PROSTATE CANCER

PROSTATE CANCER

Introduction:-

Prostate is a glandular organ present only in males.  It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter.It has got five lobes anterior,posterior,two lateral and a median lobe.Since  the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:-

1) Prostatitis:-

This is the inflamation of the prostate gland due to bacterial infection.

2) Benign enlargement of the prostate:-

This is a non cancerous tumour of  the prostate seen after the age of 50.  3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males.

Cancer of the prostate.

Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.

Site of tumour:-

Prostate cancer is seen mainly in the posterior lobe.Non cancerous enlargement is seen in other lobes.

Changes in the gland in cancer:-

The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth :-

Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Spread of tumour:-

Metastasis in cancer of prostate is very early.

1) Local spread:-

From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles.Tumour cells also move to the neck and base of the urinary bladder.

2) Lymphatic spread:-

Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

3) Spread through the blood:-

Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:--

Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

1) No symptoms:-

Tumour is small and only in the posterior lobe.  This is diagnosed accidentely.

2) Slight difficulty in urination:-

Here the tumour is enlarged and urethra is slightly compressed.Shortly there will be frequent urge for urination with difficult urination.

3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding.Urine comes drop by drop.

4) Retention of urine:-

When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.

5) Signs of metastasis:-

Some patients come with the signs and symptoms of metastasis.

a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.

b) Fracture of spine due to cancerous growth in the spine.

c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.

d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.

e) General weakness due to spread of cancer to different parts of the body.

f) Anaemia due to involment of bone marrow and increased destruction of RBCs.

Clinical examination :-

Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Investigations:-

1) Complete blood investigations;-

RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.

2) Urine analysis:-

Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests:-

Blood urea level,serum creatinine level,electrolyte level ect.

4) Serum acid phosphatase:-

Increased in cancer of prostate.

5) x-ray of the spine:-

To detect any tumour or fracture.

6) Ultra sonography;-

Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-

Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-

Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-

Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.

Treatment:-

1) If there is retention of urine catheterisation is needed.
2) Dialysis if kidney failure.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4) Specific treatment is prostatectomy(removal of prostate)

Partial prostatectomy :-

Here only the affected lobe is removed.

Radical prostatectomy :-

Total removal of prostate along with nearby lymphnodes.

5, Hormone therapy :-

Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.

7) Radiotherapy is also done for some cases.

8) Homoeopathy:-

Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.

9) Yoga and meditation is also healpful.

BRIEF IDEA ABOUT PILES (Hemorrhoids)

What is piles ?
 
Dilatation of radicles of rectal veins within the anal canal is called piles.The medical term for piles is hemorrhoids.Compared to arteries veins are weak due to thin walls and hence any backpressure in the veins can make them tortuous.There are three rectal veins namely superior, middle and inferior rectal veins.Any obstructions or increase of pressure in these veins can predispose piles.

Depending upon the situation there are two types of piles.

1) External piles.         2) Internal piles.

1) External piles:-

This type of piles is seen outside the anal opening and is covered by skin.It is black or brown in colour.This type of piles is very painful due to rich nerve supply in this area.

2) Internal piles:-

It is inside the anal canal and internal to the anal orifice.It is covered by mucous membrane and is red or purple in colour.These piles are painless.

Some times internal and external piles occure in same individual.

Factors responsible for piles:--

1) This is a familial disease.

2) Piles is seen only in animals maintain an erect posture. This is due to congestion in the rectal veins due to the effect of gravity.

3) It is common in individuals having chronic constipation.Those who have a habit of visiting the toilet due to frequent urge for stool may develop piles in future.

4) Piles is common in those who take excess of chicken, prawns, spicy food ect.Those who take vegetables and fibrous food are rarely affected.

5) Some ladies get piles during pregnancy due to compression of rectal veins by the uterus.

6) Cancerous lesions in the rectum can obstruct blood flow and result in piles.

Signs and symptoms of piles:--

1) Pain:-

Pain is common in external piles which will be worse while straining at stool.

2) Bleeding:-

Bleeding comes in splashes while pressing for stool.Bleeding may be profuse in some cases.

3) Protruding mass:-

In external piles the swelling can be felt around the anal orifice.In case of internal piles initially it can not be felt.When the disease progresses the piles protrude during stool and will go inside automatically.When the condition becomes worse the protruded piles will not go back in to the anus.

4) In some cases there will be discharge of mucus with itching around the anal orifice.

Complications of piles:--

1,Infection: The infection can spread to deep veins resulting in septicaemia.
2,Fibrosis: Here the piles become fibrosed with hardening of anal orifice.
3,Thrombosis: Here the blood inside the piles will form clots and can obstruct blood flow.
4,Gangrene: Here the tissues in the piles and nearby skin die due to lack of blood supply.
5,Suppuration: When the piles suppurate it can produce abscess with discharge of pus.

Treatment of piles:--

Initially it is treated on the basis of symptoms.Constipation should be treated.If there is anaemia iron should be give.Homoeopathic medicines can give good results. If medicinal treatment is not giving any result the following can be tried.

1) The thrombosed external pile is excised under local anaesthesia.

2) Sclerosant injection therapy can reduce the size of piles.

3) Rubber band ligation around the neck of piles is useful in some cases.

4) Cryosurgery is very effective.

5) Anal dilatation can reduce constipation and pain.

6) Haemorrhoidectomy is the surgical removal of piles.


How to prevent piles?

1) Eat plenty of fruits and vegetables.

2) Take fibrous food.

3) Avoid excess intake of meat,prawns,crabs ect.

4) Keep a regular timing for food.

6) Drink sufficient quantity of water.

7) Keep a regularity in bowel habits.

8) Take treatment for constipation.