecular...