What is Prostate Cancer?

Prostate cancer, according to the National Cancer Institute (NCI), is a cancer that starts in the prostate gland. It occurs when cells grow and divide without control. Sometimes these cells spread and cause cancer in other parts of the body. Prostate cancer usually affects older men above 65 years old.

In the United States, the National Cancer Institute estimated that there will be about 192,280 new cases of prostate cancer in 2009. Worldwide, according to the World Health Organization (WHO), prostate cancer is the fifth most frequent type of cancer.

The prostate is a gland in the male reproductive system found below the bladder and in front of the rectum. It is a walnut-sized gland made of two lobes, or regions, enclosed by an outer layer of tissue. It also surrounds the first part of the urethra, the tube through which urine passes out of the body.

The prostate gland normally enlarges as a man grows older. For this reason, prostate enlargement may either be benign or malignant. A benign enlargement, such as benign prostatic hyperplasia (BPH), is not cancer and is usually not life threatening. It can be removed and usually does not grow back. In malignant (prostate) cancer, however, the cancer cells can be a threat to life. When removed, prostate cancer can grow back and form another cancer. Cancer cells in prostate cancer can spread to other parts of the body and cause cancer. For example, cancer cells in the prostate can leak out and cause cancer in the colon. [View topic about benign prostatic hyperplasia (BPH).]

Causes and Risk Factors for Prostate Cancer

No one really knows why prostate cancer develops in men. However, research has shown that men with certain risk factors are more likely to develop the disease. A risk factor, according to the National Cancer Institute, is something that may increase the chance of getting a disease.

Studies or research have found the following risk factors for prostate cancer

• Age over 65: Age is the main risk factor for prostate cancer. The chance of getting prostate cancer increases as you get older. In the United States, most men with prostate cancer are over 65. This disease is rare in men under 45.

• Family history: Your risk is higher if your father, brother, or son had prostate cancer.

• Race: Prostate cancer is more common among black men than white or Hispanic/Latino men. It's less common among Asian/Pacific Islander and American Indian/Alaska Native men.

• Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. These prostate cells look abnormal under a microscope.

• Certain genome changes: Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may be increased. The risk increases with the number of genetic changes that are found. Also, other studies have shown an elevated risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

Having a risk factor doesn't mean that a man will develop prostate cancer. Most men who have risk factors never develop the disease.

Many other possible risk factors are under study. For example, researchers have studied whether vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles) may pose a risk, but most studies have found no increased risk. Also, most studies have shown that the chance of getting prostate cancer is not increased by tobacco or alcohol use, BPH, a sexually transmitted disease, obesity, a lack of exercise, or a diet high in animal fat or meat. Researchers continue to study these and other possible risk factors.
Researchers are also studying how prostate cancer may be prevented. For example, they are studying the possible benefits of certain drugs, vitamin E, selenium, green tea extract, and other substances. These studies are with men who have not yet developed prostate cancer.
Signs and Symptoms of Prostate Cancer

Most men with prostate cancer do not know that they have the condition during its early stages. But when symptoms do occur, it may include

• Urinary problems

o Not being able to pass urine
o Having a hard time starting or stopping the urine flow
o Needing to urinate often, especially at night
o Weak flow of urine
o Urine flow that starts and stops
o Pain or burning feeling during urination

• Difficulty having an erection
• Blood in the urine or semen
• Frequent pain in the lower back, hips, or upper thighs

Sometimes, these symptoms are caused by other health problems. It is important that you consult your doctor about your symptoms so that it can be diagnosed and treated promptly.

Treatment of Prostate Cancer

Treatment of prostate cancer depends on the age, extent of cancer (stage of cancer), symptom, and general health. Treatment options may include active surveillance (also called watchful waiting), surgery, radiation therapy, hormone therapy, and chemotherapy. Sometimes, a combination of treatments may be necessary.

It is important that you work together with your doctor in developing a treatment plan that meets your medical and personal needs.

Resources:
Prostate Cancer (November 2008). What You Need To Know About™. National Cancer Institute (NCI), National Institutes of Health (NIH). http://www.cancer.gov/cancertopics/wyntk/prostate (Accessed on October 26, 2009)

Prostate Cancer (n.d.). National Cancer Institute, National Institutes of Health. http://www.cancer.gov/cancertopics/types/prostate (Accessed on October 26, 2009)

Benign Prostatic Hyperplasia (NIH Publication No. 07–3012, June 2006). National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/ (Accessed on October 26, 2009)

Cancer (February 2009). World Health Organization (WHO). http://www.who.int/mediacentre/factsheets/fs297/en/index.html (Accessed on October 26, 2009)

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Bladder Cancer

Bladder cancer, also called urinary bladder cancer, is a type of cancer that starts in bladder tissues. The bladder is a hollow organ located in the lower abdomen. It receives urine formed by the kidneys through the two ureters and stores it until it passes out of the body during urination.

There are several types of bladder cancer depending on what cells of the bladder are involved. Types of bladder cancer include transitional cell carcinoma, squamous cell carcinoma, and adenocarcinoma.

 Transitional cell carcinoma is a type of bladder cancer that starts in the cells that normally make up the inner lining of the bladder, called transitional cells. It is the most common type of bladder cancer.

 Squamous cell carcinoma, the type of bladder cancer that begins in thin, flat cells of the bladder wall.

 Adenocarcinoma is a type of cancer that begins in cells that make and release mucus and other fluids.

The cells that form squamous cell carcinoma and adenocarcinoma often develop in the inner lining of the bladder as a result of long-term infection or irritation.

During normal processes, cells that comprise tissues divide to produce new cells. This process is needed in cases where the body needs to replace dead or worn-out cells, needed for growth of an organ, or growth of the entire individual. Sometimes this process can go wrong wherein abnormal cells divide when the body does not need them. As a result, these abnormal cells can form a mass called a growth or a tumor.

Sometimes, cancer cells may go out of the organ where they started and can cause cancer in other parts of the body. This spreading of cancer is called metastasis.

According to the National Cancer Institute (NCI), in the United States, bladder cancer is the fourth most common type of cancer in men with an estimated 38000 cases each year. It is lower in females, affecting about 15,000 each year making it the eighth most common type of cancer in females in the United States.

Who are at risk for bladder cancer?

Although the actual cause of bladder cancer still remains unclear, studies have shown that people with certain risk factors are more likely to develop the disease than others. A risk factor is anything that increases a person’s chance of developing a disease.

Researchers have found the following risk factors for bladder cancer

 Age. The chance of getting bladder cancer goes up as people get older. People under 40 rarely get this disease.

 Smoking. Smoking is a major risk factor.

 Occupation. Some workers have a higher risk of getting bladder cancer because of carcinogens in the workplace. Carcinogen, according to the National Cancer Institute, is defined as any substance that causes cancer. Workers in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.

 Infections. Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.

 Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.

 Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.

 Being a man. Men are two to three times more likely than women to get bladder cancer.

 Family history. People with family members who have bladder cancer are more likely to get the disease. Researchers are studying changes in certain genes that may increase the risk of bladder cancer.

 Personal history of bladder cancer. People who have had bladder cancer have an increased chance of getting the disease again.

Most people who have these risk factors do not get bladder cancer. On the other hand, people who do get the disease have no known risk factors. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

What are the signs or symptoms of bladder cancer?

The common symptoms of bladder cancer include

 Blood in the urine (hematuria),

 Pain during urination, and

 Frequent urination, or feeling the need to urinate without results.

Often, these signs or symptoms do not mean that a person has bladder cancer. They may be signs of another health problem or condition. For example, infections, benign tumors, bladder stones, or other problems also can cause these signs or symptoms. A person with any of these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible.

How is bladder cancer treated? What is the treatment for bladder cancer?

Treatment of bladder cancer depends on the stage of cancer, whether cancer has spread to other organs, and the person’s general health and age. The earlier bladder cancer has been detected, the better the chances of survival. There are several treatment options for bladder cancer, which a doctor can recommend or discuss with the patient. Treatment options may include surgery, radiation therapy, chemotherapy or biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.

Resources:
Bladder Cancer (n.d.). National Cancer Institute (NCI), National Institutes of Health (NIH). http://www.cancer.gov/cancertopics/types/bladder (Accessed on October 21, 2009)

Bladder Cancer (October 2009). MedlinePlus. National Library of Medicine, National Institutes of Health (NIH). http://www.nlm.nih.gov/medlineplus/bladdercancer.html (Accessed on October 21, 2009)

What You Need To Know About™: Bladder Cancer (September 2002). National Cancer Institute (NCI), National Institutes of Health (NIH). http://www.cancer.gov/cancertopics/wyntk/bladder (Accessed on October 21, 2009)

Cancer: The Leading Cause of Death Worldwide. Associated Content.
http://www.associatedcontent.com/article/2305109/cancer_the_leading_cause_of_death_worldwide.html (Accessed on October 21, 2009)

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Kidney Cancer: A Type of Kidney Disease

Kidney cancer is a type of cancer that forms in tissues of the kidneys. There are several types of kidney cancer including renal cell carcinoma, renal pelvis carcinoma, and Wilms tumor. Renal cell carcinoma is a cancer that forms in the lining of the nephrons—the very small tubes in the kidney that filter the blood and remove wastes. It is the most common type of kidney cancer occurring in adults. Renal cell carcinoma is also known as renal adenocarcinoma or hypernephroma. Renal pelvis carcinoma affects the renal pelvis of the kidney. The renal pelvis is the located in the center of the kidney where urine collects. Wilms tumor is a type of kidney cancer that commonly develops in children under the age of 5.

The National Cancer Institute in the US estimates that in 2009, there will be more than 49,000 new cases of kidney cancer (renal cell and renal pelvis carcinomas) in the United States.

What are the causes of kidney cancer?

Until now, experts are still unsure why a certain person develops kidney cancer while another person does not. However, studies have shown that people with risk factors are more likely than others to develop the disease. A risk factor, according to the National Cancer Institute, is anything that increases a person’s chance of developing a disease. Kidney cancer is not contagious. Researchers believe that kidney cancer can not be spread to other people.

What are the risk factors for kidney cancer?

Researchers have found several risk factors that may increase a person’s chance to develop kidney cancer, which include

 Smoking

 Obesity

 High blood pressure

 People undergoing long-term dialysis

 People with a rare condition called Von Hippel-Lindau (VHL) syndrome

 Occupational risk factors: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace.

 Gender. Males are more likely to develop kidney cancer than females. According to the National Cancer Institute, kidney cancer affects about 20,000 men and 12,000 women in the United States each year.

Most people who have these risk factors do not get kidney cancer. On the other hand, most people who do get the disease have no known risk factors. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

What are the signs or symptoms of kidney cancer?

A person with kidney cancer may not have symptoms during the very early stage of the disease. Signs or symptoms of kidney cancer may include:

 Blood in the urine (hematuria)

 Pain in the side that does not go away

 A lump or mass in the side or the abdomen

 Unexplained weight loss

 Fever

 Feeling very tired or having a general feeling of poor health

Often, these signs or symptoms do not mean that a person has kidney cancer. They may be signs of another health problem or condition. A person with any of these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible.

Kidney Cancer Treatment

Related Questions: How is kidney cancer treated? What is the treatment for kidney cancer?

Treatment of kidney cancer depends on the stage of cancer, whether cancer has spread to other organs, and the person’s general health and age. The earlier kidney cancer has been detected, the better the chances of survival. There are several kidney cancer treatment options, which a doctor can recommend or discuss with the patient. Treatment options may include surgery, radiation, chemotherapy or biologic therapy. Biologic therapy boosts your body's own ability to fight cancer.

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Kidney disease can mean any diseases or disorders affecting the kidney, such as kidney cancer and kidney infection. Sometimes, it is the term used to denote kidney failure.

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Resources:
Kidney Cancer (n.d.). National Cancer Institute (NCI), National Institutes of Health (NIH) http://www.cancer.gov/cancertopics/types/kidney (Accessed on October 21, 2009)

Kidney Cancer (September 2009). MedlinePlus. National Library of Medicine, National Institutes of Health (NIH). http://www.nlm.nih.gov/medlineplus/kidneycancer.html (Accessed on October 21, 2009)

What You Need To Know About™: Kidney Cancer (March 2004). National Cancer Institute (NCI), National Institutes of Health (NIH). http://www.cancer.gov/cancertopics/wyntk/kidney (Accessed on October 21, 2009)

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The Difference Between Kidney Stones and Gallstones

Kidney Stones vs Gallstones: Differentiating Kidney Stones From Gallstones

Kidney stones and gallstones are totally unrelated conditions. They form in different areas of the body.

A kidney stone is a hard mass that forms when substances in the urine harden to form crystals. Most kidney stones are small that they easily pass out of the body even without medical treatment. However, if the kidney stone is too large, it may lodge into narrower part of the urinary tract, causing pain. Sometimes the kidney stone can totally block the flow of urine and can damage the kidney. Treatment may include lifestyle changes, medications, surgery and other non-invasive procedures to break or remove the stones.

Gallstones, on the other hand, forms when substances in the gallbladder harden and form a solid mass. The gallbladder is a small, pear-like shaped sac located just below the liver in the right upper abdomen. It stores bile, a fluid made by the liver that aids in the digestion of fat. Gallstones can cause serious problems if they become trapped or lodged in the bile ducts—passageways that carry bile from the liver to the small intestine. When a gallstone gets stuck in any of the ducts, it can cause pain called gallbladder attack. Signs of a gallbladder attack may include nausea, vomiting, or pain in the abdomen, back, or just under the right arm. Treatment of gallstones may include surgery or medications to dissolve the stones. However, many people with gallstones have no symptoms. They do not interfere with gallbladder, liver, or pancreas function and may not need any special medical treatment.

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Related Post: Kidney Stones

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Reference:
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Kidney Stones in Adults. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. NIH Publication No. 08–2495, October 2007

National Digestive Diseases Information Clearinghouse (NDDIC). Gallstones. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. NIH Publication No. 07–2897, July 2007

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Chronic Kidney Disease—Mineral and Bone Disorder

Chronic kidney disease—mineral and bone disorder (CKD-MBD) occurs when the kidneys fail to maintain proper levels of phosphorus and calcium in the blood. The condition commonly occurs in people with kidney disease and affects almost all patients who undergo dialysis.

CKD-MBD is more serious when it occurs in children because their bones are still rowing. This can cause slowing down of bone growth and can also cause bone deformities. For example, children with CKD-MBD can experience inward or outward deformity of the legs. This type of deformity is referred to as “renal rickets.” Growth is also affected which can result in short stature.

In adults, bone changes from CKD-MBD can begin many years before symptoms appear. If CKD-MBD is left untreated, the bones slowly become thin and weak, which can cause bone and joint pains. Because CKD-MBD causes thinning and weakening of bones, there is a risk of developing bone fractures.

In the past, doctors used the term renal osteodystrophy to describe the mineral and hormone disturbances caused by kidney disease. Now, renal osteodystrophy is used only to describe the bone problems that occur as a result of CKD-MBD.

Role of Hormones and the Kidneys in Maintaining Normal Bone Health

The kidneys play an important role in maintaining normal bone mass and structure. They help to balance levels of calcium and phosphorus in the blood. Also, the kidneys help ensure that the vitamin D a person receives from sunlight and food becomes activated.

Calcium is a mineral that builds and strengthens bones. Calcium is found in many foods, particularly milk and other dairy products. When levels of calcium become too low in the blood, the parathyroid glands release a hormone called parathyroid hormone (PTH). This hormone draws calcium from bones to raise blood calcium levels. Too much PTH in the blood will remove too much calcium from the bones; over time, the constant removal of calcium weakens the bones.

Phosphorus, which is found in most foods, also helps regulate calcium levels in the bones. Healthy kidneys remove excess phosphorus from the blood. When the kidneys stop working normally, phosphorus levels in the blood can become too high, leading to lower levels of calcium in the blood. Low blood calcium levels can cause the release of too much PTH, which results in the loss of calcium from the bones.

Normally, the kidneys produce calcitriol, a form of vitamin D, to help the body absorb dietary calcium into the blood and the bones. However, when levels of calcitriol declines, PTH levels increase, and calcium is removed from the bones. Calcitriol and PTH work together to keep calcium balance normal and bones healthy. In a patient with kidney failure, the kidneys stop making calcitriol. The body then can't absorb calcium from food and starts removing it from the bones. As a result, the bones become weak and brittle, making the person more prone to having bone fractures.

Diagnosis of CKD-MBD

To diagnose CKD-MBD, your doctor may take a sample of your blood. The blood sample will be used to determine levels calcium, phosphorus, PTH, and sometimes vitamin D in your blood. Your doctor may also recommend a biopsy of your bone. This will help to determine if bone cells are normally building bone tissues. Bone biopsy involves taking a sample of bone from your hip, which is then analyzed under a microscope. The procedure is done under a local anesthesia.

Treatment of CKD-MBD

Controlling levels of parathyroid hormone prevents damage to bones. Overactive parathyroid glands are usually controllable with changes in the diet, dialysis treatment, or medication.

Diet

One of the most important steps in preventing bone disease is reducing the intake of phosphorus. Your renal dietician can help you plan a diet to control phosphorus levels in your blood.

Your doctor may prescribe medications called phosphate binders to be taken with meals and snacks. Phosphate binders help in decreasing absorption of phosphorus into the blood by binding with phosphorus in the intestine. Examples of phosphate binders are calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), and lanthanum carbonate (Fosrenol). (National Kidney and Urologic Diseases Information Clearinghouse, National Institutes of Health, February 2009)

Dialysis

Increasing dialysis dose by increasing patient’s flow rate or rate in treatment may also help control phosphorus.

Other medications

If your kidneys are not making enough calcitriol, your doctor may prescribe synthetic calcitriol or other forms of vitamin D as a pill or in an injectable form.

Surgery

Surgery to remove the parathyroid glands may be recommended by your doctor if your PTH levels cannot be controlled with medications or diet.

Other things you can do

 Exercising can improve your overall bone health. However, people on dialysis should consult a health care provider before beginning any exercise program.

 Quit smoking

References:
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). NIH Publication No. 09–4630, February 2009

Tortora, G. and Grabowski, S.: PRINCIPLES OF ANATOMY AND PHYSIOLOGY. 10th ed. John Wiley and Sons, Inc., 2003.

Seeley, R., Stephens, T., and Tate, P.: Essentials of Anatomy and Physiology.5th ed.Mc-Graw-Hills, Inc., 2005

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Urostomy

Urostomy is a type of urinary diversion, which requires a pouch to be worn outside the body. A urinary diversion may be necessary if a person cannot urinate because a part or parts of the urinary tract is damaged or not working properly. A doctor may recommend urinary diversion if:

 A person’s bladder has been removed to stop or prevent spread of cancer

 A person’s bladder has nerve damage

How is urostomy done?

In urostomy the surgeon creates an opening, called stoma (Illustration on the right), in the abdomen where urine is directed. There are two main types of urostomy., ileal conduit and ureterostomy.

Ileal conduit

In this type of urostomy, the surgeon takes a short segment of the small intestine. The remaining intestine is reconnected so that it functions normally. One end of the removed short segment of intestine is placed at the skin surface to create a stoma. The other end of the removed intestine is attached to the ureters—the two tubes that normally carry urine from the kidneys to the bladder.

Urine formed in the kidneys travel through the newly formed passageway, out of the stoma and into the external collecting pouch. The pouch has an outlet where urine can be released into a toilet without removing it from the stoma. (See illustration on the right)

Ureterostomy

In ureterostomy, a surgeon connects the ureters directly to the abdominal wall to create a stoma. This procedure, however, is rarely performed.

Just like the ileal conduit, a ureterostomy requires a pouch placed over the stoma, which collects the urine.

Caring for your urostomy

After the surgical procedure, your WOC nurse can work with you to help you learn how to take care of your urinary diversion. WOC stands for wound, ostomy, and continence. If you have any concerns about your urinary diversion, don’t be shy to ask your WOC nurse because they are experienced and knowledgeable regarding this matter.

Changing pouches

Your doctor or WOC nurse can work with you on how to properly change your pouch. The pouching system usually consists of two pieces—a barrier and a collecting pouch.

The barrier sticks to your skin and prevents urine from leaking making sure that urine flows to the collecting pouch. The collecting pouch collects the urine that comes out of the stoma. In some pouching systems, the barrier and pouch are a single unit.

Cleaning

You can clean your skin with wet towelette or washcloth as you change your pouch making sure that the skin is completely dry before applying the new pouch. Sometimes, the skin surrounding the stoma gets irritated. When this happens, you can use protective skin wipes or an ostomy powder, which is specifically designed to protect the skin around the stoma.

How to recognize infection

Urostomies can get infected. Some of the signs and symptoms of infection include

 Dark urine or urine containing excess mucus

 Foul odor or strong-smelling urine

 Pain in the back

 Nausea

 Vomiting

 Poor appetite

Inform your health care provider if you notice any of these warning signs. To help prevent infection, your doctor may recommend that you drink eight full glasses of water every day to help flush out bacteria.

Diet

You may not need any dietary restrictions. You can probably be able to eat your normal diet. Some foods can cause urine to have a stronger odor, such as asparagus and seafood. Your doctor or dietician can help you plan a better diet.

Clothing

You may not need any special clothing if you have undergone urostomy. However, tight clothing may not be advisable to be worn. Most modern pouches are designed to lie flat against the body so they can’t be noticed.

Activities

You will probably be advised by your doctor to limit your activities during the first few weeks after surgery. This will allow enough healing of the wound. After it has healed, you can perform most of your normal activities. However, full contact sports, such as football or karate should be avoided. You may also want to talk to your employer regarding changes in your job responsibilities.

References:

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Urostomy and Continent Urinary Diversion. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). NIH Publication No. 06–5629, May 2006

Tortora, G. and Grabowski, S.: PRINCIPLES OF ANATOMY AND PHYSIOLOGY. 10th ed. John Wiley and Sons, Inc., 2003.

Seeley, R., Stephens, T., and Tate, P.: Essentials of Anatomy and Physiology.5th ed.Mc-Graw-Hills, Inc., 2005

Image Credit: NIDDK Image Library

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