Oncology
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Treatment of early stage disease is started with external beam irradiation and lymph node dissection, followed by radical prostatectomy (surgical removal of the prostate gland). Disseminated carcinoma treatment involves hormonal manipulation to decrease the effect of androgens on cancer cell growth. This involves use of estrogens, antiandrogens, other hormonally active agents, and LH-RH antagonists, as well as surgical excision of the testes (orchiectomy, orchidectomy, orchectomy). Chemotherapy is used as an adjuvant and when response to hormone therapy fails.
Anorectal Conditions Requiring Urgent or Emergency Intervention
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Like other necrotising infections, Fournier’s gangrene results in a characteristic appearance of grey necrotic tissue, lack of bleeding, thrombosed vessels, ‘dishwater’ pus and non-contractile muscle. All necrotic tissue, including skin, subcutaneous tissue, fascia, and muscle, must be excised down to healthy, bleeding tissue. Again, there is usually much more necrotic tissue than the superficial appearance suggests, and the surgeon must be psychologically prepared for this. If crepitus is present over an area of what appears to be normal skin, the area should be explored to make sure the underlying soft tissue is viable. Although rarely involved, it may be necessary to debride the anal sphincters, irrespective of the concerns about post-operative incontinence. Vulvar, penile and scrotal skin should be excised if involved. However, an orchiectomy is almost never necessary as the blood supply to the testicles is usually preserved.16,41–42
Specific management problems posed by the primary extranodal presentations: Part II – local control of localized disease
Franco Cavalli, Harald Stein, Emanuele Zucca in Extranodal Lymphomas, 2008
Generally, surgery is not part of the management of non-Hodgkin’s lymphomas, other than to establish the diagnosis. However, there are specific management circumstances where surgery is of benefit. It is of benefit in presentations with impending airway obstruction which may need airway preservation with tracheostomy, spinal cord compression requiring laminectomy, and splenic mass or primary splenic lymphoma, which may benefit from a splenectomy. Orchiectomy is both a diagnostic and therapeutic procedure in primary testicular lymphoma. Patients who present with bone fracture may require surgical stabilization. Although surgical management is frequently a supportive measure, it may also be therapeutic, as in primary testicular and primary splenic lymphoma. For MALT lymphomas, surgery also plays a role in primary presentations in the lung and skin where complete excision may be possible. Resection may also be helpful as part of the combined modality therapy of intestinal lymphoma, testicular lymphoma, and other sites. However, overtly aggressive surgery should be avoided because it may compromise cosmesis (mastectomy, parotidectomy) or function (gastrectomy, cystectomy) and is, therefore, not recommended as a combination of chemotherapy and radiotherapy is very effective in securing local disease control.
Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence
Published in Expert Review of Hematology, 2019
Elisa Santambrogio, Maura Nicolosi, Francesco Vassallo, Alessia Castellino, Mattia Novo, Annalisa Chiappella, Umberto Vitolo
Primary testicular lymphoma (PTL) usually presents as limited stage disease, with typical unilateral testicular mass and bilateral testicular involvement in 10% of cases only. Multiple extranodal dissemination is possible (i.e. pleura, skin, soft tissue, and Waldeyer’s ring), associated with an aggressive clinical behavior. The risk of CNS progression in PTL is particularly high with up to one-third of patients who may present a CNS relapse, within 1–2 years of diagnosis in old series. Therefore, in addition to standard tests, diagnostic lumbar puncture with cytological and flow cytometry on CSF are now recommended as staging procedure [38]. Rituximab-chemotherapy with anthracycline-containing regimens improved the outcome in all patients [57]. Orchiectomy remains mandatory both for diagnosis and treatment; in addition to radiotherapy on contralateral testis. The latter significantly reduces the testicular relapse in retrospective and prospective studies [51]. CNS prophylactic strategies to reduce risk of relapse should be added to standard systemic treatment in PTL [38].
The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence
Published in International Review of Psychiatry, 2019
Belinda Winder, J. Paul Fedoroff, Don Grubin, Kateřina Klapilová, Maxim Kamenskov, Douglas Tucker, Irina A. Basinskaya, Georgy E. Vvedensky
While the use of testosterone-lowering medications is sometimes referred to as ‘chemical castration’, this term is inappropriate, since the effects are temporary and vary according to type of medicine and dosage used. Surgical castration (bilateral orchiectomy) is an irreversible procedure involving the removal of the testes or testicular parenchyma, leading to a reduction in the level of circulating sex hormones, and subsequent diminution of libido (Zvěřina, Hampl, Sulocava, & Starka, 1990). The practice of surgical castration raises important ethical and legal questions (e.g. Stojanovski 2011; van der Meer, 2014). For example, opponents of surgical castration question the extent to which people can voluntarily submit to this irreversible procedure (Heim & Hursch, 1979). Advocates emphasize the proven efficacy of the procedure, the fact that it is a logical voluntary treatment choice for many patients and their caregivers, and that it provides patients with better behavioural control and the possibility of greater independence from the healthcare system, since there is no need for continued pharmacologic treatment to lower testosterone (Krueger, Wechsler, & Kaplan, 2009).
Characteristic features of primary testicular lymphoma and survival trends: a multicenter clinical study
Published in Hematology, 2022
Yujiao Sun, Xueshen Yan, Hongguo Zhao, Zhongguang Cui, Yayun Wang, Shuxiang Sun, Xiaohan Ning, Hong Xu
In our study, 6 patients (12.24%) underwent orchiectomy only as a diagnostic and initial therapy. One patient received conservative treatment (without chemotherapeutic agents) because of advanced age, and 2 patients received chemotherapy alone without orchiectomy. Twenty-nine patients (59.18%) received inguinal orchiectomy and systemic chemotherapy. In addition, 11 patients (22.45%) received systemic chemotherapy and RT after inguinal orchiectomy. Of all patients who received chemotherapy, 1 received rituximab alone; other patients’ chemotherapy regimen contained multiple drugs. The details are presented in Tables 2 and 3. Four patients received R-hyper CVAD/MA chemotherapy, 23 patients received R-CHOP chemotherapy, 8 patients received R-CHOP combined with higher doses of MTX, and 6 patients received CHOP chemotherapy. Among the whole cohort, prophylactic intrathecal injection (ITH) was performed in 24 patients.
Related Knowledge Centers
- Palliative Care
- Surgery
- Testicular Cancer
- Abdomen
- Scrotum
- Spermatic Cord
- Prostate Cancer
- Testicular Torsion
- Testicle
- Penis