Where are glands located in the human body. How do different types of glands function. What are the main types of salivary glands. How are sweat glands distributed across the skin. Why do lymph nodes swell.

The Major Salivary Glands: Function and Location

The human body houses numerous glands, each serving specific functions. Among these, the salivary glands play a crucial role in our daily lives. They produce saliva, which aids in digestion, swallowing, and maintaining oral health. But where exactly are these glands located?

There are three pairs of major salivary glands:

• Parotid glands
• Submandibular glands
• Sublingual glands

Parotid Glands: The Largest Salivary Producers

The parotid glands, the largest of the salivary glands, are situated just in front of the ears. They consist of two lobes: the superficial lobe and the deep lobe. Between these lobes runs the facial nerve, which controls various facial expressions. The parotid glands secrete saliva into the mouth through a duct near the upper second molar.

Are parotid glands susceptible to tumors? Indeed, they can develop tumors, and the surgical removal of such growths is called a parotidectomy. This procedure requires extreme precision due to the proximity of critical structures like the facial nerve and the external carotid artery.

Submandibular Glands: The Walnut-Sized Saliva Producers

Located below the jaw, the submandibular glands are about the size of a walnut. Like the parotid glands, they also have superficial and deep lobes. These glands release saliva under the tongue.

Several important structures surround the submandibular glands, including:

• The marginal mandibular nerve (controls smiling)
• The platysma muscle (moves the lower lip)
• The lingual nerve (provides sensation to the tongue)
• The hypoglossal nerve (enables tongue movement for speech and swallowing)

Sublingual Glands: The Smallest of the Major Salivary Glands

The sublingual glands, shaped like almonds, are found under the floor of the mouth and below either side of the tongue. They are the smallest of the major salivary glands and rarely develop tumors. However, when tumors do occur in these glands, they require specialized surgical intervention.

Minor Salivary Glands: The Microscopic Saliva Producers

In addition to the major salivary glands, the human body contains hundreds of minor salivary glands. These microscopic structures are scattered throughout the mouth and aerodigestive tract. They are primarily found in the lining of the lips, tongue, roof of the mouth, inside the cheeks, nose, sinuses, and larynx.

Do minor salivary glands pose a cancer risk? While tumors in minor salivary glands are extremely rare, they are more likely to be cancerous than benign. When cancers do develop in these glands, they most commonly originate in the roof of the mouth.

Sweat Glands: The Body’s Natural Cooling System

Sweat glands are another crucial type of gland found in the human body. They are appendages of the integument and play a vital role in thermoregulation. There are two main types of sweat glands:

• Eccrine sweat glands
• Apocrine sweat glands

Eccrine Sweat Glands: Widespread Cooling Agents

Eccrine sweat glands are simple, coiled, tubular glands present throughout the body. They are most numerous on the soles of the feet. These glands are found in thin skin, which covers most of the body and also contains hair follicles, hair arrector muscles, and sebaceous glands.

Are there areas of the body without sweat glands? Yes, certain parts of the body lack sweat glands, including:

• The vermillion border of the lips
• External ear canal
• Nail beds
• Glans penis
• Clitoris
• Labia minora

Apocrine Sweat Glands: The Odoriferous Glands

Apocrine sweat glands, also known as odoriferous sweat glands, are responsible for producing malodorous perspiration. These glands are found in specific areas of the body and become active during puberty.

Where are apocrine sweat glands typically located? They are primarily found in areas with dense hair growth, such as:

• Armpits
• Groin area
• Around the nipples

Lymph Nodes: The Body’s Filtration System

While not glands in the traditional sense, lymph nodes are often referred to as glands due to their appearance and function. These small, bean-shaped structures are part of the lymphatic system and play a crucial role in the body’s immune defense.

Lymph nodes are located throughout the body, with major clusters found in the:

• Neck
• Armpits
• Groin
• Chest
• Abdomen

Why do lymph nodes swell? Lymph nodes can become swollen when they are actively fighting infection or inflammation in the body. This swelling is often a sign that the immune system is working to combat pathogens or abnormal cells.

The Importance of Glands in Human Physiology

Glands play a vital role in maintaining various bodily functions. From producing saliva for digestion to regulating body temperature through sweat production, these structures are essential for our overall health and well-being.

How do glands contribute to homeostasis? Glands help maintain the body’s internal balance by:

• Secreting hormones that regulate metabolism
• Producing fluids that aid in digestion and lubrication
• Assisting in temperature regulation
• Supporting the immune system

Glandular Disorders: When Things Go Wrong

Like any part of the body, glands can be subject to various disorders and diseases. Understanding these conditions is crucial for early detection and treatment.

Salivary Gland Disorders

Salivary glands can be affected by several conditions, including:

• Sialadenitis (inflammation of the salivary glands)
• Salivary stones (calcified deposits that block salivary ducts)
• Tumors (both benign and malignant)
• Sjögren’s syndrome (an autoimmune disorder affecting salivary and lacrimal glands)

Sweat Gland Disorders

Disorders of the sweat glands can lead to various symptoms and conditions:

• Hyperhidrosis (excessive sweating)
• Anhidrosis (inability to sweat)
• Bromhidrosis (excessive body odor)
• Hidradenitis suppurativa (chronic inflammation of sweat glands)

Lymph Node Disorders

Lymph nodes can be affected by various conditions, including:

• Lymphadenitis (inflammation of lymph nodes)
• Lymphoma (cancer of the lymphatic system)
• Metastatic cancer (cancer that has spread from other parts of the body)

Diagnostic Techniques for Glandular Issues

When glandular problems are suspected, various diagnostic techniques can be employed to identify the underlying issue.

Imaging Studies

Several imaging techniques can be used to visualize glands and detect abnormalities:

• Ultrasound
• CT scan
• MRI
• Sialography (for salivary glands)
• Lymphoscintigraphy (for lymph nodes)

Biopsy Procedures

In some cases, a biopsy may be necessary to definitively diagnose glandular conditions. Types of biopsies include:

• Fine-needle aspiration
• Core needle biopsy
• Incisional biopsy
• Excisional biopsy

Blood Tests and Other Laboratory Studies

Various blood tests and other laboratory studies can provide valuable information about glandular function and potential disorders:

• Hormone level tests
• Antibody tests (for autoimmune disorders)
• Sweat chloride test (for cystic fibrosis)
• Salivary flow rate tests

Treatment Approaches for Glandular Disorders

The treatment of glandular disorders varies depending on the specific condition and its severity. Some common treatment approaches include:

Medical Management

Many glandular disorders can be managed with medications:

• Antibiotics for bacterial infections
• Anti-inflammatory drugs for reducing swelling and pain
• Hormone replacement therapy for endocrine gland disorders
• Immunosuppressants for autoimmune conditions

Surgical Interventions

In some cases, surgery may be necessary to treat glandular disorders:

• Removal of tumors or affected glands
• Drainage of abscesses
• Reconstruction of damaged ducts
• Lymph node dissection for cancer staging

Lifestyle Modifications and Supportive Care

Certain lifestyle changes and supportive measures can help manage glandular disorders:

• Dietary adjustments
• Stress reduction techniques
• Proper hydration
• Use of specialized skin care products
• Regular exercise and maintaining a healthy weight

Understanding the location and function of various glands in the body is crucial for maintaining overall health and recognizing potential issues early. From the salivary glands in our mouths to the sweat glands distributed across our skin, these structures play vital roles in numerous physiological processes. By being aware of the signs and symptoms of glandular disorders, individuals can seek timely medical attention and receive appropriate treatment when necessary.

Salivary Glands Anatomy | Memorial Sloan Kettering Cancer Center

If you have been diagnosed with salivary gland cancer, knowing a little bit about the salivary glands will help you talk to your doctor about surgery or other aspects of your care.

The salivary glands make saliva and empty it into your mouth through openings called ducts. Saliva helps with swallowing and chewing. It can also help prevent infections from developing in your mouth or throat.

There are two types of salivary glands:

1. the major salivary glands

2. the minor salivary glands

Major Salivary Glands

The major salivary glands are the largest and most important salivary glands. They produce most of the saliva in your mouth.

There are three pairs of major salivary glands: the parotid glands, the submandibular glands, and the sublingual glands.

Parotid Glands

The parotid glands are the largest salivary glands. They are located just in front of the ears. The saliva produced in these glands is secreted into the mouth from a duct near your upper second molar.

Each parotid gland has two parts, or lobes: the superficial lobe and the deep lobe. Between the two lobes is the facial nerve. The facial nerve is important because it controls your ability to close your eyes, raise your eyebrows, and smile.

Other critical structures near the parotid glands include the external carotid artery, which is a major supplier of blood to the head and neck region, and the retromandibular vein, a branch of the jugular vein.

Surgery to treat a parotid gland tumor is called a parotidectomy. It requires great precision because the surgeon has to locate and operate around these important structures.

Learn more about parotidectomy.

Submandibular Glands

About the size of a walnut, the submandibular glands are located below the jaw. The saliva produced in these glands is secreted into the mouth from under the tongue.

Like the parotid glands, the submandibular glands have two parts called the superficial lobe and the deep lobe. Nearby structures include:

• the marginal mandibular nerve, which helps you smile

• the platysma muscle, which helps you move your lower lip

• the lingual nerve, which allows sensation in your tongue

• the hypoglossal nerve, which allows movement in the part of your tongue that helps with speech and swallowing

During treatment, we protect all of these important structures to avoid causing damage.

Learn more about submandibular gland cancer surgery.

Sublingual Glands

The sublingual glands are the smallest of the major salivary glands. These almond-shaped structures are located under the floor of the mouth and below either side of the tongue.

Tumors starting in these glands are particularly rare.

Learn more about surgery for cancers that begin in the sublingual glands.

Minor Salivary Glands

There are hundreds of minor salivary glands throughout the mouth and the aerodigestive tract. Unlike the major salivary glands, these glands are too small to be seen without a microscope. Most are found in the lining of the lips, the tongue, and the roof of the mouth, as well as inside the cheeks, nose, sinuses, and larynx (voice box).

Minor salivary gland tumors are extremely rare. However, they are more likely to be cancerous than benign. Cancers of the minor salivary glands most often begin in the roof of the mouth.

Anatomy, Skin Sweat Glands – StatPearls

Introduction

Sweat glands are appendages of the integument. There are eccrine and apocrine sweat glands. They differ in embryology, distribution, and function. Eccrine sweat glands are simple, coiled, tubular glands present throughout the body, most numerously on the soles of the feet. Thin skin covers most of the body and contains sweat glands, in addition to hair follicles, hair arrector muscles, and sebaceous glands. Exceptions are the vermillion border of the lips, external ear canal, nail beds, glans penis, clitoris, and labia minora, which do not contain sweat glands. The thick skin covering the palms of hands and soles of feet lack all skin appendages except sweat glands.

Apocrine sweat glands, also referred to as odoriferous sweat glands, are known for producing malodorous perspiration. They are large, branched glands, mostly confined to the axillary and perineal regions, including the perianal region, labia majora in women, and the scrotum and prepuce in men. Apocrine sweat glands are also present in the nipples and areolar tissue surrounding the nipples. [1][2][3]

Structure and Function

Eccrine sweat glands serve a thermoregulatory function via evaporative heat loss. When the internal temperature of the body rises, sweat glands release water to the skin surface. There, it quickly evaporates, subsequently cooling the skin and blood beneath.; this is the most effective means of thermoregulation in humans. Eccrine sweat glands also participate in ion and nitrogenous waste excretion. In response to emotional or thermal stimuli, sweat glands can produce at least 500 mL to 750 mL in a day.[4][5][6]

Apocrine sweat glands start to function at puberty under the stimulation of sex hormones. They are associated with hair follicles in the groin and axillary region. The viscous, protein-rich product is initially odorless but may develop an odor after exposure to bacteria. Modified apocrine sweat glands include the wax-producing ceruminous glands of the external auditory meatus, the Moll glands found at the free margins of the eyelids, and the mammary glands of the breast.

Sweat glands play a regenerative role in skin damage. In second-degree cutaneous burns, which extend into the reticular dermis, regeneration of the epithelium occurs via skin appendages, including hair follicles, sebaceous glands, and sweat glands. The epithelial cells surrounding these appendages produce more epithelial cells that progress to form a new epithelium, a process that can take 1 to 3 weeks.[7]

Embryology

Both eccrine and apocrine sweat glands originate from the epidermis. Eccrine glands begin as epithelial cellular buds that grow into the underlying mesenchyme. The glandular secretory components then form by elongation of the gland and coiling of the ends. Epithelial attachments of the developing gland create primordial sweat ducts. Finally, the central cells degenerate to form the lumen of the sweat duct. Cells on the periphery of the gland differentiate into secretory and myoepithelial cells. Eccrine sweat glands first appear on the palms and soles during the fourth month of gestation; they become functional soon after birth.

On the other hand, apocrine sweat glands do not function until hormonal stimulation during puberty. Their ducts do not open onto the skin surface; this is because these glands originate from the stratum germinativum of the epidermis. Therefore, down-growth does not produce a duct open to the skin surface. Instead, the ducts open into hair follicles, and sweat is released through the hair opening in the skin. The canals of these apocrine sweat gland ducts enter the hair follicle superficial to the sebaceous gland, which results in a protein-rich sweat rather than the watery sweat associated with eccrine sweat glands.

Blood Supply and Lymphatics

Sweat glands, along with all other skin appendages, receive blood supply from cutaneous perforators of underlying source vessels. The perforators may branch directly from the source as septocutaneous or fasciocutaneous perforators or from muscular branches as musculocutaneous perforators. Once these perforators reach the skin, they form extensive networks called dermal and subdermal plexuses. Interconnections between these plexuses form via connecting vessels that run perpendicular to the skin surface, creating a continuous vascular plexus in the skin.

Lymphatic drainage parallels the blood supply, starting with blind-ended lymphatic capillaries in the dermal papillae. These drain into dermal and deep dermal plexuses that eventually coalesce to form larger lymphatic vessels.

Nerves

Eccrine sweat glands receive sympathetic innervation via cholinergic fibers that send impulses in response to changes in core body temperature. The thermoregulatory center of the hypothalamus mediates sympathetic innervation to the sweat glands. A short preganglionic cholinergic fiber originates from the thoracolumbar region of the spinal cord synapses with the postganglionic neuron via nicotinic acetylcholine. The postganglionic fiber releases acetylcholine, which differs from all other sympathetic postganglionic fibers that release norepinephrine. Cholinergic stimulation of muscarinic receptors induces sweating. Apocrine sweat glands receive adrenergic sympathetic innervation. Because apocrine sweat glands respond to norepinephrine, they are involved in emotional sweating due to stress, fear, pain, and sexual stimulation.

Muscles

Myoepithelial cells are thin, spindle-shaped cells that show features of both epithelium and smooth muscle. These cells are found in the outer layer of eccrine sweat glands and contract to help expel sweat from the glands.[8]

Clinical Significance

Given the role of sweat glands in thermoregulation, both eccrine and apocrine glands have correlations with various diseases ranging from mild and discomforting to life-threatening. Disorders of sweating can have emotional, social, and professional implications.[9][10][11]

Hyperhydrosis is the excessive excretion of sweat above the quantity needed for thermoregulation. It can be idiopathic or due to another endocrine, neurologic, cardiovascular, neoplastic, infectious disorders, or secondary to intake of medication. Treatment options include topical medications, oral medications, surgical procedures, or botulinum toxin injection. Bromhidrosis is a similar disorder that presents with excessive malodorous perspiration. It can involve either apocrine or eccrine sweat glands; apocrine bromhidrosis tends to develop after puberty, while eccrine bromhidrosis may develop at any age. It is caused by excessive perspiration that secondarily becomes malodorous by the bacterial breakdown. Because poor hygiene most often aggravates bromhidrosis, an effective treatment strategy includes improving personal hygiene. Surgical approaches, antibacterial agents, and antiperspirants are treatment options as well.[12][13][14]

The sweat glands of patients with cystic fibrosis (CF) are ineffective at reabsorbing salt, which has significant implications. CF is an autosomal recessive congenital disease in which the cystic fibrosis transmembrane regulator (CFTR) that normally inhabits the apical membrane of epithelial cells is defective. CFTR is a transmembrane protein that functions as part of a cAMP-regulated chloride ion channel; in normal sweat glands, the ductal epithelium reabsorbs sodium and chloride ions in response to aldosterone so that sweat is hypotonic. In CF patients, the sweat glands fail to reabsorb chloride, affecting sodium reabsorption resulting in salty sweat and an inability of sweat glands to participate in ion regulation. Disruption of the same membrane proteins in the respiratory and gastrointestinal epithelium results in accumulations of thick mucus.[15]

Another autosomal recessive congenital disorder that affects sweat glands is lamellar ichthyosis. Infants with this condition present with persistent scaling skin and impaired growth of hair are possible. Impairment of sweat gland development often causes infants to suffer in severely hot weather as they cannot maintain thermoregulation through sweating. General defectiveness of the skin barrier function can also lead to dehydration and increased susceptibility to infections. [16]

Hidradenitis suppurativa is a chronic, inflammatory disease affecting the hair follicles. It is a multifactorial disease where environmental factors and genetics play a significant role. This ailment has classically been associated with the apocrine sweat glands as it manifests after puberty in the apocrine-gland concentrated areas of the body. However, the pathophysiology involves follicular occlusion rather than an apocrine disorder, as previously thought. Patients often present with tender, suppurative subcutaneous nodules, and abscesses in the axillae and groin. The lesions can form sinus tracts and extensive scarring.[17]

Hypohydrotic ectodermal dysplasia is a disease characterized by hypotrichosis (decreased growth of scalp and body hair), hypodontia (congenital absence of teeth), and hypohidrosis. This disease is inherited through an X-linked recessive mode of inheritance that is normally seen in males. The term “hypohidrotic” indicates impairment in the ability to perspire. Patients born with hypohidrotic ectodermal dysplasia have difficulty regulating body temperature and, therefore, must learn to modify their environment to control exposure to heat.[18] 

References

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Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol. 2019 Sep;81(3):657-666. [PubMed: 30710604]

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Fulton EH, Kaley JR, Gardner JM. Skin Adnexal Tumors in Plain Language: A Practical Approach for the General Surgical Pathologist. Arch Pathol Lab Med. 2019 Jul;143(7):832-851. [PubMed: 30638401]

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Grubbs H, Nassereddin A, Morrison M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 8, 2021. Embryology, Hair. [PubMed: 30521215]

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Urso B, Lu KB, Khachemoune A. Axillary manifestations of dermatologic diseases: a focused review. Acta Dermatovenerol Alp Pannonica Adriat. 2018 Dec;27(4):185-191. [PubMed: 30564831]

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Kabashima K, Honda T, Ginhoux F, Egawa G. The immunological anatomy of the skin. Nat Rev Immunol. 2019 Jan;19(1):19-30. [PubMed: 30429578]

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Rittié L, Sachs DL, Orringer JS, Voorhees JJ, Fisher GJ. Eccrine sweat glands are major contributors to reepithelialization of human wounds. Am J Pathol. 2013 Jan;182(1):163-71. [PMC free article: PMC3538027] [PubMed: 23159944]

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Balachander N, Masthan KM, Babu NA, Anbazhagan V. Myoepithelial cells in pathology. J Pharm Bioallied Sci. 2015 Apr;7(Suppl 1):S190-3. [PMC free article: PMC4439666] [PubMed: 26015706]

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Gagnon D, Crandall CG. Sweating as a heat loss thermoeffector. Handb Clin Neurol. 2018;156:211-232. [PubMed: 30454591]

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Murota H, Yamaga K, Ono E, Katayama I. Sweat in the pathogenesis of atopic dermatitis. Allergol Int. 2018 Oct;67(4):455-459. [PubMed: 30082151]

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Benzecry V, Grancini A, Guanziroli E, Nazzaro G, Barbareschi M, Marzano AV, Muratori S, Veraldi S. Hidradenitis suppurativa/acne inversa: a prospective bacteriological study and review of the literature. G Ital Dermatol Venereol. 2020 Aug;155(4):459-463. [PubMed: 29683279]

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Wadhawa S, Agrawal S, Chaudhary M, Sharma S. Hyperhidrosis Prevalence: A Disease Underreported by Patients and Underdiagnosed by Physicians. Indian Dermatol Online J. 2019 Nov-Dec;10(6):676-681. [PMC free article: PMC6859754] [PubMed: 31807447]

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Wang Y, Sun P, Leng X, Dong Z, Bi M, Chen Z. A new type of surgery for the treatment of bromhidrosis. Medicine (Baltimore). 2019 May;98(22):e15865. [PMC free article: PMC6708810] [PubMed: 31145340]

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Perera E, Sinclair R. Hyperhidrosis and bromhidrosis — a guide to assessment and management. Aust Fam Physician. 2013 May;42(5):266-9. [PubMed: 23781522]

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Reddy MM, Stutts MJ. Status of fluid and electrolyte absorption in cystic fibrosis. Cold Spring Harb Perspect Med. 2013 Jan 01;3(1):a009555. [PMC free article: PMC3530040] [PubMed: 23284077]

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Chao K, Aleshin M, Goldstein Z, Worswick S, Hogeling M. Lamellar ichthyosis in a female neonate without a collodion membrane. Dermatol Online J. 2018 Feb 15;24(2) [PubMed: 29630152]

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Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N, Fabbrocini G, Monfrecola G. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-115. [PMC free article: PMC5402905] [PubMed: 28458570]

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Paramkusam G, Meduri V, Nadendla LK, Shetty N. Hereditary hypohidrotic ectodermal dysplasia: report of a rare case. J Clin Diagn Res. 2013 Sep;7(9):2074-5. [PMC free article: PMC3809686] [PubMed: 24179947]

Salivary Glands

Where Are Your Salivary Glands?

The glands are found in and around your mouth and throat. We call the major salivary glands the parotid, submandibular, and sublingual glands.

They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth.

Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.

As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.

What Causes Salivary Gland Problems?

Salivary gland problems that cause clinical symptoms include:

Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed.

It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms.

Infection: The most common salivary gland infection in children is mumps, which involves the parotid glands. While this is most common in children who have not been immunized, it can occur in adults. However, if an adult has swelling in the area of the parotid gland only on one side, it is more likely due to an obstruction or a tumor.

Infections also occur because of ductal obstruction or sluggish flow of saliva because the mouth has abundant bacteria.

You may have a secondary infection of salivary glands from nearby lymph nodes. These lymph nodes are the structures in the upper neck that often become tender during a common sore throat. In fact, many of these lymph nodes are actually located on, within, and deep in the substance of the parotid gland or near the submandibular glands. When these lymph nodes enlarge through infection, you may have a red, painful swelling in the area of the parotid or submandibular glands. Lymph nodes also enlarge due to tumors and inflammation.

Tumors: Primary benign and malignant salivary gland tumors usually show up as painless enlargements of these glands. Tumors rarely involve more than one gland and are detected as a growth in the parotid, submandibular area, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head and neck surgeon should check these enlargements.

Malignant tumors of the major salivary glands can grow quickly, may be painful, and can cause loss of movement of part or all of the affected side of the face. These symptoms should be immediately investigated.

Other Disorders: Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjögren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis. Diabetes may cause enlargement of the salivary glands, especially the parotid glands. Alcoholics may have salivary gland swelling, usually on both sides.

How Does Your Doctor Make the Diagnosis?

Diagnosis of salivary gland disease depends on the careful taking of your history, a physical examination, and laboratory tests.

If your doctor suspects an obstruction of the major salivary glands, it may be necessary to anesthetize the opening of the salivary ducts in the mouth, and probe and dilate the duct to help an obstructive stone pass. Before these procedures, dental x-rays may show where the calcified stones are located.

If a mass is found in the salivary gland, it is helpful to obtain a CT scan or a MRI (magnetic resonance imaging). Sometimes, a fine needle aspiration biopsy in the doctor’s office is helpful. Rarely, dye will be injected through the parotid duct before an x-ray of the gland is taken (a sialogram).

A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases.

How Is Salivary Gland Disease Treated?

Treatment of salivary diseases falls into two categories: medical and surgical. Selection of treatment depends on the nature of the problem. If it is due to systemic diseases (diseases that involve the whole body, not one isolated area), then the underlying problem must be treated. This may require consulting with other specialists. If the disease process relates to salivary gland obstruction and subsequent infection, your doctor will recommend increased fluid intake and may prescribe antibiotics. Sometimes an instrument will be used to open blocked ducts.

If a mass has developed within the salivary gland, removal of the mass may be recommended. Most masses in the parotid gland area are benign (noncancerous). When surgery is necessary, great care must be taken to avoid damage to the facial nerve within this gland that moves the muscles face including the mouth and eye. When malignant masses are in the parotid gland, it may be possible to surgically remove them and preserve most of the facial nerve. Radiation treatment is often recommended after surgery. This is typically administered four to six weeks after the surgical procedure to allow adequate healing before irradiation.

The same general principles apply to masses in the submandibular area or in the minor salivary glands within the mouth and upper throat. Benign diseases are best treated by conservative measures or surgery, whereas malignant diseases may require surgery and postoperative irradiation. If the lump in the vicinity of a salivary gland is a lymph node that has become enlarged due to cancer from another site, then obviously a different treatment plan will be needed. An otolaryngologist-head and neck surgeon can effectively direct treatment.

Removal of a salivary gland does not produce a dry mouth, called xerostomia. However, radiation therapy to the mouth can cause the unpleasant symptoms associated with reduced salivary flow. Your doctor can prescribe medication or other conservative treatments that may reduce the dryness in these instances.

Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. Treatment is readily managed by an otolaryngologist-head and neck surgeon with experience in this area.

Adrenal Conditions: What are Adrenal Glands? Symptoms, Treatment, Diagnosis

What are Adrenal Glands?

Adrenal glands are triangular-shaped glands located on top of the kidneys. The adrenal glands are an endocrine gland, which means they make hormone.

Adrenal glands make:

• Cortisol
• Aldosterone
• Sex Hormones
• Epinephrine and norepinephrine (aka adrenaline and noradrenaline)

Pheochromocytoma and Paraganglioma Adrenal Surgery

Adrenal Nodules, Adrenal Masses, Thickened Adrenal Glands, and Adrenal “Incidentalomas”

When patients have images taken of their abdomen with a CT scan or MRI, it is very common to see an adrenal nodule. In fact, we see adrenal nodules in 4 out of every 100 people that get a CT or MRI. An adrenal nodule is when normal tissue grows into a lump. Most incidental adrenal nodules do not cause health problems. However, they need to be evaluated for signs of excess hormone production or suspicion of malignancy. Because we often find adrenal nodules or masses when we were not looking for them, doctors will informally call these “incidentalomas.”

If you discover that you have an adrenal nodule, it is important to have a proper workup. Phone: 310-267-7838

Request An Appointment

Work-up of Adrenal Nodules: Functional or Non-Functional?

At UCLA Endocrine Center, we start by performing a comprehensive review of a patient’s history and thorough physical exam. We are looking for signs that the adrenal nodule may be making too much hormone. Most adrenals nodules do not produce hormones.

When nodules make hormone, doctors refer to them as “functional.” When nodules do not make hormone, they are “non-functional.” 

85% of adrenal nodules are non-functional
15% of adrenal nodules are functional
          9% make the stress hormone cortisol
          4% make epinephrine and norepinephrine
          2% make aldosterone
          <1% make sex hormones

Sometimes patients feel completely normal despite making excess hormones. That is why we will typically perform regular lab testing for all the mentioned hormones when an adrenal tumor is found. Sometimes, this involves blood tests. Sometimes, this requires urine testing.  In rare circumstances, we will also recommend a biopsy of the adrenal tumor.

What are the Signs and Symptoms of an Adrenal Nodule?

When abnormal amounts of the aforementioned hormones are secreted by functioning tumors, they can cause serious abnormalities in the body.

Adrenal Causes of High Blood Pressure

UCLA endocrine surgeon Masha Livhits, MD, presented a live-streaming webinar to discuss an overview of adrenal hormones and their role in causing high blood pressure, when adrenal hormone levels should be checked and what are the treatment options.

When adrenal tumors make too much cortisol, this is called Cushing’s syndrome. Patient with Cushing’s syndrome may experience:

• High blood pressure
• High blood sugar (diabetes)
• Weight gain, especially in cheeks and shoulders
• Menstrual irregularities
• Weakening of muscles and bones
• Skin changes
• Easy bruising
• Purple striae (stretch marks)
• Rarely, can raise sex hormones that causes women to grow facial hair, voices to deepen, balding, etc

When adrenal tumors make too much epinephrine or norepinephrine, this is called a pheochromocytoma. Patients with a pheochromocytoma may experience:

• Episodic headaches
• Sweating
• Fast heart rate
• High blood pressure (can be always or sometimes)

When adrenal tumors make too much aldosterone, this is called a Conn’s syndrome or hyperaldosteronoma. Patients with a hyperaldosternoma may experience:

• High blood pressure that is not well controlled on multiple drugs
• You may be told your potassium levels are low on blood testing

Do Adrenal Nodules Contain Cancer?

Adrenal Surgeons at UCLA

Cancers that come from the adrenal gland are called adrenocortical carcinomas, and they are very, very rare. Adrenocortical carcinomas occur in about 0.0001% of people, or 1 in one million of the population per year in the United States. These cancers, just like nodules, can be functional or non-functional.

There are no obvious symptoms or signs unless the adrenal cancer is producing excessive hormones. This makes it hard to detect at an early stage.

There are some characteristics that are concerning for adrenal cancer: when the mass has irregular borders, when the tumor is bigger than 4 cm, when there are enlarged lymph nodes, nearby, and when we can detect distant metastases. Distant spreading ACCs generally metastasize to the lungs, liver, bone, and lymph nodes. It remains controversial, however, whether functioning or nonfunctioning tumors are more aggressive.

Other Cancers Traveling to the Adrenal Gland

There are some cancers that arise from other parts of the body that can spread (or metastasize) to the adrenal gland. These include breast cancer, lung cancer, and melanoma. When we evaluate patients with adrenal tumors, this includes a thorough review of a patient’s history and making sure your cancer screening in up to date. Sometimes, if the only site of spread is to the adrenal gland, surgical removal of the disease can help improve patient outcomes. This decision is made by team consensus after thorough review of the case.

What Causes Adrenocortical Carcinoma?

The answer is unknown. There is no known association with smoking, alcohol consumption, or other occupational or environmental exposures. Genetic factors may play a role in a small number of patients.

How Can Adrenocortical Carcinoma Be Treated?

Early stage disease is highly curable through surgical resection of the tumor by specially trained surgeons who specialize in treating this disease. The problem is that many, if not most, adrenal cancers are found at advanced stages.

Treatment of adrenal cancer should always be done by a team of experts. An example of a team of physicians dedicated to this challenge is the UCLA endocrine surgery team. Any patient with this rare disease should be encouraged to seek, at minimum, evaluation at a center like UCLA’s, which is dedicated to treatment of these rare tumors. We work with endocrinologists, endocrine surgeons, oncologists, radiologists, and pathologists to make decisions at every step along the way.

If the tumor can be fully removed, surgical resection is recommended. After surgery, mitotane treatment (a drug therapy) and/or chemotherapies may be utilized to potentially improve cure rates and increase survival. The need to use mitotane or chemotherapy should be decided on a case by case basis.

Contact us for more information or to request an appointment.

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Phone: 310-267-7838

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5.3B: Sebaceous (Oil) Glands – Medicine LibreTexts

1. Last updated

2. Save as PDF

1. LEARNING OBJECTIVE
2. Key Takeaways
3. Key Points
4. Key Terms
5. The Function of Sebum

Sebaceous glands are found in most of the skin (except the palms of the hands and the soles of the feet).

LEARNING OBJECTIVE

Describe the location and function of sebaeous glands

Key Takeaways

Key Points

• Sebaceous glands are located throughout the skin except in the palms of the hands and soles of the feet.
• Sebum is an oily substance composed of fat (lipids) and the debris of dead fat-producing cells.
• Sebaceous glands are classified as holocrine glands.

Key Terms

• sebum: A thick oily substance, secreted by the sebaceous glands of the skin, that consists of fat and cellular debris.
• holocrine gland: The sebaceous gland is an example of a holocrine gland because its product of secretion (sebum) is released with remnants of dead cells.

Sebaceous glands are the oil secreting glands of your body. This is why they are also called the oil glands. They are a type of holocrine simple saccular (alveolar) gland. Their function is to secrete a substance called sebum, a mixture of fatty substances, entire sebum-producing cells, and epithelial cell debris. The sebaceous glands are located in the dermis, the middle layer of the skin, and they develop from the epithelial cells of the hair follicle itself (the external root sheath of the hair follicle).

Sebaceous gland ducts thus usually open up into the upper part of a hair follicle, called the infundibulum. The infundibulum is part of the pilosebaceous canal, the one responsible for discharging sebum and one that is composed of the infundibulum and the short duct of the sebaceous gland itself. However, some sebaceous gland ducts open directly onto our skin surface such as at the corner of the mouth and the glans penis. Regardless, the secretion of sebum out of the gland is helped along by the contraction of the arrector pili muscle.

While the sebaceous glands are present just about all over the skin, they are notably absent on the palms of the hands and the soles of the feet. The sebum being excreted by your body today began production around 8 days ago.

The Function of Sebum

Sebaceous Gland: Schematic view of a hair follicle with sebaceous gland.

The sebum produced by these glands plays numerous important roles:

1. Sebum is a lubricant and inasmuch it helps to moisturize the skin. It does so by preventing the excess evaporation of water from the skin.
2. Sebum serves to keep us healthy by keeping in check the growth of certain bacteria on our skin. That’s because sebum contains chemicals that kill bacteria. This helps ensure bacteria don’t invade into deeper layer of our skin.
3. It helps to condition the hair. Meaning, it ensures our hair doesn’t become too dry and brittle.

Sebaceous glands are involved in numerous conditions. During puberty, various hormones cause them to produce a lot of sebum and this therefore contributes to oily skin. If a duct of a sebaceous gland is clogged with sebum, a whitehead results. If this material is allowed to dry and oxidize, it will become darker, forming a blackhead. If a sebaceous gland becomes infected, moderate and severe forms of acne are the result.

The glands lining the ear canal that produce earwax (cerumen) are called ceruminous glands. They are modified sebaceous glands.

The Adrenal Glands – Location – Structure

The adrenal (or suprarenal) glands are paired endocrine glands situated over the medial aspect of the upper poles of each kidney.

They secrete steroid and catecholamine hormones directly into the blood.

In this article, we shall look at the anatomy of the adrenal glands – their location, structure and vascular supply.

Fig 1 – The right adrenal gland, situated over the medial aspect of the upper pole of the right kidney.

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Anatomical Location and Relations

The adrenal glands are located in the posterior abdomen, between the superomedial kidney and the diaphragm. They are retroperitoneal, with parietal peritoneum covering their anterior surface only.

The right gland is pyramidal in shape, contrasting with the semi-lunar shape of the left gland.

Perinephric (or renal) fascia encloses the adrenal glands and the kidneys. This fascia attaches the glands to the crura of the diaphragm. They are separated from the kidneys by the perirenal fat.

The adrenal glands sit in close proximity to many other structures in the abdomen:

Right adrenal gland		Left adrenal gland
Anterior	Posterior	Anterior	Posterior
Inferior vena cava Right lobe of the liver	Right crus of the diaphragm		Left crus of the diaphragm

Fig 2 – Posterior view of the abdomen, demonstrating the anatomical relations of the adrenal glands.

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Anatomical Structure

The adrenal glands consist of an outer connective tissue capsule, a cortex and a medulla. Veins and lymphatics leave each gland via the hilum, but arteries and nerves enter the glands at numerous sites.

The outer cortex and inner medulla are the functional portions of the gland. They are two separate endocrine glands, with different embryological origins:

• Cortex – derived from the embryonic mesoderm.
• Medulla – derived from the ectodermal neural crest cells.

The cortex and medulla synthesise different hormones.

Cortex

The cortex is yellowish in colour. It secretes two cholesterol derived hormones – corticosteroids and androgens. Functionally, the cortex can be divided into three regions (superficial to deep):

• Zona glomerulosa – produces and secretes mineralocorticoids such as aldosterone.

• Zona fasciculata – produces and secretes corticosteroids such as cortisol. It also secretes a small amount of androgens.

• Zona reticularis – produces and secretes androgens such as dehydroepiandrosterone (DHES). It also secretes a small amount of corticosteroids.

Fig 3 – Histological appearance of the cortex and medulla of the adrenal gland.

Medulla

The medulla lies in the centre of the gland, and is dark brown in colour. It contains chromaffin cells, which secrete catecholamines (such as adrenaline) into the bloodstream in response to stress.

These hormones produce a ‘flight-or-fight‘ response. Chromaffin cells also secrete enkephalins which function in pain control.

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Vasculature

The adrenal glands have a rich blood supply via three main arteries:

• Superior adrenal artery – arises from the inferior phrenic artery
• Middle adrenal artery – arises from the abdominal aorta.
• Inferior adrenal artery – arises from the renal arteries.

Right and left adrenal veins drain the glands. The right adrenal vein drains into the inferior vena cava, whereas the left adrenal vein drains into the left renal vein.

Innervation

The adrenal glands are innervated by the coeliac plexus and greater splanchnic nerves.

Sympathetic innervation to the adrenal medulla is via myelinated pre-synaptic fibres, mainly from the T10 to L1 spinal cord segments.

Lymphatics

Lymph drainage is to the lumbar lymph nodes by adrenal lymphatic vessels. These vessels originate from two lymphatic plexuses – one deep to the capsule, and the other in the medulla.

[start-clinical]

Clinical Relevance: 

Pheochromocytoma

A pheochromocytoma is a tumour of the adrenal medulla or preganglionic sympathetic neurones. It secretes adrenaline and noradrenaline uncontrollably, causing blood pressure to greatly increase. Patients may present with palpitations, headaches and diaphoresis (profuse sweating).

Phenoxybenzamine, a competitive, irreversible antagonist of adrenaline, can be used in treatment to reduce blood pressure by binding to adrenaline receptors, making less available for adrenaline to act upon.

Fig 4 – CT scan of a pheochromocytoma.

[end-clinical]

Hurtla cell carcinoma – MyPathologyReport.ca

What is Hurtle cell carcinoma?

Hertle cell carcinoma is a type of thyroid cancer. It is made up of large pink cells called Hertle cells. This type of cancer develops more often in older people and is rare in children. Patients with Hurtl cell carcinoma may notice a lump or lump in the front of the neck. An ultrasound scan may show one or more thyroid nodules.

Thyroid gland

The thyroid gland is a U-shaped gland located in the front of the neck. The normal thyroid gland is divided into right and left lobes, which are connected in the middle by an isthmus. Some people have another small lobe above the isthmus called the pyramidal lobe.

The thyroid gland produces thyroid hormone. Most of the cells in the thyroid gland are called follicular cells.Follicular cells join together to form small, round structures called follicles. Thyroid hormone is stored in a material called a colloid that fills the center of the follicles.

How do pathologists make this diagnosis?

The diagnosis of Gurtle cell carcinoma can only be made after the entire tumor has been removed and sent to a pathologist for examination under a microscope. However, most patients undergo a small surgical procedure called fine needle aspiration, or FNA, before complete removal of the tumor.This procedure uses a very fine needle to remove a small amount of tissue from the abnormal area of ​​the thyroid gland. This tissue is then examined by a pathologist under a microscope. An FNA biopsy provides a preliminary diagnosis that can guide further treatment.

Most tumors are separated from the normal surrounding thyroid gland by a thin tissue barrier called the tumor capsule. Over time, part of the tumor capsule may disappear, and large tumors may not have a tumor capsule at all.

Hertle cell carcinoma consists of large pink Hertle cells. Hurthle cells are usually found in small to medium sized follicles. When viewed under a microscope, Hurtl cell carcinoma cells can look very similar to non-malignant thyroid tumors called so-called thyroid tumors. Gurtle cell adenoma. The only difference between Hertle cell carcinoma and Hertle cell adenoma is that tumor cells in Hertle cell carcinoma have broken through the tumor capsule and entered the surrounding normal thyroid gland.Pathologists call this the tumor capsule. invasion. In contrast, all abnormal cells in the Hertle cell adenoma are separated from the normal thyroid by the tumor capsule.

Tumor size

This is the size of the tumor in centimeters (cm). A tumor is usually measured in three dimensions, but your report only describes the largest size. For example, if the tumor is 4.0 cm by 2.0 cm by 1.5 cm, your report will describe a tumor of size 4.0 cm. Tumor size plays an important role in determining pathologic tumor staging for Hurtle cell carcinoma (see Pathologic Staging below).

Invasion models

The transfer of tumor cells into the surrounding normal thyroid tissue is called invasion. Hertle cell carcinoma can exhibit two patterns of invasion:

• Minimally Invasive – This means that the tumor is surrounded by the tumor capsule but it was found that the tumor cells spread past the capsule into the normal thyroid gland.Tumor cells that have spread beyond the tumor capsule are usually only found after examining the tissue under a microscope.
• Widely invasive – This means that the tumor is not surrounded by the tumor capsule or that only a small portion of the tumor capsule remains. The cells of a highly invasive tumor have spread much further into the normal thyroid gland than cells in a minimally invasive tumor. In some cases, the spread of tumor cells into the normal thyroid gland can be seen without a microscope during a rough examination.Widely invasive tumors are more likely to spread to lymph nodes and other parts of the body. The spread of tumor cells to a lymph node or other area of ​​the body is called metastasis.

Vascular invasion (angioinvasion)

Blood vessels carry blood throughout the body. Tumor cells that enter a blood vessel can spread to distant parts of the body, such as the lungs and bones. Moving tumor cells to another part of the body is called metastasis.

Tumor cells found inside a blood vessel are called vascular invasion (angioinvasion). If vascular invasion is observed, your pathologist will count the number of vessels containing tumor cells.

Your report will describe vascular invasion as negative if cancer cells are not found inside a blood vessel, positive and focal if cancer cells are less than 4 vessels, and positive and diffuse if there are 4 or more blood vessels with cancer cells….

Lymphatic invasion

Lymphatic vessels are small, thin vessels through which fluids and cells leave tissue. Lymphatic vessels are found throughout the body. Tumor cells that enter the lymph vessel can spread to other parts of the body, in particular the lymph node.

Tumor cells found inside a lymphatic vessel are called lymphatic invasion. Your pathologist will carefully examine your tissue for lymphatic invasion.If lymphatic invasion is observed, this will be considered positive. If no lymphatic invasion is observed, it will be considered negative.

Extrathyroidal dilatation

Extrathyroid expansion is the movement of tumor cells from the thyroid gland into the surrounding tissues. Tumor cells that extend far enough from the thyroid gland may come into contact with additional structures such as muscles, esophagus, or trachea.

There are two types of extrathyroid enlargement:

• Microscopic – Tumor cells outside the thyroid gland were only found after examining the tumor under a microscope.
• Macroscopic (general) – The tumor can be seen growing into the surrounding tissue without using a microscope. This type of extrathyroid enlargement may be seen by your surgeon during surgery or by a pathologist’s assistant performing a gross examination of tissue targeted for pathology.

Macroscopic (macroscopic) extrathyroid enlargement increases the stage of the tumor (see Pathological stage below) and is associated with a worsening prognosis. Microscopic extrathyroid enlargement does not change the stage of the tumor.

Fields

A margin is tissue that the surgeon must cut to remove the thyroid gland from your body. The limit is considered positive if the cancer cells are at the very edge of the cut tissue. A negative margin means that no cancer cells were found on the tissue section.

Lymph node

The lymph node is a small immune organ located throughout the body. Tumor cells can travel from the thyroid gland to the lymph nodes through the lymphatic ducts located in and around the tumor.Lymphatic invasion above). The movement of tumor cells from the thyroid gland to the lymph node is called metastasis.

Lymph nodes in the neck are sometimes removed at the same time as the thyroid gland in a procedure called neck dissection. The lymph nodes that are removed are usually taken from different areas of the neck, and each area is called a level. The levels in the neck are numbered from 1 to 7. The pathology report will often indicate how many lymph nodes were found at each level sent for examination.

The lymph nodes on the same side as the tumor are called ipsilateral, and the lymph nodes on the opposite side of the tumor are called contralateral.

Your pathologist will carefully examine each lymph node for tumor cells. Lymph nodes that contain tumor cells are often called positive, and those that do not contain cancer cells are often called negative. Most reports indicate the total number of lymph nodes examined and the number of cancer cells, if any.

Tumor deposits

A group of cancer cells inside a lymph node is called tumor deposition. If a tumor deposit is found, your pathologist will measure it and your report will indicate the largest tumor deposit found.

Extranodal Extension (ENE)

The entire lymph node is surrounded by a capsule. Extranodal enlargement (ENE) means that tumor cells have broken through the capsule and have spread into the tissue surrounding the lymph node.

Pathological stage (pTNM)

Pathologic Hurtle cell carcinoma staging is based on the TNM staging system, an internationally recognized system originally established by the American Joint Committee on Cancer. This system uses information about the primary tumor (T), lymph node (N) and distant metastatic disease (M) to determine the complete pathologic stage (pTNM). Your pathologist will examine the tissue presented and assign a number to each part. In general, a higher number means more advanced disease and worse.forecast.

Tumor stage (pT) for Gurtle cell carcinoma

Hertle cell carcinoma is given a tumor stage from 1 to 4 depending on the size of the tumor and the presence of tumor cells outside the thyroid gland (see Extrathyroid enlargement above).

• T1 – The tumor is less than or equal to 2 cm and the cancer cells do not extend beyond the thyroid gland.
• T2 – The tumor is larger than 2 cm, but less than or equal to 4 cm, and cancer cells do not extend beyond the thyroid gland.
• T3 – The tumor is larger than 4 cm. OR Cancer cells have spread to muscles outside the thyroid gland.
• T4 – Cancer cells have spread to structures or organs outside the thyroid gland, including the trachea, larynx, or esophagus.

Nodal stage (pN) for Gurtle cell carcinoma

Hertle cell carcinoma is assigned nodal stage 0 or 1 depending on the presence or absence of tumor cells in the lymph node and the location of the affected lymph nodes.

• N0 – No tumor cells were found in any of the lymph nodes examined.
• N1a – Tumor cells were found in one or more lymph nodes at levels 6 or 7.
• N1b – Tumor cells were found in one or more lymph nodes at levels 1 through 5.
• NX – Lymph nodes were not sent for pathological examination.

Metastatic stage (pM) for Gurtle cell carcinoma

Follicular carcinoma is assigned metastatic stage 0 or 1, depending on the presence of tumor cells in a distant part of the body (for example, in the lungs).The metastatic stage can only be determined if tissue from a distant site is sent for pathological examination. Because this tissue is rarely dispatched, metastatic stage cannot be identified and indicated as MX.

Jason Wasserman, MD, FRCPC (updated July 16, 2021)

About prostate surgery

This guide will help you prepare for prostate surgery at Memorial Sloan Kettering (MSK).It will also help you understand what to expect as you recover.

Read this manual at least once before your surgery and use it as a reference as you prepare for the day of your surgery. Take it with you on all visits to MSK, including the day of your surgery. You and your healthcare team will refer to him throughout your treatment.

to come back to the beginning

About the prostate gland

Your The prostate gland is located below the bladder, in front of the rectum, and is shaped like a walnut.picture 1). It surrounds the urethra, which is the tube that carries urine out of your body. The prostate gland works with other glands in your body to produce sperm.

The seminal vesicles are small glands near the prostate gland that produce secretions that make up the semen (see Figure 1).

Lymph nodes are small bean-shaped structures found throughout the body.They produce and store blood cells to fight infection.

Figure 1. Male reproductive system

to come back to the beginning

About prostate surgery

Radical prostatectomy is an operation to completely remove the prostate gland and seminal vesicles. It also removes some of the lymph nodes in the pelvic area. This is done to prevent the spread of prostate cancer to other parts of your body.

Radical prostatectomy can be performed in one of two ways. One, called open prostatectomy, involves making an open incision (surgical incision). Another method involves the use of a laparoscope – a tubular instrument with a camera. Your surgeon will discuss with you which option is best for you.

Open prostatectomy

In open prostatectomy, the surgeon makes an incision from the pubic bone towards the umbilicus (see Fig.Figure 2). After that, the pelvic lymph nodes are first removed, then the prostate gland, and then the adjacent formations.

Figure 2. Open prostatectomy incision

Laparoscopic or robotic prostatectomy

In a laparoscopic or robotic prostatectomy, your surgeon will make several small incisions in your abdomen (abdominal wall) (see Figure 3). A laparoscope is then inserted into one of the incisions and your abdomen is expanded with gas.The prostate gland will be removed through other incisions using surgical instruments. Several surgeons at MSK have received special training in the use of robotic instruments during surgery.

Figure 3. Incisions for laparoscopic or robotic prostatectomy

to come back to the beginning

Before surgery

The information in this section will help you prepare for your surgery.Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches. It contains important information about what you need to do before your surgery. Write down any questions you have and remember to ask your doctor or nurse.

The information in this section will help you prepare for your surgery. Read this section after you have assigned your surgery and refer to it as the date of your surgery approaches. It contains important information about what you need to do before your surgery.Write down any questions you have and remember to ask your doctor or nurse.

Preparation for surgery

You and your healthcare team will prepare for your surgery together.

Help us make your transaction as secure as possible: Tell us if any of the statements below match your situation, even if you’re not entirely sure.

• I am taking blood thinning medication. These drugs include aspirin, heparin, warfarin (Coumadin ^® ), clopidogrel (Plavix ^® ), enoxaparin (Lovenox ^® ), dabigatran (Pradaxa ^® ), apoxixaban (90 E197) ^{and riv Xarelto ® ).There are others, so be sure to tell your doctor about any medications you are taking.}
• I take over-the-counter (over-the-counter) medicines, including patches and ointments.
• I take nutritional supplements such as herbs, vitamins, minerals, and natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter defibrillator (AICD), or other cardiac pacemaker.
• I have sleep apnea.
• Previously, I had problems with anesthesia (drugs that make a patient fall asleep).
• I am allergic to some drugs or materials, including latex.
• I don’t want to have a blood transfusion.
• I drink alcohol.
• I smoke.
• I am taking soft drugs.

On the use of alcoholic beverages

The amount of alcohol you drink may affect your condition during and after surgery.Planning for your care requires that you talk with healthcare providers about your alcohol use.

• Abrupt withdrawal from alcohol can cause seizures, alcoholic delirium and lead to death. If we know that you are at risk for these complications, we can prescribe medications for you to prevent them.
• If you drink alcohol regularly, there is a risk of other complications during and after surgery.These include bleeding, infections, heart problems, and longer hospital care.

Here’s what you can do before surgery to prevent potential problems:

• Tell your healthcare provider honestly how much alcohol you drink.
• After the appointment of the operation, try to stop drinking alcoholic beverages. If you experience headaches, nausea, increased anxiety, or have trouble sleeping after stopping alcoholic beverages, tell your doctor right away.These are early signs of alcohol withdrawal that can be treated.
• Tell your healthcare provider if you are unable to stop drinking.
• Ask us any questions about alcohol and your surgery. As always, we will ensure the confidentiality of all your medical information.

On smoking

During surgery, smokers may experience breathing problems. Quitting smoking even a few days before surgery will help prevent these problems.If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also contact this program by calling 212-610-0507.

Sleep apnea information

Sleep apnea is a common breathing disorder that causes a person to temporarily stop breathing during sleep. The most common type is obstructive sleep apnea (OSA). In the presence of OSA, the airways become completely blocked during sleep.This can cause serious problems during and after surgery.

Let us know if you have sleep apnea attacks, or if you suspect you may have such attacks. If you are using a breathing apparatus (CPAP) to prevent sleep apnea, take it with you on the day of your surgery.

Ask about medicines

We recommend taking medications to help you achieve an erection. This will promote blood flow to your penis and help keep its tissues healthy.Most insurance companies, including Medicare, do not cover prescription drugs such as sildenafil citrate (Viagra ^® ) or tadalafil (Cialis ^® ). For details, consult your insurance provider prior to surgery. If your insurance does not cover the use of these drugs, other, more affordable options may be considered. Ask your doctor or nurse about this question to get started before your surgery.

Within 30 days prior to surgery

Preoperative study (PST)

Before your surgery, you will be assigned a presurgical testing (PST). The date, time and location of the preoperative examination will be indicated in the reminder you will receive at the surgeon’s office. On the day of your scheduled preoperative examination, you can take your food and medication as usual.

During your visit, you will meet with a senior nurse / nurse with whom the specialists in the anesthesiology department work closely (doctors and specialized nurses / nurses who will give you medication to help you sleep during the operation).A senior nurse / nurse will review your medical record and your surgical history with you. You will need to undergo a number of tests, including an electrocardiogram to check your heart rate, chest x-rays, blood tests, and other tests necessary to plan your treatment. Your qualified nurse may also refer you to other health care providers.

The Nurse will also advise you on what medications you will need to take on the morning of your surgery.

You will be of great help to us if you take the following with you to the preoperative examination:

• A list of all medicines you take, including prescription and over-the-counter medicines, patches, and creams;

90,039 Results of any tests you did outside of MSK, such as exercise ECG, echocardiogram, or carotid Doppler

90,039 the names and phone numbers of your doctors.

Complete Health Care Decision Form

If you have not yet completed the Health Care Proxy, we recommend that you do so now.A power of attorney to make decisions about health care is a legal document that specifies the person who will represent your interests in case you cannot do it yourself. The person you specify will be your health care agent.

If you would like to complete a Health Care Proxy Form, contact your nurse. If you have already completed the form, or if you have any other advance directive in case of loss of decision-making ability, bring it with you to your next appointment.

Sperm storage

This operation will render you sterile. Although you will still be able to orgasm, you will not be able to produce the sperm needed to have biological children. Before surgery, you should consider depositing your semen for storage. Contact your nurse / nurse for more detailed advice on this procedure. For more information, ask your nurse for reference Building Your Family after Cancer Treatment: Information for Men and Sperm Banking , or find them at web page www.mskcc.org/pe.

Male Sexual and Reproductive Medicine Program

Most men will find it difficult to achieve an erection immediately after surgery. You can make an appointment with a specialist in the Sexual Health and Male Reproductive Medicine Program by calling 646-888-6024 to discuss the effect of this operation on your sexual health.

Do breathing exercises and exercises that stimulate coughing

Take deep breaths and clear your throat before surgery.You will receive an incentive spirometer to help expand your lungs. For more information, read resource , How to Use Your Incentive Spirometer . If you have any questions, talk to your nurse or pulmonary therapist.

Physical activity

Try to do aerobic exercise daily, such as walking at least 1 mile (1.6 km), swimming, or cycling.If it’s cold outside, take the stairs at home, go to a mall or store. Physical activity will help improve the condition of the body for the operation, as well as help facilitate and speed up the healing process.

Stick to a healthy diet

You should have a well-balanced, healthy diet prior to surgery. If you need help with nutritional issues, ask your doctor or nurse to refer you to a dietitian doctor.

Determine who will look after you

Your caregiver plays an important role in your treatment. Your healthcare provider will tell you and your caregiver about the surgery. Your caregiver needs to be present after surgery and receive post-discharge guidance to help care for you at home. Your caregiver will also need to drive you home after your surgery.

10 days before surgery

Stop taking vitamin E

If you are taking vitamin E, stop taking it 10 days before surgery because it may cause bleeding.For more information, read resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) .

Do pelvic floor exercises (Kegel exercises)

These exercises will help you strengthen the pelvic floor muscles that will be weakened by the surgery. Start doing Kegel exercises before surgery so you know how you should feel.For more information, read resource Pelvic Floor Muscle (Kegel) Exercises for Men.

Figure 4. Hibiclens Skin Cleanser

Buy everything you need

Hibiclens ^® is a skin cleanser that kills microorganisms and prevents their appearance within 24 hours after use (see.Figure 4). Showering with Hibiclens before your surgery will reduce your risk of infection after surgery. You can buy Hibiclens at your nearest pharmacy without a prescription.

To prepare your bowel for surgery, you will also need to purchase a saline enema (eg Fleet ^® ). You can buy it at your local pharmacy without a prescription.

7 days before surgery

Stop taking certain medications

If you are taking aspirin, ask your surgeon if you should continue.Aspirin and medications containing it can cause bleeding. For more information, read resource , Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop taking herbal remedies and other supplements

Stop taking herbal remedies and other supplements 7 days before surgery.If you are taking a multivitamin, ask your doctor or nurse if you should continue taking them. For more information, read resource , Herbal Remedies and Cancer Treatment .

2 days before surgery

Stop taking certain medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil ^® , Motrin ^® ) or naproxen (Aleve ^® ).These medicines can cause bleeding. For more information, read resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

1 day before surgery

Record the time at which the operation is scheduled

The Admitting Office will call you after 2:00 pm the day before your surgery.He will tell you what time you should arrive at the hospital for your surgery. If your surgery is scheduled for a Monday, you will receive a call the previous Friday. If no one contacts you by 7:00 pm on the day before your surgery, please call 212-639-5014.

Eat a gentle diet

Eat light, dietary foods such as small sandwiches, eggs, toast, crackers, or soup. Limit your intake of dairy products. Eliminate fried foods and foods with a lot of seasonings from your diet.

Prepare the intestines for surgery

In the evening before the operation, use a saline enema in accordance with the instructions for its use.

Shower with Hibiclens

Shower with Hibiclens the night before your surgery.

1. Wash your hair with your usual shampoo. Rinse your hair thoroughly.
2. Wash your face and genital area with your usual soap. Rinse your body thoroughly.
3. Open the vial of Hibiclens.Pour a small amount of the solution into your hand or onto a washcloth.
4. Move away from the water stream to avoid rinsing off the Hibiclens immediately after application.
5. Lightly rub the Hibiclens into the body from the neck to the feet. Do not apply Hibiclens to your face or genital area.
6. Return under the tap and rinse off the Hibiclens.
7. After showering, dry yourself with a clean towel.
8. Do not use any type of lotion, cream, deodorant, makeup, powder or perfume after showering.

Sleep

Go to bed early and try to get a good night’s sleep.

Eating food and drinks before surgery

• Do not eat after midnight before your surgery. This also applies to candy and chewing gum.

• Between midnight and two hours before your scheduled arrival time at the hospital, you may not drink more than 12 ounces (350 ml) of water.drawing).

• Avoid eating or drinking two hours before your scheduled hospital arrival time. This also applies to water.

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Morning on the day of surgery

Shower with Hibiclens

Shower with Hibiclens before going to the hospital. Use Hibiclens as you did the night before.

Do not use any lotion, cream, powder, deodorant, makeup or perfume after showering.

Take medication

If your doctor or nurse has asked you to take certain medications in the morning before your surgery, take only those medications with a small sip of water. Depending on the medications and the upcoming surgery, this may be some or all of the medications you usually take in the morning, or not at all.

Points to remember

• Do not use any lotion, cream, deodorant, makeup, powder or perfume.
• Do not wear metal objects. Remove all jewelry, including body piercings. The equipment used during the operation may cause burns if it comes into contact with metal.
• Leave valuables at home, such as credit cards, jewelry, or a checkbook.
• Before going to the operating room, you will need to remove your hearing aid, dentures, dentures, wig, and religious paraphernalia.
• Put on comfortable, loose-fitting clothing.
• If you wear contact lenses, remove them and put on your glasses. During surgery, contact lenses can injure your eyes.

What to take with you

• Loose pants, e.g. training pants.
• Briefs type swimming trunks 1-2 sizes larger than your usual.
• Sneakers with laces. Your feet can swell, and you can easily wear lace-up sneakers over swollen feet.
• CPAP device for the prevention of sleep apnea attacks, if you have one.
• Portable player if desired. However, you will need to give it to someone for safekeeping when you go to surgery.
• Incentive spirometer, if you have one.
• Power of Attorney for Health Care Decisions, if completed.
• Mobile phone and charger.
• A briefcase for keeping your personal belongings such as glasses, hearing aids, dentures, dentures, wig, and religious paraphernalia, if you have one.
• These are recommendations. Your healthcare team will use these guidelines to help you take care of yourself after your surgery.

Upon arrival at the hospital

You will need to name and spell your first and last name several times, as well as indicate your date of birth. This is for your safety. People with the same or similar names can be operated on on the same day.

Change for operation

When it’s time to change before your surgery, you will be given a hospital gown, gown, and non-slip socks.

Meet the Nurse

You will meet with the nurse before your surgery. Tell her / him the doses of all medications (including patches and creams) that you took after midnight and when you took them.

Your nurse will give you an intravenous (IV) line in one of your veins, usually in your hand or the crook of your arm. An IV line will be used to administer fluids and anesthesia during surgery.

Meet with the anesthesiologist

Anesthesiologist:

• will review the medical record with you;
• will talk about your comfort and safety during the operation;
• will tell you about the type of anesthesia you will receive;
• will answer any questions you may have about anesthesia.

Prepare for Operation

After a nurse visit, 1-2 visitors will be able to stay with you while you wait for your surgery to start. Before the operation begins, your visitors are escorted to the waiting area.

You will go to the operating room yourself, or you will be taken there on a gurney. A member of the OR team will help you lie down on the operating table. Special compression boots will be worn on the bottom of your feet. They will inflate and deflate smoothly to improve blood flow in your legs.

When you fall asleep, a breathing tube will be inserted through your mouth into your windpipe to help you breathe. You will also receive a urinary catheter (Foley catheter ^® ) to drain urine from your bladder.

Surgical stitches will be placed on your incision after the operation is complete. The breathing tube is usually removed while you are still in the operating room.

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Post-operation

The information in this section will help you know what to expect after surgery, while you are in the hospital, and when you are discharged home.You will learn how to safely recover from surgery. Write down any questions you have and remember to ask your doctor or nurse.

What to expect

When you wake up from your surgery, you will be in the Post-Anesthesia Care Unit (PACU) or the Postoperative Care Unit.

You will receive oxygen through a thin tube under your nose called a nasal cannula.The nurse will monitor your body temperature, heart rate, blood pressure, and oxygen levels.

You will have a catheter inserted into your bladder to monitor the amount of urine you are making. You may also be fitted with a Jackson-Pratt ^® Drain System (JP Drain) to drain fluid that collects under surgical incisions.
In addition, compression boots will be worn to improve circulation in your legs.

You may be given a pain-relieving pump called a patient-controlled analgesia (PCA).For more information, see resource , Patient-Controlled Analgesia (PCA) . Pain medication will be given through an IV line.

A nurse will tell you how to recover from surgery. Below are some guidelines to help make this process safer.

• You are advised to walk with the support of a nurse or physiotherapist. We will give you medicine to relieve your pain.Walking helps reduce the risk of blood clots and pneumonia. It also helps to stimulate and restore bowel function.
• Use an incentive spirometer. This will help expand the lungs, which will prevent pneumonia from developing. For more information, read resource , How to Use Your Incentive Spirometer .

Frequently Asked Questions

Will I have pain after surgery?

The doctor and nurse will often ask you about your pain and give you medication as needed.If pain persists, tell your doctor or nurse.

Typical pain after surgery to remove the prostate gland includes:

• Pain in the area of ​​surgical incisions in the abdomen;

90,039 pain due to gas;

• Pain in other parts of your body such as your back and shoulders
• Feeling of heaviness in the rectum, as if the need to empty the bowels. The prostate gland is located just above the rectum, so this sensation is quite common.They usually go away with time.

What other symptoms may I have after surgery?

Gas pain after laparoscopic or robotic prostatectomy

If you have undergone a laparoscopic or robotic prostatectomy, the gas used during your surgery can apply pressure and cause pain in various areas of your body, especially your shoulders. This will go away in a few days. Walking will help your body absorb gas faster and reduce your pain.

Bladder spasms
You may have bladder spasms after surgery. They can manifest as sudden and intense cramps in the lower abdomen and in the penis. You may also feel an urgent need to urinate. These spasms usually resolve over time.

Bruises
You will have bruises on your abdomen, penis and scrotum. They will go away in 1-2 weeks after the operation.

Bloating
You may experience bloating for several days.Walking can help you reduce gas and bloating. Eliminate carbonated (fizzy) drinks until the elimination of gases from the body is normalized.

How can I manage pain at home?

You may still have pain when you return home, and you may be taking pain medication. Follow the guidelines below.

• Take your medications as directed by your doctor and as needed.
• Call your doctor if the prescribed medication does not relieve pain.
• Do not drive or drink alcohol while you are taking prescription pain medication.
• As your incisions heal, the pain will decrease and you will need less pain medication. Mild pain relievers, such as acetaminophen (Tylenol ^® ) or ibuprofen (Advil ^® ), can help relieve pain and discomfort.However, taking large amounts of acetaminophen can damage the liver. Do not take more acetaminophen than what is listed on the bottle, or as directed by your doctor or nurse.
• Pain medications should help you get back to your normal routine. Take enough medication so you can exercise comfortably. Pain medications are most effective 30 to 45 minutes after you take them.
• Keep track of the time you take your pain medication. It is better to take the medicine when the pain first appears and not wait for it to intensify.

Pain medications may cause constipation (less frequent bowel movements than usual).

How can I reduce the edema of the penis and scrotum?

You will have swelling and bruising on the penis and scrotum. Your scrotum can reach the size of a grapefruit. These phenomena are normal and will gradually subside after removal of the catheter.

You can reduce swelling by placing a rolled towel under your scrotum when you are sitting or lying down. Wearing panties like swimming trunks instead of loose panties like shorts will also help.

Do I need to change my diet (diet)?

In the first few days after the operation, eat only light food (sandwiches, yogurt, soup and drinks) before the first bowel movement. Avoid foods that can cause gas production, such as legumes, broccoli, onions, cabbage and cauliflower, from your diet.After the first bowel movement, you can return to your normal diet, taking into account the individual tolerance of certain foods.

It is important to drink enough fluids while you have your catheter in place after surgery. Until your normal appetite is restored, a variety of soups and broths are good choices for you.

How will bowel movements change after surgery?

• You may not have a bowel movement for 5 days after your surgery.This is fine.
• If you have gas and have no bowel movements by the evening of the second day after you leave the hospital, start taking MiraLAX and continue taking it until your bowel movements are normal.
• If you have not had a bowel movement in 4 days, call your doctor or nurse.
• If you have not emitted gas for 2 days, call your doctor.
• Do not use enemas or suppositories (rectal suppositories) for at least 6 weeks after surgery.

How can I prevent constipation?

• Take 1 capsule of sodium docusate (Colace ^® ) 3 times daily. It is a stool softener with fewer side effects.
• Walking can help stimulate the intestines and restore normal bowel function.
• Drink 8 glasses (8 ounces (240 ml) each, 2 L total) of liquid daily. Drink water, juices, soups, milkshakes, and other decaffeinated drinks. Caffeinated beverages, such as coffee and soda, flush fluid from the body.
• Gradually increase your dietary fiber content to 25-35 grams per day. Fiber is found in fruits, vegetables, whole grains, and cereals. If you have a stoma or recently had bowel surgery, check with your doctor or nurse before making any dietary changes.

Can I take a shower?

Yes. You can shower 24 hours after surgery. A warm shower relaxes and helps relieve muscle pain.When showering, use soap and gently wash your incision. After showering, pat these areas dry with a towel and do not bandage the incision (if there is no discharge). Call your doctor if you notice redness or discharge from your incision.

Do not take a bath until you discuss it with your doctor at your first visit after surgery.

How do I care for my incisions?

The location of the incision will depend on the type of surgery performed. If the skin under the incision is numb, this is normal, because some of the nerve endings were cut off during the operation.After a while, the numbness will disappear.

• By the time you are discharged from the hospital, your surgical incision will begin to heal.
• You and your caregiver should work with your nurse to examine your incision before you leave to see what it looks like.
• If there is any discharge from the incision, record the amount and color. Call your doctor’s office and talk to your nurse about incision discharge.

Change the dressing at least once a day, and more often if it gets wet from discharge.If the cut has stopped flowing, you can leave it open.

If Steri-Strips ^TM was applied to your surgical incisions at the time of discharge, they will come off and fall off on their own. If they do not fall off after 10 days, you can take them off.

If glue is applied to the stitches during discharge, it will also come off and peel off by itself, like Steri-Strips. Do not touch the glue or try to peel it off.

When is it safe for me to drive?

You will be able to drive after the catheter is removed, unless you are taking pain relievers that can make you drowsy.

Do not ride a motorcycle or bicycle for 3 months after surgery.

What exercises can I do?

Exercise will help you gain strength and improve your well-being. Hiking and climbing stairs are excellent physical activity.
Gradually increase the walking distance. Climb the stairs slowly, resting and stopping as needed.
Check with your doctor or nurse before proceeding to more vigorous exercise.

When can I lift weights?

Consult your doctor before lifting weights. In most cases, you should not lift anything heavier than 10 pounds (4.5 kg) for at least 6 weeks after your surgery. Ask your doctor how long you should refrain from lifting weights.

Will I still have any tubing or drainage after I leave?

Urinary catheter

You may still have a urinary catheter when you leave the hospital.Figure 5). The nurse will teach you how to care for it at home and provide you with the necessary supplies. The catheter is usually removed 7-14 days after surgery.
Catheter care is an important part of taking care of yourself after surgery. For more information, read resource Caring for Your Urinary (Foley) Catheter .

Figure 5. Urinary catheter (Foley catheter)

While you have a catheter in place, your urine may contain blood, sticky tissue, and blood clots.This is fine. This is because the incisions (surgical cuts) inside your body heal and the scabs that form on them pass through the urine. Drink at least 1 cup (8 oz. (240 ml)) of liquid every hour while you are awake.

Also, while walking or stool, blood or urine may leak from the tip of your penis around the catheter. It is normal for you to see that urine continues to drain into the drainage bag. If you cannot see urine flowing into the drainage bag, call your doctor.

Keep the tip of your penis clean and dry. Apply the moisturizer given to you by your nurse around the tip of your penis. This will prevent irritation.

Jackson-Pratt Drainage System

You may also be discharged home with a Jackson-Pratt drainage system (see Figure 6).
Your doctor will decide when to remove the drainage system based on the amount of fluid coming out. If there is a need to leave the drainage system after discharge, your nurse will teach you how to care for it.See Caring for Your Jackson-Pratt Drainage System for more information.

Figure 6. Jackson-Pratt Drainage System

What to expect after catheter removal?

Within 2 days of removing the catheter, your bladder and urethra will be weakened. Do not try to push when urinating or forcefully urinate.Let the urine come out on its own. Do not strain when you have a bowel movement.

Are there special instructions to follow after removal of the catheter?

After the catheter is removed, you should reduce the amount of fluids you drink daily to your normal intake. You should drink 4-6 glasses (8 ounces (240 ml)) of liquid every day.

• Limit the amount of fluids you drink after 7:00 pm and empty your bladder before bed.This will help you avoid having to get up at night.
• If you have copious urination, limit the amount of alcohol and caffeinated beverages you drink.
• Discuss with your healthcare professional before resuming Kegel exercises.

After removing the catheter, call your doctor or nurse if you have:

• unable to urinate;
• there was severe pain in the lower abdomen when urinating.

Will I have difficulty controlling urination?

The muscles holding urine in your bladder will be weakened after the removal of the prostate gland. As a result, you may have difficulty controlling urination.

Other reasons why you may have urinary incontinence (leakage):

• your bladder is full;
• you are tired;
• You have consumed alcohol or beverages containing caffeine.

It may take several months for you to fully regain control of your bladder.

After removing the catheter, you can do muscle strengthening exercises. These are exercises for strengthening the pelvic floor muscles (Kegel exercises) that you practiced before the operation.

After removing the catheter, you may also experience urine leakage. It will decrease over time. Leakage can also occur when you strain, cough, or lift heavy objects. This is called stress incontinence.

At first you may notice that you have better control of your bladder at night.This is because there is less pressure on the bladder when you are lying down. During the first few months after surgery, you may need to urinate quite often. It takes time for your bladder to expand (expand) after it has been continuously emptied through the catheter.

For most people, urination control is not difficult. Recovery of your muscle tone after surgery can take up to 12 months. If after 12 months you still have difficulty controlling urination, talk to your surgeon.Surgical procedures such as a urethral sling or an artificial urinary sphincter can help. For more information visit the National Association for Continence website www.nafc.org

When can I return to work?

In most cases, patients can return to work 2–4 weeks after surgery. After removing the catheter, you can feel quite comfortable working at your desk or in the office.If your job involves a lot of physical activity, you may need more recovery time. Talk to your surgeon about when you can return to work safely.

When can I resume sexual activity?

You can resume sexual activity after the catheter is removed.

Will I be able to achieve an erection?

Erectile dysfunction (ED) refers to the inability to achieve an erection.After prostate surgery, restoration of erectile function will take some time (from weeks to months). In the first weeks after your catheter is removed, you may not be able to achieve an erection strong enough for sex, even with medications such as sildenafil citrate (Viagra). Your healthcare team will talk with you about possible methods to improve erectile function.

What are the treatments for erectile dysfunction?

We recommend taking your erectile dysfunction medications daily.It promotes blood flow to your penis and helps keep its tissues healthy. Most insurance companies do not cover prescription drugs such as sildenafil citrate (Viagra ^® ). Please consult with your insurance provider for details prior to surgery.

Your doctor or nurse will give you information about your medication schedule. Follow this schedule prior to your postoperative visit to your surgeon.

The following are options for such a schedule:

Medicines	Usual dose	Loading dose
sildenafil citrate (Viagra)	Take 25 mg in the evening, 6 days a week. For a 25 mg dose, divide the 100 mg tablet into 4 parts.Use a pill divider from your local pharmacy.	Take 100 mg in the evening 1 day per week.
sildenafil citrate (generic)	Take 1 (20 mg) tablet in the evening, 6 days a week.	Take 5 (20 mg) tablets in the evening, 1 day per week.The total dose is 100 mg.
tadalafil (Cialis) 20 mg tablets	Take 1 (20 mg) tablet every other day.	Do not take a loading dose. The tadalafil (Cialis) 20 mg dose is the highest dose you should be taking.
tadalafil (Cialis) 5 mg tablets	Take 1 (5 mg) tablet in the evening, 6 days a week.	Take 4 (5 mg) tablets in the evening, 1 day per week. The total dose is 20 mg.

Loading dose information

• When you take a loading dose, do it on an empty stomach. Drink the medicine about 2 hours before dinner.
• The medicine begins to work after 30-60 minutes. It will remain in the body for up to 8 hours. At any time during these 8 hours, try to achieve sexual arousal from contact with a partner or from self-stimulation.Write down what happened and tell your doctor about it at your next appointment.
• If you have not had any reaction after taking the loading dose for 4 weeks, call your doctor. He can refer you to our sexual health specialists.

What if the pills don’t work?

You may not be able to get an erection strong enough for sex right away, even with pills such as Viagra. This will take time.Taking medications your doctor has prescribed can help you get better erections, but they don’t work for everyone.

If medications don’t help you, there are other erectile dysfunction treatments you can take. If you are interested in information about other treatments for erectile dysfunction, make an appointment with a Specialist in the Male Sexual & Reproductive Medicine Program by calling 646-888-6024.

When will I receive the lab results?

The surgeon will receive your laboratory results 10-14 days after the operation. If you are not contacted within 14 days, call your surgeon’s office.

What should I discuss with my healthcare provider?

• Final report of your laboratory results
• Prostate specific antigen (PSA) blood test results
• Any problems with your postoperative recovery
• Any other treatment you may need

What follow-up care will I need?

After your surgery, you will need to have a prostate specific antigen (PSA) blood test.PSA is a common protein produced by your prostate gland. In the presence of cancer, PSA levels usually increase. If the cancerous tissue has been completely removed, the test results should not show the presence of PSA.

• Have a PSA blood test according to the following schedule:
  • 6-8 weeks after surgery Date: ______________________________
  • 3-6 months after surgery Date: ______________________________
  • 12 months after surgery Date: ______________________________
• After 12 months of surgery, have a PSA blood test every 6 months.Continue doing this for 5 years after your surgery.
• After 5 years of surgery, have a PSA blood test every 12 months. Keep doing this your whole life.
• Your doctor may ask you to have your PSA blood test done more often.
  In this case, the nurse will provide you with additional information.

Get PSA blood tests at MSK offices if possible. If this is not possible, you can go to the nearest health care point in your place of residence.Ask to fax the results to your doctor at MSK.

Doctor at MSK: ___________________________

Fax: ___________________________

Can I continue my treatment at MSK?

Yes. As part of our Survivorship Program, we offer men who have undergone prostate cancer treatment a comprehensive follow-up treatment. Your doctor will help you decide if you are ready for this step. Through this program, you will receive help and support in coping with the physical and emotional consequences of prostate cancer, and will be monitored for any signs of recurrence.

A nurse with the highest qualifications will interact with your doctor and be directly responsible for your further treatment. MSK’s Prostate Cancer Team is comprised of highly trained nurses who are experts in the care of cancer survivors. Nurse / Nurse of the highest qualification will be:

• to monitor for signs of cancer recurrence;
• Help manage the effects of treatment such as pain and fatigue;
• recommend screening tests for other cancers;
• Advise you on how to lead a healthy lifestyle, such as diet, exercise and quitting smoking;

During your visit to a Nurse Qualified Nurse, you will:

• Discuss medical records;
• to undergo a medical examination;
• Receive referrals for additional tests, such as x-rays, scans, or blood tests;
• receive referrals to other healthcare professionals as needed;
• to receive prescriptions for taking medications, if necessary.

If you would like more information about our cancer survivor program, talk to your doctor or nurse, or visit our Cancer Survivor Center website at www.mskcc.org/experience/living-beyond -cancer

How can I deal with my feelings?

After surgery for a serious illness, you may experience a new feeling of depression. Many people say that at some point they felt like crying, had to experience sadness, anxiety, nervousness, irritation and anger.You may find that you are unable to contain some of these feelings. If this happens, try to find emotional support.

The first step on this path is to share your feelings. Friends and family can help you. A nurse, doctor, and social worker can give you comfort and support and advice. Be sure to tell these professionals about your emotional state and about the emotional state of your friends and loved ones. Numerous materials are available for patients and their families.Whether you are in the hospital or at home, nurses, doctors and social workers are ready to help you, your friends, and loved ones deal with the emotional aspects of illness.

What if I have other questions?

If you have any questions or concerns, talk to your doctor or nurse. You can reach them Monday through Friday, 9:00 am to 5:00 pm.

After 5:00 pm, and on weekends and holidays, call 212-639-2000 and ask the doctor who is on duty in your place.

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Call your doctor if you have:

• The temperature has risen to 101 ° F (38.3 ° C) or higher;
• Severe pain in the lower abdomen (abdomen) occurs when urinating
• unable to urinate;
• there are swelling or pain (when touching) in the calves or hips, especially if one leg is more swollen than the other;
• shortness of breath or coughing up blood appeared.

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Resources

Educational Resources

MSK Support Services

This section contains a list of MSK support services as well as a list of materials that have been referenced in this guide.These resources will help you prepare for your surgery and recover safely. Write down any questions you have and remember to ask your doctor or nurse.

Anesthesia Department
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you would like to become a blood or platelet donor.

Bobst International Center
888-675-7722
MSK accepts patients from all over the world. If you are from another country, call for help arranging your treatment.

Chaplaincy Service
212-639-5982
At MSK, chaplains are ready to listen, support family members, pray, reach out to local clergy or religious groups, or simply provide comfort and a helping hand.Anyone can apply for spiritual support, regardless of their formal religious affiliation. The Interfaith Chapel is located next to Memorial Hospital’s main lobby and is open 24 hours a day. If you have an emergency, call the hospital operator and ask to speak to the duty chaplain.

Counseling Center
646-888-0200
Counseling counseling helps many people.We provide counseling for individuals, couples, families and groups of individuals, and we provide medications to help you cope with anxiety or depression.

Incontinence Medical Specialist
646-497-9068
If you think that consulting an urologist specializing in incontinence will help you, talk to your surgeon about a referral.

Integrative Medicine Service
646-888-0800
The Integrative Medicine Service offers patients a variety of services in addition to traditional health care.This includes music therapy, mind / body therapy, dance and movement therapy, yoga and tactile therapy.

Male Sexual and Reproductive Medicine Program
646-888-6024
Our Sexual and Reproductive Medicine Program for Men helps patients with cancer-related sexual health problems, including erectile dysfunction.

MSK Prostate Cancer Support Group
646-888-8106
Monthly meetings of men with prostate cancer are held.Call for more information or registration.

Patient-to-Patient Support Program
212-639-5007
You may be encouraged to talk to a cancer survivor or caregiver who has received similar treatment. Through our Patient-to-Patient Support Program, we offer you the opportunity to connect with former patients and caregivers.

Patient Billing
646-227-3378
Call Patient Billing for prior approval from your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about a health care power of attorney or concerns about caring for you.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about who MSK will share your information with during your surgery.

Private Duty Nursing Office
212-639-6892
You can request the assistance of a Private Duty Nursing Office or Companions. Call for more information.

Resources for Life After Cancer [RLAC] Program
646-888-8106
At MSK, patient care does not end after active treatment is completed. The Resources for Life After Cancer (RLAC) program is designed for patients who have completed their treatment and for their families. This program offers a variety of services such as workshops, workshops, support groups, and post-treatment counseling.She also helps with health insurance and employment issues.

Social Work
212-639-7020
Social workers help patients, their families and friends cope with the challenges of cancer. They provide one-on-one counseling and support groups during your treatment and can help you connect with your children and other family members. Our social workers can also refer you to local agencies and programs, and provide information on additional financial resources, if you are eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

For more information online, go to the LIBGUIDES page on the MSK Library website (http://library.mskcc.org) or the prostate cancer section at www.mskcc.org. You can also call the library staff at 212-639-7439 for help.

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External resources

Access-A-Ride Organization
web.mta.info/nyct/paratran/guide.htm
877-337-2017
MTA New York offers ridesharing and escort services for people with disabilities who are not can take the bus or metro.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Shelter ( Hope Lodge is a free stay for patients and their caregivers during cancer treatment.

American Urological Association Foundation
www.auafoundation.org
866-746-4282
Provides free information on prostate diseases.

Cancer and Careers Website
www.cancerandcareers.org
One-stop resource for educational materials, tools and information on various activities for working people with cancer.

Cancer Organization Care
www.cancercare.org
800-813-4673
275 Seventh Avenue (between West 25 ^th Street and 26 ^th Street)
New York, NY 10001
Consulting, groups support, educational workshops, publications and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and educational materials for people facing cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides educational materials and support for those caring for loved ones with chronic conditions or disabilities.

Organization Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel for medical treatment around the country through available seats on corporate flights.

fertileHOPE Resource
www.fertilehope.org
855-220-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women and children with cancer receive social and emotional support through communication, workshops, lectures and community events.

Good Days Organization
www.mygooddays.org
877-968-7233
Offers financial assistance to cover copayments during treatment. Patients must have health insurance, they must meet a number of criteria, and they must be prescribed medications that are on the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health insurance premiums, and deductibles for certain drugs and treatments.

Joe’s House
www.joeshouse.org
877-563-7468
Provides cancer patients and their families with a list of places to stay near treatment centers.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for members of the LGBT community, including online support groups and a clinical trial database that welcome participation from members of the LGBT community.

LIVESTRONG Fertility Organization
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides information on fertility and support for cancer patients whose treatment involves fertility risks and cancer survivors.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free Cancer Advocacy Program.

National Cancer Institute (NCI)
www.cancer.gov
800-4-CANCER (800-422-6237)
Provides educational materials and support for cancer patients and their families.

National Association for Continence
www.nafc.org
Provides information and support for patients with incontinence.

National Comprehensive Cancer Network (NCCN)
www.nccn.org
215-690-0300
Find information and resources for people living with cancer and their carers, including support groups and education. The following publications may be helpful:

Advice for Prostate Cancer Patients
www.nccn.org/patients/guidelines/prostate/files/assets/common/downloads/files/prostate.pdf

National LGBT Cancer Network
www.cancer-network.org
Provides educational materials, training courses and advocacy for LGBT cancer survivors and at-risk patients.

Needy Meds Resource
www.needymeds.org
Provides a list of programs that support patients in obtaining generic and registered brand drugs.

NYRx Organization
www.nyrxplan.com
Provides prescription drug benefits to current and former NYS employees who meet certain eligibility requirements.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps eligible patients who do not have prescription drug coverage get drugs for free or purchase them at a low cost.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides co-payment assistance for insured patients.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to medical care, financial assistance, insurance assistance, job security and access to a national resource directory for people with insufficient health insurance.

Prostate Cancer Foundation
www.pcf.org
800-757-CURE (800-757-2873)
Provides education and support programs for patients with prostate cancer.

RxHope Organization
www.rxhope.com
877-267-0517
Provides help for people to get drugs they may not have enough money for.

SHARE Organization
www.sharecancersupport.org
866-891-2392
Offers support groups for survivors of breast cancer, metastatic breast cancer and ovarian carcinoma in Manhattan, Queens, Brooklyn and Staten Island.

US TOO
www.ustoo.org
800-808-7866
Provides education and support programs for prostate cancer patients. Open meetings for cancer patients and their carers. US TOO publishes a monthly newsletter called Hotsheet.

to come back to the beginning

Breast Augmentation | MENTOR® Breast Implants

IMPORTANT SAFETY INFORMATION

Breast implants MENTOR ^® MemoryGel ^® and MENTOR ^® CPG ^** are intended for breast augmentation in women over 18 years of age or for breast reconstruction.Operation on the installation of breast implants is prohibited for the following categories of women: pregnant and lactating; with any active infection in any organ system; with an oncological disease or precancerous condition of the breast for which proper treatment has not been carried out.

Safety and efficacy in patients with autoimmune diseases (eg, lupus and scleroderma), a weakened immune system, conditions that prevent healing and blood clotting, or reduced blood supply to breast tissue have not been established.Patients diagnosed with depression or other psychiatric disorders should wait until these conditions resolve or stabilize before breast implantation surgery.

There are risks associated with breast implant placement. These implants have a limited lifespan and may need to be repeated over time. The likelihood of developing complications increases with the passage of time since the operation. You may need additional unplanned breast surgeries due to complications or unacceptable cosmetic results.Many changes to your breast after implantation are irreversible (they cannot be reversed), and breast implants can affect your ability to breastfeed by reducing or eliminating milk production.

Breast implants cannot serve for life, and breast implant surgery is not a one-time intervention. The most common complications associated with the installation of MENTOR ^® MemoryGel ^® Ұ round gel breast implants are the following complications: repeated interventions, capsular contracture, changes in nipple sensitivity, removal of implants with or without replacement.The most common complications of CPG ^** breast augmentation implants include reoperation for any reason, removal of the implant with or without replacement, and ptosis. There is also a relatively small chance of implant rupture. The health consequences of a silicone gel-filled implant rupture are not yet fully understood. MRI screening is recommended three years after the initial implantation surgery and then every two years thereafter to detect a hidden rupture.Breast implants are also associated with the risk of implant-associated anaplastic large cell lymphoma of the breast (BIA-ALCL), which is a rare type of lymphoma. Based on worldwide case numbers, the risk of developing BIA-ALCL with MENTOR ^® breast implants is low.

For more information on the risks and benefits of using MENTOR ^® Breast Implants, see the brochure Important Information for Women Considering Breast Implants.The brochure is available at https://breastimplantsbymentor.net/en-GB/mentor-safety. It is important to read this material carefully when considering the placement of the MENTOR ^® Breast Implants.

What is radiation therapy (radiotherapy)

Radiation therapy is used in the treatment of various oncological pathologies. This applies not only to malignant tumors, but also to benign ones. It is carried out both after surgical removal of the tumor, and independently, without surgery.

How is radiation therapy different from radiosurgery?

In principle, both of these methods are referred to as remote exposure methods. Radiation therapy (radiotherapy) is generally performed in many sessions (so-called fractions) over several weeks. Radiosurgery is performed in one fraction. Radiation therapy uses mask fixation of the patient using thermoplastic materials, while radiosurgery uses rigid fixation using a stereotaxic frame.

How is radiotherapy equipment different from radiosurgery equipment?

Irradiation in both cases is carried out on linear accelerators. At nuclear centers , radiosurgery is performed on a specialized installation – a linear accelerator equipped with a built-in micromulti-leaf collimator. It allows high-precision irradiation of small targets of complex shape located near radiosensitive intracranial structures. Pre-radiation preparation is carried out immediately before irradiation.

Radiotherapy is performed on a more powerful accelerator that allows irradiation of larger targets located both in the patient’s body and intracranially. This accelerator is equipped with a large multileaf collimator, which also makes it possible to irradiate relatively larger targets of complex shape with high accuracy than in radiosurgery. Pre-radiation preparation can be done in advance.

How is the irradiation accuracy guaranteed?

Typically, the radiology department has a system of measures to ensure the “quality assurance” of radiation therapy.It includes physical and dosimetric support in accordance with international protocols, continuous monitoring of the operation of radiodiagnostic and radiotherapy equipment, high-quality dose-anatomical planning and other activities. These measures make it possible to bring the necessary therapeutic dose to the pathological formation while minimizing the exposure of even closely spaced healthy tissues.

Can a person become radioactive during treatment?

External beam radiation therapy cannot induce the appearance of radioactivity in the human body.Therefore, there is no need to avoid close contact with others in people receiving radiation therapy. Even hugs, kisses, sexual intercourse do not carry the risk of radiation hazard.

What are the side effects of radiation therapy?

Side effects of radiation therapy are most often observed in the area of ​​radiation. Your doctor should alert you to potential side effects and what to do if they occur. You must inform him of any new symptoms that occur during your treatment.It can be redness or peeling of the skin, nausea, headache, fever, various paroxysms, general malaise and weakness. Most of the side effects observed during radiation therapy, although subjective and unpleasant, can be controlled by medical measures and appropriate diet. They usually regress within a few weeks after treatment ends. However, some side effects can last for a long time.At the same time, many patients have no side effects at all.

During your treatment, your radiation therapist will regularly monitor the effect of your treatment. You may not feel a change in the dynamics of the tumor, but you may notice a decrease in headache, dizziness, or other symptoms, especially after the end of radiation therapy. Over time, you may notice an even more significant improvement in your well-being. Your doctor may recommend some tests to make sure that the radiation did not cause any damage to normal cells.You may be advised to have a routine blood test to check your white blood cell and platelet levels, which may drop during radiation therapy.

What should be done to reduce the side effects of radiation therapy?

Each patient’s body reacts differently to radiation therapy. That is why the doctor, when drawing up a radiation treatment plan, takes into account the characteristics of your body and the characteristics of your disease. In addition, he will give advice on how you should behave at home, taking into account the specifics of your treatment, in order to reduce or prevent side effects.

Nearly all patients receiving radiation therapy for cancer must take some form of self-care in order to facilitate successful treatment and improve their condition. Some guiding principles for this are given below:

• Use more rest time. You need to sleep as much as you want. Your body uses up a lot of extra energy during treatment and you may feel fatigued. Sometimes general weakness can continue for another 4-6 weeks after the end of treatment.
• You need to eat well. You need to have a balanced diet to prevent weight loss.
• Avoid wearing tight clothing with tight collars or belts in the radiation area. It’s best to wear old suits that make you feel comfortable and comfortable, which you can wash or throw away if they find themselves stained with marker paint.
• Be sure to tell your doctor about any medications you have been taking. If you have taken or are taking any medication, even aspirin, your doctor should be aware of this before starting treatment.
• Ask your doctor, radiation therapist, any questions you are interested in. Only he can properly advise on your radiation treatment, side effects, home monitoring and other medical measures.

Additional skin care in the area of ​​radiation:

• Do not use any soap, lotion, deodorant, medicine, perfume, cosmetics, powder or talcum powder, or any other substance on the radiation area without talking to your doctor.
• In the radiation area, clothing should be loose, loose cotton fabric.
• Clothes should not be starchy.
• Do not rub or scrape the skin in the irradiated area.
• Do not use adhesive plaster in the radiation area. If dressing is necessary, an adhesive plaster with pores outside of the irradiation area or a bandage can be used.
• Do not heat or cool (heating pad, ice, etc.) the irradiated area.Even hot water can harm your skin. For bathing and washing, you can use only moderately warm water, especially in the area of ​​radiation.
• For shaving, if this area is exposed to radiation, it is best to use an electric shaver after consulting your doctor. Don’t use shaving lotions or hair removers.
• Protect your skin from sunlight. Before going outside, wear a hat and loose clothing to cover the exposed skin.Check with your doctor regarding the use of sunblock creams. Sometimes it makes sense to use them if you get easily sunburned and your skin is too delicate. Protecting your skin from excessive sun exposure is essential for at least one year after the end of radiation therapy.

What is the duration of radiation therapy?

The duration of the course of radiation therapy depends on the characteristics of the disease, the dose and the method of radiation used.The course of gamma therapy generally takes 6 to 8 weeks (30-40 sessions). In most cases, radiation therapy is well tolerated by the patient and hospitalization is not required. For certain indications, radiation therapy is performed in a hospital setting.

90,000 PET CT for breast cancer

Breast cancer is the No. 1 cause of death among cancer in women. Every year, up to 1,000,000 new cases are detected in the world, more than 70,000 in Russia, and the number is constantly growing.

And these are not just statistics.

This is one woman every hour who is diagnosed with a tumor for the first time.

These are 47 children who are deprived of their mothers every day.

This is every eighth woman in Russia who is fighting for her life and health.

Systematic screening tests reduce morbidity by 30%, and at an early stage, more than 90% can recover completely.

We are ready to help and increase the chances – not just to identify a tumor, but also to clarify its nature, degree of malignancy, prevalence, to assess the response to treatment.

How PET CT helps in breast cancer

PET CT detects the disease at an early stage. Computed tomography in “tandem” with the introduction of 18F-FDG – fluorodeoxyglucose labeled with fluorine-18 isotope. The drug is accumulated by tumor cells, and a CT scanner specifies exactly where this tumor is located.

This one performs a number of tasks and is suitable for:

• Refine screening data – Finding a malignant neoplasm before symptoms appear.With the help of PET CT, it is possible to identify a lesion with a size of 4 mm and to take action before the tumor begins to spread.
• Diagnostics of the primary tumor – determination of its localization, size, activity of metabolic processes, degree of malignancy. With these data, the doctor is able to plan the treatment in such a way as to achieve the best possible treatment result.
• Staging – to determine the size of the tumor, the defeat of regional lymph nodes and the detection of metastasis in other organs.PECT CT gives a clear idea of ​​whether the tumor has spread to soft tissues, bones, other organs, which helps to prescribe adequate complex therapy.
• Treatment planning – With the help of diagnostic data, the doctor plans the volume of surgery, as well as radiation and chemotherapy, allowing a targeted effect on the focus. The method avoids unnecessary interventions and their side effects.
• Observations after surgery, radiation and chemotherapy – to adjust the treatment regimen in time and, if necessary, change it with minimal damage to the body.This improves the prognosis and reduces risks.
• Evaluations of the treatment results – how much it was possible to get rid of the tumor with the help of surgery, radiation therapy, chemotherapy techniques. The role of PET CT in treatment can hardly be overestimated – the technique shows how the tumor reacted and allows you to decide on further tactics.
• Detection of relapse – to start a new course of treatment on time and eliminate the lesion before it reaches a significant size, thereby prolonging the patient’s life.

What are the benefits of PET CT in breast cancer?

• Does not cause pain or discomfort – quickly, efficiently and safely performs its tasks – the search for malignant neoplasms in the mammary gland and throughout the body.
• Detects a tumor before symptoms develop – when you can still do with minimal intervention, and reduce the amount of damage to the body and the risks of complications of treatment.
• Allows you to develop an individual tactics of therapy , taking into account the characteristics of a specific tumor, stage of breast cancer, the general condition of the patient’s body, for the most effective treatment.

What does this mean for you?

PET CT of the mammary glands and the whole body gives you the opportunity to:

• Get more information for your doctor to make the right decision, develop optimal tactics and help you.
• Reduce anxiety levels – you worry less because you understand what the doctor is doing and why.
• Avoid unnecessary interventions , which in your case are inappropriate, and the risks associated with them.
• Make sure that the treatment is effective , or that you need to change the regimen. You have information and can make informed decisions.
• Seek medical attention as soon as possible if relapse occurs, to take action before the tumor manifests itself.

Who needs PET CT?

• Those with signs of breast cancer, to clarify the nature of the tumor;
• For those who want to know if other organs are affected or not;
• Those whose doctor is planning a biopsy;
• Those whose doctor is planning an operation;
• Those who have already been operated on to develop further treatment tactics;
• For those who have completed the full course and want to know the result;
• Those who have entered remission – for periodic monitoring of the condition;
• Those who have increased tumor markers – in order to detect relapse in time and start treatment.

Why contact the Center for Medicine and Nuclear Technology?

1. We work with leading industry experts – our doctors have worked for many years in leading centers of the country, are members of the European Association of Nuclear Medicine, the European Society of Radiologists, are engaged in both practical medicine and scientific research, publish, speak at specialized conferences.
2. We specialize in oncology, radiology, radiology .We are competent in diagnostics in the field of breast cancer and other localizations. We know how various tumors behave, their early signs, and are ready to provide full information.
3. We provide diagnostic accuracy – Thanks to many years of practical experience, we can confidently exclude or confirm the presence of a malignant neoplasm and its stage.
4. We produce radiopharmaceuticals ourselves – which allows us not to depend on suppliers and ensure uninterrupted operation.All planned examinations are done on time so that patients do not waste precious time.
5. We guarantee compliance with international GMP standards – we work according to protocols accepted all over the world. This allows patients to seek treatment both in Russian and foreign clinics, with the results of our research.
6. Providing status information – you receive a conclusion, snapshots with key moments and a record on disk. A full interpretation of the results is given by your doctor, taking into account the signs of breast cancer, the results of additional methods, including the study of PEC CT.
7. We protect the interests of patients – adhering to strict confidentiality, and do not transfer information about you to third parties.

PET CT provides the maximum information in breast cancer and at the same time does not give side effects and is performed without discomfort for the patient.

Don’t waste your time. Take the chance.

Ultrasound of the pancreas in Saratov

Clinic “Alfa-Health Center” invites you to undergo an ultrasound scan of the pancreas at a reasonable price.The examination is carried out by experienced doctors-diagnosticians; the clinic uses modern digital equipment. The interpretation of the ultrasound results is ready in a few minutes. In our clinic, you can also get advice from qualified doctors, do laboratory tests, and undergo additional examinations.

Structure and function of the pancreas

The organ is an important part of the digestive system. The pancreas performs both exo- and endocrine functions.In functional cells, pancreatic juice is produced, hormones glucagon, insulin, ghrelin are synthesized, which is responsible for the manifestation of appetite. The gland is actively involved in digestion and metabolism.

The structures of the organ are quite sensitive, therefore, even small violations are manifested by a deterioration in well-being. The cause of pancreatic disease can be food or drug poisoning, long-term medication, bad habits, poor ecological environment, etc.e. Under the influence of external factors, tissues lose their functionality.

Indications for ultrasound of the pancreas

The organ is located behind the stomach and closed with ribs, therefore, it is impossible to detect pathologies by palpation. An ultrasound examination of the pancreas helps to accurately establish the pathology, assess changes in the patient’s condition during treatment.

Indications for the examination:

• pain in the left hypochondrium;
• fast weight loss for no apparent reason;
• past history of hepatitis;
• bitterness in the mouth;
• yellowing of mucous membranes and skin;
• bloating, upset stools;
• closed abdominal trauma;
• suspicion of a tumor;
• postoperative period;
• congenital anomalies;
• corresponding deviations in blood tests;
• pathology of the stomach and duodenum on x-ray, etc.d.

What an ultrasound scan of the pancreas shows

Ultrasound data is analyzed in combination with the results of other diagnostic methods. The sonogram shows the shape, size, contours, structure of the tissues of the pancreas, the state of the parenchyma, the vascular network.

With the help of ultrasound, they diagnose:

• Pancreatitis The enlargement of the gland is determined, on the screen it looks white. A decrease in echogenic activity indicates acute pancreatitis, an increase – about chronic.
• Neoplasm. The tumor itself may not be visible. A neoplasm is suspected by the deviation of individual parts of the pancreas. The doctor carefully examines the sonogram of each part of the organ, determining the possible location of the tumor. Indirectly, pathology may be indicated by a change in the shape and size of nearby structures.
• Pancreatic necrosis. Extensive abscesses, exudates, stones, etc. are visualized.
• Small gland.The organ is reduced in size, but the pathology does not show clinical symptoms. The tissue structure is homogeneous, within normal limits. As a rule, shrinkage is a natural process for an aging patient.
• Lipomatosis. The so-called lobular pancreas is visualized on the screen. Functional tissue is replaced by adipose tissue, which has a higher echogenic activity.
• Inflammation. Visible diffuse enlargement of the gland, thickened tissue. Such pathologies require urgent additional examination of patients.

Ultrasound also determines the presence of scars, cysts, pseudocysts, calcium salt deposits. The interpretation of the examination results is individual. An enlarged pancreas on ultrasound and other pathologies indicate only a functional disorder. Therefore, an examination of one organ is rarely carried out, more often the abdominal cavity and the retroperitoneal space as a whole are examined. The pathologies of the adjacent tissues help to more accurately assess the condition of the pancreas. To establish a diagnosis, you will also need laboratory tests, which can be passed in our clinic.

Norm of ultrasound of the pancreas for women and men

A healthy organ in men and women has a homogeneous integral structure. The presence of small seals is considered a normal option. The echogenic activity of tissues increases with aging of the body. In a healthy gland, the body, isthmus, head, tail, Wirsung duct with a diameter of not more than 2.5 mm are clearly defined. The contours should be even.

Normally, the ultrasound scan of the pancreas in women and men has a body size of 8-18 mm (up to 25 mm), a tail – 22-24 mm (up to 30 mm), a head – 18-28 mm (up to 32 mm).Indicators are approximate and vary greatly depending on the age, gender of the patient, the presence of diseases of the gastrointestinal tract.

Patient’s age, years	Gland body length, mm	Gland head length, mm	Gland tail length, mm
4-6	6-8	7-9	9-11
7-9	8-10	12-14	14-16
13-15	12-14	16-17	17-18
18 +	8-18	18-28	22-24

Contraindications to ultrasound of the pancreas

There are no direct contraindications.The method is non-invasive, painless, does not create radiation exposure to the body. You can do an ultrasound of the pancreas for an adult, a child, a pregnant woman. The presence of wounds, acute eczema in the abdominal area limits the possibilities of research – this impedes the movement of the sensor, worsens its contact with the skin and may affect the accuracy of the diagnosis. In these cases, the procedure is postponed until healing.

How is an ultrasound scan

An ultrasound examination of the pancreas takes a few minutes.The patient is placed on a couch in a supine position. During the examination, the doctor may ask the patient to lie on his right side or stand up – in such positions, individual parts of the organ are better visible.

Before the start of the ultrasound, a gel is applied to the abdomen, which enhances the acoustic transparency of the tissues. The doctor moves the scanner, receiving a three-dimensional image on the monitor. On command, it is necessary to inflate the abdomen or hold the breath so that the intestinal loops move, allowing better visualization of the gland.

What does the interpretation of the ultrasound results include

The basis for a medical opinion is a sonogram – a graphic display of an organ obtained as a result of the transformation of reflected sound waves.

In conclusion, the pancreas is described in detail:

• shape, size;
• clarity and evenness of the contours;
• location of the gland relative to adjacent organs and the spine;
• the structure of the pancreatic duct;
• echogenic tissue activity;
• features of individual elements of the pancreas.

If the parameters correspond to the norm, then the organ is considered healthy. Each discrepancy is described in the conclusion.

Make an appointment for ultrasound of the pancreas in Saratov

All types of examinations, including ultrasound of various organs, are carried out in the clinic “Alpha-Health Center”.

Why choose “Alpha Health Center”:

• A wide range of services. In the clinic, you can get advice from an endocrinologist, gastroenterologist, oncologist, doctors of related specialties based on the results of ultrasound, and undergo additional examinations.You don’t have to travel to different medical centers looking for a good doctor or a modern laboratory.
• High diagnostic accuracy. For ultrasound, a new generation General Electric LOGIQ scanner is used. The equipment shows a clear sonogram without distortion and interference. An experienced doctor using such a device will reveal even minor deviations from the norm.
• Comfortable conditions. Reception is by appointment. The patient chooses the day and time for an ultrasound scan of the pancreas.No queues or long waiting times. For small patients, we have installed children’s corners where the child can have an interesting time before the appointment. Our employees are always friendly, polite, answer all questions of patients in detail.
• Affordable prices. The cost of ultrasound of the pancreas is indicated on our website. Prices for additional consultations and analyzes can be checked with the registrars of the clinic.

To make an appointment for an ultrasound scan in Saratov, call us or fill out the feedback form.

Ultrasound of the thyroid gland – inquire about the service, make an appointment. MEDSI network of clinics in Barnaul

Make an appointment for diagnostics for patients with complaints about:

• lethargy, apathy, weakness and fatigue
• nervousness, irritability and mood swings
• increase or decrease in body weight without changing the schedule of physical activity and diet
• arrhythmia (after examination of the cardiovascular system)
• increased hair loss
• brittle nails
• skin deterioration
• hand tremor
• a slight increase in body temperature (up to 38 degrees)
• sensation of a foreign object in the throat
• tickling and coughing without other signs of colds and flu

An ultrasound scan is also carried out for prophylactic purposes.

Diagnostics are assigned at:

• Planning and Pregnancy
• diabetes
• hereditary tendency to thyroid diseases
• work in hazardous industries

The examination is recommended for all patients over the age of 40.

Also, it should be passed by people taking various hormonal drugs.

Important! For preventive purposes, ultrasound examination is performed at least once a year. In some cases, patients are referred for diagnosis more frequently.

The technique is relevant not only in identifying pathologies and making a diagnosis, but also in treatment, as it allows you to increase the effectiveness of therapy by changing medications, their dosages, time of administration, etc.

The thyroid gland is examined using ultrasound and if neoplasms are suspected.The technique has gained relevance and as allowing to control the puncture. Ultrasound ensures accurate material sampling.

The modern diagnostic technique makes it possible to identify such common pathological conditions and diseases as:

• Hypothyroidism. This disease is characterized by a reduction in the production of hormones due to a decrease in its size. Pathology proceeds with such general symptoms as weakness and lethargy, low body temperature, swelling, sexual dysfunction and depression of mental activity
• Thyroiditis. This disease is inflammatory. It can be provoked by viruses and bacteria. The pathology is characterized by symptoms such as headaches, discomfort in the neck, fever
• Diffuse toxic goiter. Pathology develops with an increase in the thyroid gland in volume. Goiter patients suffer from hyperexcitability and irritability and an increased heart rate. Often, patients also suffer from changes in body weight
• Nodular goiter. With this formation, the lump is easily felt on the neck. Different stages of goiter are characterized by their own symptoms. Usually patients themselves notice nodes in the thyroid gland
• Cysts, benign and malignant tumors. These neoplasms form gradually and may not appear at first

An endocrinologist can identify other diseases and pathological conditions.

Important! You should not try to diagnose yourself by decoding the results of the examination.This task should be solved exclusively by a specialist. He focuses not only on the indicators of the norm, but also on his own skills and knowledge. Also, the endocrinologist takes into account the results of laboratory tests, instrumental and functional examinations. This allows us to identify all pathologies and select therapy, taking into account the individual characteristics of the patient, detected and concomitant diseases, as well as a number of other factors.

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