Technical Considerations In Radiation Oncology: The Case For Map
Theoretically, if daily repositioning is performed on the bony anatomy, wider margins should be considered around the prostate to take into account daily variations of prostate position . If daily repositioning is performed on the prostate or on implanted fiducial markers in an attempt to protect mostly the rectum, then margins around the pelvic and/or paraaortic nodes should be increased. Real-time re-planning of dose distribution based on daily CBCT, which would take into account the position of both volumes, would be ideal but remains time-consuming. To circumvent this obstacle, we have proposed an alternative strategy that can be used in routine practice. This is referred to as multiple adaptive plans IMRT. Without requiring any additional hardware or software, the MAP strategy is to choose a plan from the pool that most closely matches the prostate position of the day. This position can be determined by dual imaging registrations: one aligned to the implanted markers in the prostate and the other aligned to the pelvic bones. Because the number of possible prostate positions for each patient could be very large, we created a pool of five plans based on a planning CT to compensate for the most significant prostate movements. With this strategy, we showed that the daily dose received by 95% of the target volumes was > 95% of the prescribed dose in 100% of the treatment days for the lymph node volume and 65% of the treatment days for prostate volume.
Symptoms Of Metastatic Prostate Cancer
Metastatic prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. It is also called advanced prostate cancer.
If your prostate cancer has spread you might:
- have bone pain
- feel generally unwell
- have weight loss for no known reason
You might have specific symptoms depending on where the cancer has spread to. These symptoms can also be caused by other medical conditions so might not be a sign that the cancer has spread.
Receiving Treatment For Prostate Cancer That Has Spread
At Moffitt Cancer Center, the experts within our Urologic Oncology Program treat patients with all stages of prostate cancer, including advanced-stage cancers that have metastasized to other areas of the body. Our multispecialty team collaborates as a tumor board, ensuring each patient receives a treatment plan tailored to his unique needs. For individuals with metastatic prostate cancer, treatment plans aim to alleviate symptoms, slow the rate of cancer growth and shrink tumors to help improve quality of life.
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Prostate Cancer Metastatic To The Cervical Lymph Nodes
Luis Sepúlveda
1Urology Department, Trás-os-montes and Alto Douro Hospital Center, 5000-508 Vila Real, Portugal
2Internal Medicine Department, Trás-os-montes and Alto Douro Hospital Center, 5000-508 Vila Real, Portugal
Abstract
Prostate cancer is the most common cancer in men, often presenting with regional lymph node or bone metastasis and rarely with supradiaphragmatic lymph node involvement. Most metastatic cancers involving the cervical lymph nodes are from cancers of the upper aerodigestive tract. In this report, we describe two cases with cervical lymph node enlargement due to metastatic prostate cancer as the initial clinical presentation: a 43-year-old male, initially misdiagnosed with a tumor of the upper aerodigestive tract and an 87-year-old male with right lobe pneumonia and cervical lymph node enlargement, initially attributed to be an acute inflammatory lymph node reaction. To the best of our knowledge, there are less than 50 cases reported in the literature of adenocarcinoma of prostate metastatic to the cervical lymph nodes and only one case presenting in men younger than 45 years. The authors intend to highlight the importance of digital rectal exam and PSA test in case of persistent left cervical lymph node enlargement, including men younger than 45 years of age.
1. Introduction
2. Case Report 1
3. Case Report 2
4. Discussion
Conflict of Interests
What Is Cancer Of The Lymph Nodes
When cancer originates in the lymph nodes or other areas of the lymphatic system, its referred to as lymphoma.2 The most common types are hodgkins lymphoma and non-hodgkins lymphoma. In rare instances, theres also a chance for the development of lymphoma of the skin. If youre wondering, Is lymphoma hereditary, we cover this question in our latest blog article.
People with hodgkins lymphoma usually experience enlarged lymph nodes with a small number of Reed-Sternberg cells present surrounded by normal immune cells. With classic hodgkins lymphoma, which accounts for 9 out of 10 cases of this type of cancer, there are four subtypes that may develop.3 These are:
- Nodular sclerosis hodgkins lymphoma is the most common and tends to start in the lymph nodes in the neck or chest. Though it is more prevalent in teens and young adults, it can develop at any age.
- Mixed cellularity hodgkins lymphoma is the second most common subtype and occurs mainly in the lymph nodes found in the upper half of the body. Its mostly detected in people with HIV infection and affects mostly children and the elderly.
- Lymphocyte-rich hodgkins lymphoma is a rarer subtype and usually occurs in the upper half of the body in a few lymph nodes.
- Lymphocyte-depleted hodgkins lymphoma is the rarest subtype of this type of cancer and occurs mainly in older people with HIV infection. Its mostly found in lymph nodes in the stomach, spleen, liver, and/or bone marrow.
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What Is Metastatic Cancer
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
White Patients Derive A Larger Conditional Mortality Benefit Than Non
In order to determine whether race interacted with survival, we repeated our initial analyses after stratifying by race and by modeling an interaction term. Among patients with M1 disease, conditional mortality was similar between white and non-white patients . However, among patients with N1 disease, non-white patients did not have a significant reduction in conditional mortality at 5, 10, or 15 years of survival compared to diagnosis , while white patients had similar mortality as the overall cohort, with adjusted hazard ratios of 1.10 , 0.898 , and 0.712 , respectively. While non-white patients with T4 disease had improved 5-year PCSM after having survived 5, 10, or 15 years, their improvements were 20-39 % smaller than those of white patients .
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
What Are The Symptoms Of Lymph Node Metastasis
Lymph node metastasis symptoms can vary widely. Typically, one or more of your lymph nodes will become hard or swollen.
However, due to the variance of size and location of your lymph nodes, you might not even feel anything. This is especially true of lymph nodes located deep inside your stomach or internal organs. However, if your affected lymph node presses on organs or structures, you may have symptoms.
When the lymph nodes press on the blood vessels, it can interfere with how the blood moves and lead to blood clotting. You may have:
- Redness
- Trouble breathing
- Chest pain
Cancer cells can interfere with the passage of lymph fluid throughout your body. In the most severe cases, this happens in your arms or legs and is called lymphedema. As a result, you will notice swelling in those areas.
Otherwise, you might also have generalized cancer symptoms like:
- Loss of appetite
- Fatigue
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What Happens If My Cancer Starts To Grow Again
Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.
You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:
Which treatments are suitable for me?
Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.
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Surgery For Prostate Cancer
There are many types of surgery for prostate cancer. Some are done to try to cure the cancer others are done to control the cancer or make symptoms better. Talk to the doctor about the kind of surgery planned and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know so they can help you.
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Spreading To Lymph Nodes Helps Cancer Metastasize
The researchers first asked whether cancer in the lymph nodes of mice helps tumors metastasize to the lungs, one of the most common places cancer spreads to.
They implanted groups of melanoma cells under the skin of mice and let them form tumors. In some mice, the cancer spread to the lymph nodes, and in other mice, it didnt. After several weeks, the researchers injected melanoma cells that dont spread to lymph nodes into the veins of the mice and then checked their lungs for cancer.
There were far more tumors in the lungs of mice that had cancer in their lymph nodes than in mice that didnt, they found.
So, it appears that spreading to lymph nodes helps cancer metastasize to the lungs, Dr. Engleman said.
Stage Iv Bladder Cancer
Stage IV cancer is the most advanced form of bladder cancer. It is called metastatic. This means the cancer has spread to distant lymph nodes or organs. Cancers that have spread beyond the bladder into the wall of the abdomen or pelvis are also considered Stage IV. Stage IV cancer is usually treated with chemotherapy and, more recently, with immunotherapy as well.
People with bladder cancer of all stages may be able to participate in a clinical trial. Clinical trials are research studies that test new treatments to see how well they work.
If your prostate cancer spreads to other parts of your body, your doctor may tell you that itâs âmetastaticâ or that your cancer has âmetastasized.â
Most often, prostate cancer spreads to the bones or lymph nodes. Itâs also common for it to spread to the liver or lungs. Itâs rare for it to move to other organs, such as the brain, but that can happen.
Itâs still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.
Metastatic prostate cancer is an advanced form of cancer. Thereâs no cure, but you take steps to treat and control it. Most men with advanced prostate cancer live a normal life for many years.
The goals of treatment are to:
- Manage symptoms
- Slow the rate your cancer grows
- Shrink the tumor
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Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
A physician can recommend a number of treatments to address an enlarged prostate. An enlarged prostate will require surgery to relieve the symptoms. In most cases, surgical treatment for an enlargement of the penis is enough. Moreover, a doctor may recommend a course of treatment based on symptoms. A TURP procedure is not painful and requires less recovery time than open surgery. The recovery period will be shorter and less traumatic.
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How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
Cancer Spreading To The Lymph Nodes
Cancer appearing in the lymph nodes is an indicator of how the cancer is spreading. If cancer cells are only found in the lymph nodes near the original tumor, it may indicate the cancer is in an earlier stage and has not spread far beyond its primary area.
On the other hand, if your doctor finds the cancer cells have traveled to lymph nodes far from the initial tumor, the cancer may be spreading at a faster rate and could be in a later stage.
Additionally, its important to know how many cancer cells have traveled to the respective lymph node. If theres visible or palpable cancer in lymph nodes, or the cancer has grown outside the lymph node walls, the cancer may have progressed further and may require a different treatment plan.
If cancer cells have spread to your lymph nodes , symptoms may include:
- lump or swelling in your neck, under your arm, or in your groin
- shortness of breath
- pain
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