Laryngeal cancer

Head and neck cancers focused on otolaryngology are thought to be about 5% of all cancers, but they include lips and oral cancer, nasal and sinus cancer, nasopharyngeal cancer, oropharynx Cancer, hypopharyngeal cancer, laryngeal cancer, salivary gland carcinoma, thyroid carcinoma · · ·, and so on. Among them, occupying about 30%, the most frequent occurrence is laryngeal cancer. Recent statistics are about 3 to 4 people per 100 thousand population, men have smoking history more than 10 times and more than 90% of women, and are representatives of tobacco-related cancer.



Conversely, if you do not smoke it will be almost a cancer that will not be affected, but people who have a lot of opportunities to passive smoking also need attention. It is also known that cancers in the upper gastrointestinal tract are likely to be duplicated, as with other head and neck cancers.
Laryngeal cancer is divided into glottic cancers that can be made in the vocal cords, glottic tops that can be made on the mouth side than that, and vocal canards that can be made on the trachea side. Percentage is about 60% of glottic cancers and about 50% of glottic cancers About 30%, the occurrence of subgroup cancer is slight. It is a transnasal endoscope photograph of each. Since vocal cords produce voices by vibrations of the left and right vocal cords, glottic cancers are diagnosed at an early stage and often diagnosed, but on glottic tops, it progresses relatively, and pain and swelling of the throat when feeling swallowed It is often found after the symptoms such as the swelling of the lymph nodes that metastasized to the neck is the initial symptom. I do not have symptoms until GOOM further progress, so it is an impression that often breathing difficulties have already come at the time of consultation. (It is hard to understand in the photograph because it is developing on the back of the vocal cord, but there is actually a considerable spreading.) Tracheotomy is necessary for breathing difficulties. If there is abnormality like a photograph at the outpatient visit, we pick up the tissue on the spot and confirm the diagnosis (It takes about one week.). For diagnosis of progress degree, image inspection such as MRI and CT is performed.


Treatment of laryngeal cancer is performed mainly by surgery or radiotherapy, depending on the progress of the larynx cancer, in a way that combines them with anticancer drug treatment alone or in combination. As shown in the figure the larynx is framed by several cartilage centered on thyroid cartilage and cricoid cartilage which is palpated as a throat Buddha.


As with cancer in other areas, TNM classification detailed in the handling regulations is stipulated for degree of progression, but roughly invasion into this framework or progressive disorder of vocal cords progresses Cancer, those not going to that point may be thought of as early cancer. If lymph node metastasis or distant metastasis occurs in the neck, it will be advanced only. The cure rate of the laryngeal cancer as a whole is 7 to 80%, which is higher in head and neck cancers, but this is often found at an early stage, and even if locally advanced cancer is comparatively metastatic It is because it is few. There is no curative treatment in the case of distant metastasis, anticancer drug treatment and so on according to the situation. In cases where it is limited to lymph node metastasis in the cervical region, it can often be expected that cure can be achieved by treating the primary lesion with treatment based on surgery such as cervical lymphadenectomy. I will describe the treatment of the primary lesion.
In cancer surgery, it is said that curability is high enough to largely cut the tissue around the cancer. However, if such an operation is performed on the laryngeal cancer, there is a problem that it not only hinders speech but also makes it easy to aspirate, so as not to cause these as much as possible, It is important. The most invasive surgery for laryngeal cancer is a total laryngectomy that resects the larynx with the whole frame of the cartilage and can eradicate many cancers but in this case it not only loses the sound source , A hole called a permanent trachea hole is made in the anterior neck for breathing.

As the airway and the esophagus are separated, the risk of aspiration disappears, but there is a danger of drowning due to the action that water can enter the permanent tracheostomy such as bathing, inconvenience comes to life. It still falls under the disabled person. As much as possible, it is not necessary to take out the entire larynx, and it is necessary to select a treatment so that cancer can be cured.

For early cancer, T1 and T2 will be taken from the shallow one, but for these, 8 to 90% of the radiation alone can obtain a cure of 5 to 70%. Although radiotherapy is usually done at hospital, the greatest advantage is that there is no exacerbation of speech. A disadvantage is that there is a risk of complications due to radiation, but it may be that it takes a treatment period of nearly two months. If you do not feel comfortable you need surgery. For surgery for early cancer, there is a technique to remove a portion of the laryngeal framework, but there are many cases to choose laser surgery under a direct mirror that is performed by oral operation without damaging the framework. Although it is difficult to do depending on the extent of the progress of the lesion, the treatment effect is similar to radiotherapy, close to the operation of benign lesions such as vocal cord polyps, and in our department we usually go to hospital for 2 nights and 3 days. The disadvantage is that there is a possibility that the voice may worsen because there are many cases where the vocal cords are excised.

For advanced cancers, it is difficult to cure radiation alone, so we usually use multiple anticancer drugs in combination. Side effects of anticancer drugs often appear strongly, and the control rate is further deteriorated, so surgery will be mainly focused on. Among them, total laryngectomy is often selected, and further enlarged resection is sometimes required, but on the other hand, there is a subtotal laryngectomy as a technique that has been relatively popular in the country recently . It is a method of resecting cancer in a mass with thyroid cartilage which is the center of the laryngeal framework. Completely resected to one side of the arytenoid cartilage is made possible and after a lesion resection, it is a slightly rough seeming operation that severely fixes the hyoid bone and cricoid cartilage, but the greatest advantage is that it does not form a permanent tracheostomy It is a point.
This method was devised and improved in France in the 1950s, but it is said that about 30% of cases that had previously performed a total laryngectomy is subject to this surgery. The problem is that the local edema after surgery becomes stronger, the tracheostomy hole temporarily placed can not be closed easily, it takes time to be able to swallow successfully, so the length of stay in hospital becomes as long as about 2 months (In the case of our department of total laryngectomy, it is within 3 weeks at the shortest.). Also, even if cancer can be cured, it is expected that aspiration will come afterwards, and it seems that sufficient follow-up observation is necessary. For this reason it is not recommended for elderly people.

Although we will lose vocal cords after total laryngectomy, there are several alternative voicing methods such as artificial larynx use and esophageal vocalization. Among them, there is a method that uses a voice button with a one-way valve formed by forming a tracheoesophageal fistula and allowing it to easily acquire relatively good voice. Push your trachea with your fingers and send the expiration toward the oral cavity. There is no intonation voice, but there are people who speak on the phone. Because the voice button gets dirty, it is necessary to change it about once a year in a clinic.
In our department, we have chosen patients to inform patients about the disadvantages of the treatment regimen. In the three years since fiscal 2011, 47 people who underwent treatment in our department, 43 of those who had the initial anticancer treatment, the treatment of the primary tumor was 13 radiation alone therapy, radiation There were 4 chemotherapy, 16 laser surgery, 1 laryngectomy and 9 laryngectomy.

Introduction
When asking "brain tumor", there are many people who seems to be such as "Is it a very scary disease?" "Can it be cancer?" "Why does it become"? Brain tumors occur at a frequency of about 19 people per 100,000 people and are seen in every generation from infants to the elderly. Here I will briefly explain the brain tumor.


What is a brain tumor?
Brain tumor is a generic term for tumors occurring in the skull. Inside the skull, there are brain / meningeal (mucosa), cranial nerve, pituitary gland (macaque), blood vessels and so on. Tumors arising from these tissues are collectively referred to as primary brain tumors . On the contrary, we distinguish tumor metastasizing from other parts of the body as primary tumor as metastatic brain tumor .
In Kumamoto Prefecture, approximately 400 primary brain tumors and about 200 metastatic brain tumors each year (estimated to be over 600 cases actually) have been found each year.

Types and causes of brain tumors
Types and features
Although
it shares the same point that it occurs in the head of the primary brain tumor (intracranial), its kind varies depending on the type and nature of the cell (Fig. 1).　
2
The most common is meningioma . Due to recent advances in diagnostic imaging, there are increasing cases (asymptomatic) that happen to be found even without symptoms. Meningioma is slow to increase (0 - 2 mm a year), and it is curable if it is totally removed. In the elderly, one person is found in about 40 people, and in the case of asymptomatic nature, images are taken every 6 months to 1 year to observe the follow up.
The next most common is glioma (glioma) . There are also several kinds of this glioma. Among them, those called glioblastomas grow quickly and sometimes fall into a dangerous state in several months after symptoms appear. Although it is representative of brain tumor that is difficult to cure, recently radiation and medication therapy has advanced and treatment outcomes are improving. I am doing treatment in cooperation with Kumamoto University neurosurgery.
Pituitary adenomas are tumors arising from the pituitary gland and can be seen in the 20s to the elderly. As the tumor grows, visual disturbance and field narrowing are caused. Endocrine symptoms such as lactation, infertility, loss of libido and motivation, increase in body fat, hirsutism, etc. may occur in hormone-producing ones. It enables safe and less burden surgery using internal therapy and neuroendoscopy.

Metastatic brain
tumor This is a tumor that metastasizes from the rest of the body to the brain. Lung cancer is the most common primary lesion, followed by breast cancer, colon cancer, and stomach cancer (Figure 2).
Brain tumor _ page _ 2
Symptoms vary in the place where it metastasized to the brain.

Cause
The cause of brain tumor is genetic abnormality, radiation of high dose, aging etc, but further things are still unknown now. The possibility of gender differences, racial differences, family history of brain tumors, etc. is also considered, but I do not know what was clear.

Main symptoms (Figure 3)
Four
There are three main symptoms of brain tumor as follows.
(1) Chronic headaches and nausea
It is said that persistent, irregular headache often accompanies nausea and vomiting at the time of getting up. Unlike subarachnoid hemorrhage, suddenly it is not often attacked by a strong headache.
(2) Local symptoms (nest symptoms)
Various symptoms appear depending on where the tumor has formed. "Numbness / limb paralysis" "words are not fine" "Some view, blurred," Personality changed "and others.
(3) Convulsive seizure It
is caused by a brain current short-circuiting due to brain tumor. Treatment with anticonvulsant.

Inspection (Figure 4)
Five
Basically, we first do image diagnosis. In particular CT (computed tomography) and MRI (nuclear magnetic resonance image) are common. There are also things understood by blood test (tumor marker, hormone test). If necessary, investigate the tumor tissue itself. This is to know the type and the degree of malignancy of brain tumor in detail, and the treatment policy is decided from this result.

Treatment
The treatment of brain tumor varies according to the type. First, we diagnose the type of tumor accurately and decide the treatment policy. If surgery to remove all tumors is good, radiation therapy, chemotherapy (medication therapy), and combining them (collective treatment) are available. In addition, it may be good to follow up without treatment and it is necessary for an experienced doctor to understand the pathology of brain cancer well.
Even after surgery and radiotherapy treatment, we have to visit the hospital regularly for a while and see the progress. In the periodic medical examination, we perform image inspection and blood test.

Finally
About 70% of brain tumors are said to be treatable benign tumors. It is important to ask the specialist to check early if "I feel something wrong ... ...", "Something strange ...". If you can detect it at an early stage, it will be easier to treat as much.
If you have any questions or concerns, please do not hesitate to contact us.

The number of skin cancer patients who treated in Kumamoto City Hospital dermatology department in 2014 was 106 cases (Table 1). The most common were 45 cases of basal cell carcinoma, and 21 cases of squamous cell carcinoma were second.
Table 1 Skin cancer treatment record at Kumamoto citizen's hospital (2014)



Figure 1: Structure of human skin
(2) Most of the cells making the outermost epidermis are keratinocytes (keratinocytes). This keratinocyte will change from basal cell to spinocyte to granule cell to keratin, from birth to death. The part where each cell exists is called basal layer, spinous layer, granular layer, horny layer.
Figure 2: Structure of epidermis
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(3) This keratinocyte became cancer, basal cell carcinoma and spinocellular carcinoma.
(4) Also, since keratinocytes contain a pigment called melanin, there are colors in humans. Melanocytes supply melanin to keratinocytes, and melanoma is the melanocyte that is cancerous.

Epidemiology of skin cancer
In recent years, the number of skin cancer patients has increased rapidly. Details are unknown because the nationwide patient registration system is not maintained, but there are reports that the incidence doubled in the 10 years from 1998 to 2007 (Okayama Prefecture Medical Association Report No. 1312, 2011 Issued on June 25th). The cause is considered to be aging and environmental changes such as ultraviolet rays amount. Because young people 's skin cancer is not increasing, aging is expected to be the most important factor. Therefore, in Japan where the aging of the population is progressing further, the number of skin cancer patients is expected to increase in the future.

Classification of skin cancer
Skin cancer is divided into epithelial (epidermal) system and nonepithelial system that originate from the surface of the skin, but most (90% or more) is epithelial (epidermis) type cancer.
1 from occurring skin cancer skin portion
　(1) basal cell carcinoma, squamous cell carcinoma, melanoma
　(2) actinic keratosis, Bowen's disease, extramammary par jet disease
skin cancer occurring than 2 non-skin portion
　(1 ) Sarcoma
　　　A. Raised Skin Fibrosarcomae A Leiomyosarcoma
　　　Tumor
　　　Sarcoma
　(2) Malignant Lymphoma
　　　A Adult T Cell Leukemia / Lymphoma
　　　I Mycosis fungoerosis

Skin cancer is the order of basal cell carcinoma> spinal cell carcinoma> melanoma from the larger number of patients. However, the degree of malignancy is opposite, it is the order of melanoma> squamous cell carcinoma> basal cell carcinoma.

Basal cell carcinoma (BCC)
Basal cell carcinoma is the most common cancer in the skin cancer, but it is
1. Do not cause metastasis
2. Therefore, basically not related to life
3. However, it
is characterized by recurrence without sufficient surgery .

Classification of basal cell carcinoma
Basal cell carcinoma is classified into the following 6 types depending on its shape and personality.
(1) Nodular ulcer type: Most frequent type, often with ulcers on the surface
(2) Scarring flat type: scar like in the center, embankment rising around the periphery
(3) Type: flat, large in trunk
(4) spotted scleroderma type: it looks as if the center is depressed and the skin becomes hard
(5) destruction type: mold with
developed nodular ulcer type (6) Pinkus tumor:
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Treatment of basal cell carcinoma
① Test
basal cell carcinoma does not basically transfer, so it is not necessary to examine metastasis by CT or MRI.
However, surgery (local anesthesia or general anesthesia) is required for surgery if surgery is necessary.

② Surgical
recommendation sentence: Most of the clinically well-established basal cell carcinomas are resected 3 to 10 mm apart, resulting in high complete resection rate and long term remission. (From Guidelines for Skin Malignancy Clinical Practice)
　1. For types other than the plaque scleroderma type, remove it 3 to 5 mm apart from the tumor
　2. In the case of the plaque scleroderma type, resection is performed 7 to 10 mm away from the tumor

③ For anticancer drugs, immunotherapy etc. Basal cell carcinoma is basically unnecessary because it does not cause metastasis.

④ Radiation therapy is effective for treatment of basal cell carcinoma, but it is inferior in terms of outcome when compared with surgery. If surgery is not possible, it is worth considering radiation therapy.

⑤ follow-up
Basal cell carcinoma does not cause metastasis but it is highly likely that it will recur (20% to 40% is said to recur), so if after scrub, the scratches calm down, regularly on your own Please check whether there is a recurrence (black spots are not formed, ulcer is not formed etc) (self check). If you think it is doubtful, please do it again at an early stage.

Squamoid cell carcinoma (SCC)
Skin cancer derived from cutaneous epidermal cells, other than basal cell carcinoma is called squamous cell carcinoma. Its characteristic is to recognize many preceding lesions (skin diseases that cause cancer). For example, injuries and burns, sunlight, arsenic (hidden) exposure, radiation, viral infections, sometimes congenital nevus (cutaneous malformations) and the like can lead to lesions of spinous cell cancer.

Squamous cell carcinoma is the second most common cancer in skin cancer after basal cell carcinoma, but
1. Transit when left untreated
2. Therefore, it concerns life
3. Clinically make nodules and ulcers, and when it grows there is a characteristic malodor
. It is the most common skin cancer including prodromal lesions and
features early (precursor lesion) surgery is recommended .

Precursor lesion

Solar keratosis
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It is skin aging (carcinogenesis) caused by long-term exposure to sunlight, and it is said that 20 to 40% will become spinous cell carcinoma within 5 years. Most occur on the face and hand back.
The most serious problem of the recent increase in skin cancer is this increase in sunscreen keratosis.

Bowen's disease
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In the past, relationships with arsenic (hiss) ingestion were said, but recently it has been pointed out that it is involved with virus infection. It is characterized by rustling and reddish surface. It will be transferred to spinous cell carcinoma (Bowen cancer) from several years to over ten years.

(Burn) scar
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Spinal cell carcinoma that occurred on a burn scar. If you leave burns due to burns, you may develop cancer several years to decades later.

Sebaceous nevus
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Congenital skin malformation that occurs mostly in the head. In many cases it is noticed as born hair loss (baldness). When left untreated, most of it will become cancerous by the middle age.

Treatment of squamous cell carcinoma
① When
premature lesion is examined , basically it will not spread, so there is no need to check metastasis by CT or MRI. However, in a state where the surface grows large and forms ulcers, CT, MRI, echocardiography etc. are used to examine the presence or absence of metastasis of the whole body.

② Surgical
Recommendation Text: Remove the primary tumor at least 4 mm apart. For high-risk lesions (see commentary and appendix), remove them 6 to 10 mm apart. (From Guidelines for Dermatologic Malignancy Clinical Practice)
If a lymph node metastasis is suspected by whole body examination, it will be applied for sentinel lymph node biopsy (described later) or lymph node dissection.

③ For anticancer drugs, postoperative anticancer drugs are not recommended. There are several kinds of regimens for anticancer drug treatment against spinous cell carcinoma that caused metastasis.

④ Radiation therapy is effective as a treatment for spinal cell cancer. However, if the patient is older or the tumor is huge and surgery is not possible, we will consider radiotherapy.

⑤ Progress Observation Since
spinal cancers can cause metastasis, if scratches calm down, check yourself regularly for recurrence (self-check). If you think it is doubtful, please do it again at an early stage.

Melanoma (malignant melanoma, MM, malignant melanoma)
Melanoma is one of the most unfavorable cancers among skin cancer. Melanoma patients are only about 5% of all skin cancers, but over 80% of those who die of skin cancer are melanoma patients.
This is
1. Metastasize to lymph nodes and lungs at an early stage
2. There are few effective anticancer drugs (anti-cancer drugs are less effective)
3. It depends on radiation sensitivity being low (radiotherapy is not effective)
. However, immunotherapy (monoclonal antibody, T cell recognition tumor regression antigen, gene therapy) for so-called cancer is expected to be an immunologic tumor.

Classification of melanoma
Melanoma is classified into the following four types of clinical disease depending on its shape and personality.
(1) Malignant lentiginous melanoma (LMM) : Many occur in the face (frequent in Westerners)
(2) Expanded melanoma (SSM) : Many occur in the back and arms (many in Europeans and Americans)
(3) Nodular melanoma (NM) : Many occurs in extremities and bodies
(4) Terminal melanogaster type melanoma (ALM) : Many occurs in the soles of the feet and the palm of the hand (many in yellow race)

(1) Malignant lentiginous melanoma (LMM) : LMM developed on the left cheek. The center of pigment spots is invasive carcinoma.
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(2) Superficial expanded melanoma (SSM) : A mass with reticular pigment spots is characteristic.
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(3) Nodular melanoma (NM) : a tumor without pigment spots.
a
(4) end Kuroko melanoma (ALM) : and easy to be in the sole of the foot type, about half of the Japanese of melanoma is ALM.
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Progress of melanoma (progress of stage)
Stage classification of melanoma
→ Stage 0 to IV.
→ It becomes difficult to recover as the stage progresses.
→ Determine the stage:
· Depth of tumor cellsh
- the presence or absence of ulceration of the tumor surface
(from the tumor or not and out of the blood)
of lymph node metastasis whether
the presence or absence of metastases to the-other

pT N M classification
For example, if the depth is 1 mm (pT1), there is no ulcer (a), lymph node metastasis, no transition to the other, pT1aN0M0 will be in the state of stage IA.
Stage of skin malignant melanoma (UICC, 2010 revision)


Treatment of melanoma
1) Tests
The main treatment for melanoma is surgery, anticancer drug treatment and examination for the presence or absence of metastasis. Before surgery, we will check whether there is metastasis other than skin.
Examination of the presence or absence of metastasis
1. Echocardiography: Inspect for lymph node metastasis, etc.
2. CT examination: The lungs are examined for metastasis to internal organs such as the liver (sometimes omitted in early melanoma)
3. MRI examination: Examine presence / absence of metastasis to the brain (sometimes omitted in early melanoma)
4. PET-CT examination: examination of whole body metastasis (sometimes omitted in early melanoma)
5. Inspection for surgery (local anesthesia or general anesthesia)

② Surgery
1. Depending on the degree of progress (size and depth of the tumor), presence or absence of metastasis to the regional lymph node
is judged by sentinel lymph node biopsy (see Appendix) 2. The tumor is 0.5 cm (In the case of Stage 0), 1.0 cm (in the case of Stage 1 or 2), 2.0 cm (in the case of Stage 2 to 3) separated and excised
3. In cases where a clear transition to the lymph node is suspected in the preoperative examination Do not conduct sentinel lymph node biopsy, do lymph node dissection

③
Depending on the degree of progression of anticancer drugs , treatment other than Stage 1 A basically requires immunotherapy with interferon.

④ follow-up observation
After leaving hospital, we will visit the outpatient at regular intervals (initially in about 1 to 2 weeks, after that, depending on the degree of progress, every 3 months, every 6 months, after 12 months) I will check for melanoma recurrence / metastasis.
Specifically, we do image examination such as consultation, echo, CT and blood sampling test.
About sentinel lymph nodes
Melanoma in most cases causes lymphatic metastasis. In other words, cancer cells do not jump suddenly around the body, but
1. Cancer cells enter the lymph duct of the skin
2. It flows to the belonging lymph node, and it grows there
3. Then it transfers to the surrounding lymph nodes and
so on.
In other words, in the early days, the lymph nodes that migrate are considered to be limited to 1 or 2 lymph nodes.
This lymph node that initially transfers is called sentinel lymph node. A sentinel is a sentry (guard).
In other words, if the sentinel lymph node is excised and there is no cancer cell metastasis there, it is considered to be an early melanoma that has not yet metastasized.
This procedure to acquire the sentinel lymph node and to confirm that there are no cancer cells is called sentinel lymph node biopsy.
In recent years, the usefulness of sentinel lymph node biopsy has been confirmed with melanoma and breast cancer, and it is applied for insurance.

Extramammary Paget's disease
Out-of-breast Paget's disease was previously rare skin cancer, but it is one of skin cancers that has increased markedly with the aging of the population in recent years. It is said that there are many racial differences, and it is said to be more in oriental series such as Japanese as compared with Westerners. Extra-breast Paget's disease is classified as in situ (cancer in the epidermis) as skin cancer, but when it progresses it becomes extra-breast Paget Cancer (adenocarcinoma), death by lymph node metastasis or distant metastasis Sometimes.
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1. Most occur in the genital region, rarely also in the axilla and the navel umbilical cord
2. Because of erythema occurring in the vulva, many cases are misunderstood as ringworm (indigestion, tamugi) and diaper rash
3. Apocrine sweat gland-derived adenocarcinoma is thought to be
4. Although it is cancer in the epidermis, cancer cells also exist in the epidermis of the hair follicle (pore) part, so if the hair follicle part is not completely resected, recurrence · Metastasis
5. The boundary of cancer is often unclear
6. Since cancer cells have various hormone receptors, hormonal therapy and molecular targeted drugs are effective
7. Although radiation sensitivity is good , It
is characterized by not being able to hope for complete cure by radiation therapy .

Treatment of extramammary paget
(1) Examination
of the presence or absence of examination transfer
1. Echo examination: examination of lymph node metastasis etc.
2. CT examination: examination of the presence of metastasis to the internal organs such as lung and liver (done with advanced breast Pudget cancer)
3. PET-CT examination: examination of whole body metastasis (advanced breast-spread breast cancer is prone to bone metastasis)
4. examination for surgery (local anesthesia or general anesthesia)
5. mapping biopsy: breast In outside Paget 's disease, the boundary of the tumor is often unclear, and it is difficult to judge the range of cancer only with macroscopic findings. In that case, pathological examination of 6 to 12 places of skin 1 cm away from the range of cancer clearly confirms the presence or absence of cancer cells in advance

② Surgical
operation scope: Recommendation sentence (From skin malignancy clinical practice guidelines)
There is no highly reliable evidence on the cut-out area (resection margin) on the skin side necessary to completely excise the primary lesion of extravascular Paget's disease, For a part where the macroscopic boundary of the lesion is clear or a part determined to be negative by mapping biopsy, an ablation margin of about 1 cm is considered good. For other unclear border areas, a margin of about 3 cm is recommended.
Sentinel lymph node biopsy: If you have been diagnosed as extramammary Pudget cancer by preoperative examination, sentinel lymph node biopsy (described above) will be performed.
Lymph node dissection: If clear lymph node metastasis is observed in preoperative examination, lymph node dissection is performed.

③ There are several types of anti-cancer drug regimens and molecular targeted drugs in case of anticancer drug transfer.

④ follow-up observation
After discharge, we will visit the outpatient at regular intervals (initially every 3 months, every 6 months, every 12 months) and check for recurrence / metastasis of extramammary Paget's disease.
Specifically, we do image examination such as consultation, echo, CT and blood sampling test.

Cervical cancer
Cervical cancer is said to be caused by HPV (human papillomavirus) infection, it develops through cervical dysplasia and intraepithelial carcinoma, and in recent years it tends to be young. In our hospital, we are conducting a precision examination of cervical cancer screening examination registration medical institution, we will also conduct a precision examination of those who have been scrutinized by mass screening or facility screening. For premalignant lesions such as dysplasia and intraepithelial cancers, 70 to 80 cases of laser therapy and cone resection are performed per year, especially for laser therapy day treatment. For invasive cancer, we perform diffuse total hysterectomy and radiotherapy.

Uterine body cancer
Traumatic bleeding is the main symptom and diabetes, hypertension, obesity, etc. are also called risk factors. As with ovarian cancer, it is on an increasing trend in recent years. Treatment is surgical therapy, which is standard treatment, and chemotherapy and radiotherapy may be used together after surgery depending on the condition of the removed tissue.

Ovarian cancer
There are no obvious symptoms such as bleeding, and it is a disease that is often found in examination and swelling of stomach. It is on an increasing trend in recent years as well as uterine body cancer. The principle of treatment is surgery and chemotherapy after that, chemotherapy may be preceded in some cases.

What is prostate cancer
First of all, the prostate is under the bladder, shaped like the pointed one of chestnut faces towards the penis, and the urethra is lodged in the interior leading to the urethra in the penis. The function of the prostate secretes the liquid component of semen and helps sperm movement.


1
The prostate is an organ only in men, it does not exist in women. It is embryologically equivalent to a woman's uterus. Cancer that occurs in this prostate is called prostate cancer.

Epidemiology
I will show male cancer incidence in Japan and future prospects.
2
I can see that prostate cancer has increased markedly. In 2020, it is estimated that it will be the second largest affected number after lung cancer. The background of the increase is related to the fact that as society ages, the dietary habits become westernized, and the diagnosis technology advances, many things have come to be discovered.
I will show you the incidence of prostate cancer by age.
It turns out that prostate cancer is a typical elderly cancer that increases with age.

Diagnosis
As a test and diagnosis of prostate cancer, we conduct tumor marker, PSA examination, rectal examination, ultrasound examination by blood test as examination to find a person with cancer possibility. If you suspect cancer here, you will do a prostate biopsy and tissue examination to confirm cancer, but before you undergo a biopsy to see where in the prostate cancer is likely to occur, a tomogram called MRI I will take. When cancer is confirmed, we will examine bone metastasis called CT tomography and bone scintigraphy to investigate the spread of cancer.

3
PSA test is a convenient method of finding prostate cancer by blood test. "Prostate" "Unique" "Antigen" English initial letters were attached. PSA is a type of protein made in the prostate and exists in the blood even when it is healthy but it is used as a tumor marker for prostate cancer because a large amount of PSA flows out into the blood when prostate cancer develops It began.

4.
The relationship between PSA value and prostate cancer detection rate, the higher the PSA value, the higher the likelihood of prostate cancer. If the PSA value is higher than 4, prostate cancer is suspected, 10 in 1/3 and 1/20 in half, and in more than 50 in prostate cancer is found in most people. Also, the possibility of metastasis will also come if you get 50 or more.

5.
If prostate cancer is suspected, a tissue examination called prostate biopsy will be conducted, but under anesthesia, ultrasound is inserted from the anus, a fine needle is stabbed while observing the image, about 10 prostate tissues are collected To do. Then examine with a microscope for cancer. Because I do anesthesia, there is hardly any pain.

6
Although it is an image examination, in MRI, it is investigated whether there is spread to the cancer place and surroundings, in CT, whether the lymph nodes and other organs have metastasis.

7
Bone scintigraph examines the presence or absence of bone metastasis. The place where the transition exists is blackened. With X-rays, the place where the transition exists is whiter than other places.

8
Treatment
Treatment for prostate cancer can be broadly divided into treatment to the whole body and treatment to the prostate. There is hormonal therapy for the treatment of the whole body, but there are treatments of medication treatment and removal of the testicles. Treatment for the prostate, the surgical treatment will remove all the prostate. As radiation treatment, there are methods of irradiating from outside the body and irradiation from the inside of the body.

9
Hormonal therapy
Male hormones promote proliferation of cancer cells in the prostate. Hormonal therapy is the reverse of this. Prostate cancer growth is suppressed and the cancer is reduced as a result of removing the testicles or by taking medicine to prevent the transition of the nutritional source, androgen, to prostate cancer. In medicine, there are drinking drugs that suppress the actions of male hormones, and injection medicines that suppress the secretion of male hormones. If the effect of hormonal therapy is lost, treatment of anticancer drugs is necessary.


Surgical treatment
Surgery is called total prostatectomy. Laparotomy was a standard procedure in the operation to remove the seminal vesicle attached with the prostate, and gradually moved to laparoscopic surgery


10
Laparoscopic surgery is a surgical operation performed by observing the endoscope image with inflating carbon dioxide and carbon dioxide in the stomach like this. Insert the forceps and the endoscope with the instrument called a trocar as a passage

11
In laparoscopic surgery, the surgeon stands on the patient's left side, assistant, photographer on the right side. Then surgery is performed while watching the monitor on the foot side

12
It is the first advantage of laparoscopic surgery for prostate cancer, but it is not only small and inconspicuous but also has a mild postoperative pain and rehabilitation faster. Although it is surgical wound, laparotomy surgery enters about 20 cm incision in the lower abdomen, but in laparoscopy there are only 5 small scratches from 5 to 12 mm

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The second advantage is that the pressure due to pneumoperitoneum results in a very small amount of bleeding compared to laparotomy, requiring transfusion is rare. As a third advantage, because of the enlarged visual field through the endoscope, it is expected to improve cancer cancers and postoperative quality of life (urinary incontinence, deterioration of sexual function) by delicate surgery. The probability of resection is the probability of cancer at the end of the resected prostate, but in our hospital it is also lower than laparotomy with laparoscopic surgery, the rate of recurrence is small and laparoscopic surgery is radical It is clear that it is excellent in the ability to cure cancer. As for surgical operation time, it is technically difficult compared to laparotomy surgery, so it is said that surgery is long, but our hospital has no difference from laparotomy with 2 hours to 2 and a half hours (median 2 hours 25 minutes) .


Radiation treatment
It is a treatment method which irradiates radiation and kills cancer cells. Since the burden on the body is less than surgery, treatment is possible for elderly people and people who have heavy medical history. There are two methods of irradiation from the outside of the body and irradiation from inside the body. A therapy that radiates radiation to the prostate from outside the body keeps a mark on the skin and irradiates the radiation there. One irradiation time is 5 minutes, there is no pain due to irradiation. Therefore, even outpatient treatment is possible. Usually, I continue to irradiate 5 days a week once a day for 7 weeks. Inflammation to the place you see is seen as a complication during treatment. If inflammation of the skin or inflammation of the bladder occurs, urination pain and frequent urine are seen, and diarrhea and anal pain are seen when the rectum is inflamed. There is bleeding as a complication of late period for a while after treatment, hematuria and blood stool may be seen. However, due to the progress of instruments, complications are decreasing considerably. Irradiation from the body is a new treatment that embeds the source of radiation inside the prostate and kills cancer cells. Insert the source of radiation while watching with ultrasound. The time is about a few hours. It is a short period, but hospitalization is necessary. If you have cancer at a very early stage, you can expect the same therapeutic effect as surgery.