i'd just been on a month-long holiday. i sat opposite the doctor. he ran his finger around a dark blur on anultrasound scan. then he said the scariest words i have everheard. this is typical of a large cancer mass. prostate cancer stage 3b. are you a man with prostate cancer? do you want to understand your disease soyou can talk sensibly to your doctors? you're in the right place - so am i.
i'm not a doctor. i'm just a man with locally advanced prostatecancer. one of the things the doctor said was staget3 something, something. was this stage number another measure of aggressiveness like gleason score? i cover gleason score in another video. i came to understand the t3 thing was aboutprostate cancer staging - particularly tnm staging. an explanation of tnm staging is fairly simple. but it helps to know a little basic anatomy,which not all my audience may know.
so, a few quiz questions, after the fashionof the tv show qi. ok, contestants, hands on buzzers, no conferring,no saying the answer out loud. our first question: your probably know that the heart pumps theblood around the body. an easy question to see first if you knowsimple terms. all the fresh blood flows from the heart throughthe arteries. all the used blood flows to the heart throughthe veins. true or false? if you said true, stand up and take a bow.now!
if you took a bow, i guess you don't watchqi. qi is full of tricky questions where the answermost people would give is wrong. the screen flashes black, and a klaxon sounds. which i simulate now [noisy klaxon] the reason you were wrong was that i said all the used blood. not all the used blood flows back throughthe veins - which will become clearer when you answerthe next question:
during the time it takes for the 5 litresof blood in your body to circulate around your body, about 10% of is extracted as aclear-ish fluid and takes a different path. can you name that fluid. i'll take a medical term, or a less politeterm as an answer. if your answer was urine, or pee, or piss.stand up and take a bow that 5 or so litres of blood circulates aroundyour body in around one minute. i'm afraid that if 10% of your blood everyminute was destined for the toilet, very simple maths shows you would last nolonger than 10 minutes! the medical term for the clear-ish fluid fromyour blood that does not flow back to your
heart through your veins is lymph. i don't know any less polite terms. so, roughly speaking, your heart pumps 100%of your fresh blood through your arteries and 90% of your used blood through your veins. 10% of your used blood travels back to theheart through your lymphatic system. what moves the lymph through the lymphaticsystem back to the heart: pumping of the heart skeletal muscles such as the muscles thatmove your arms and legs? smooth muscles similar to the muscles thatmove food through your bowels along the lymphatic
tubes? muscles that you use to breathe? a series of one-way valves inside the lymphatictubes? did you say the heart? not the heart! here we can see a section of the tube thatthe lymph flows along, a lymph vessel. that green blob in the lymph vessel is lymphwhich will travel up the vessel. the pairs of blue lines are one-way valves. here they are closed as they normally are.
the red ovals either side of the tube aremuscles. when these muscles contract they will pushthe lymph against the one-way valves. like this. the valves only work one way, so the bottomvalve stays shut, while the top valve opens to let the lymph through. when the muscles relax again, as here, thelymph is on its way. so, when you squash a lymphatic tube, thelymph can only flow towards the heart. and what can squash a lymphatic tube? your skeletal muscles like those in your armsand legs.
your breathing muscles that move your diaphragm. and, in some places, some special smooth muscles that just workon the lymphatic tubes. so for full points, you had to choose allfour of answers b, c, d, and e. one time we notice the lymphatic system iswhen it goes wrong. if we don't work our skeletal muscles - especiallyarms and legs - or our breathing muscles enough, the lymph cannot flow back, and collects,especially in low places. so, if you spend time as a couch potato, ortrapped in an aircraft seat for a long time, you may notice the lymph collecting aroundyour feet and ankles, making them swell.
oedema is the medical term. another time we notice the lymphatic systemis when it is going right - when it is doing part of its job. which brings us to our next question: ok, hands on buzzers, no conferring, no sayingthe answer out loud. i went to the doctor recently and reportedfeeling a little off colour. the doctor put his hands on me something likethis. what was the doctor looking for? five points if your answer had lymph nodesin it.
ten points if your answer had swollen lymphnodes in it. in around 100 places around your body thereis a bulge in the lymph vessel called a lymph node. one of the jobs of a lymph node is to helpthe immune system to handle infection. as it fights infection it temporarily swells. many lymph nodes are hidden well inside yourbody. but some, like those in your neck, under yourarmpit, or in your groin are close enough for the doctor to feel. you can feel them yourself.
if the doctor feels the lymph nodes here areswollen, he or she will perhaps be looking for a throat infection. final question on lymph nodes. in a few places in the body there are bunchesof lymph nodes. i'm in my late sixties as i make this video. i'll be in my early seventies when you arewatching it. i've lost a couple of bunches of lymph nodes.what is the most likely cause? if you said cancer, stand up and take a bow... if you dare
certainly if you've had surgery for cancer,you may have lost some lymph nodes at that time. but take yourself a full 10 points if yousaid tonsils. the two bunches of lymph nodes either sideof the throat are called the tonsils. chronic infection of the tonsils is sometimestoday dealt with by surgical removal. but when people my age were younger tonsilremoval was much more common, and that's the most likely reason people myage have lost bunches of lymph nodes. but i digress. enough of the qi type questions for now.
back to the topic of cancer stage, particularlythe t n m stage. no. it's not a measure of aggressiveness - that'sgleason score, and there's another video on that. i promised you that tnm staging is simple.here it is: doctors use the tnm stage to tell where thecancer is. that's t for tumor. tumor is another name for cancer. n for nodes.
that's lymph nodes. you should know a bitabout them now. m for metastases. metastases are bits of cancer growing awayfrom the original site. let me show you the tnm stages. this is my picture of a prostate. the real thing is probably not so pretty. but i am not a doctor, or anything medical,so i wouldn't know, really. the prostate has a sort of skin around it,called the capsule wall. apparently it is quite thin. but i have mademine thick and orange so you can see it better.
the prostate is made of two lumpy bits calledlobes. i'll just show them with a line down the middle. there are important bits around the prostateand running through it. but i like things simple, so the only thingsi am going to show are the seminal vesicles. i don't know exactly where they attach, orwhat they look like, so i put them at the top. the seminal vesiclesmake part of the fluid for sex. so first the t rating. t for tumour. tumour is another name for cancer. your t rating tells about the cancer thatstarted growing in your prostate.
t1, t2, t3, t4 higher numbers are generally more serious. i can't picture t1 cancers. a t1 cancer can't be felt by a doctor, orseen on a scan. so we'll start with t2 cancers. t2 cancerscan be felt by doctors. here's our first one. the cancer is completely inside the capsule. the cancer is completely inside one lobe. the cancer takes up less that half of onelobe.
this is called a t2a cancer. here's our next one. the cancer takes up more that half of thelobe. this is called a t2b cancer. the cancer is inside both lobes. this is called a t2c cancer. so, the key thing about t2 cancers is that they are completely contained within the prostate. t2a - less than half of one lobe
t2b - more than half of one lobe t2c - both lobes now we move to the t3 cancers. if the cancer has grown right through thecapsule wall, but not into any other organs it is t3a. it has to be right through the capsule wall. just growing into the capsule wall itselfis not enough. next, here's where our seminal vesicles comein. if the cancer has grown through the capsulewall and up into one or both the seminal vesicles,
we call it t3b. the final t rating - t4 comes if the cancerhas grown out of the prostate and into other organs - like the bladder or bowel which are both uncomfortablyclose by. so: t3a - growing through the wall t3b - growing into the seminal vesicles t4 - growing into other nearby organs. in short:
t2 the cancer is completely contained withinthe prostate. t3 the cancer has grown through the prostatewall. t4 the cancer has grown through the prostatewall into vital organs. so the t of tnm was about the cancer in yourprostate and how far it grew. n and m are about any new cancers it may havestarted in other parts of your body. n is for node - lymph nodes - but not allthe lymph nodes. for the n rating, doctors are only interestedin the lymph nodes that are near to your prostate. if you are close enough to the screen, youcan see some of the lymph nodes around this man's body.
zero of them have any cancer so he scoresn0. this guy is not so lucky. one of the lymphnodes near to his prostate has cancer. let me highlight that. because he has cancer in one or more lymphnodes near his prostate he scores n1. so n: no nearby lymph nodes n0. one or more nearby lymph nodes n1. finally we move to cancers that have movedfurther afield - the m for metastasis score. first the guy with zero distant cancers.
he scores m0 next a guy who has cancer in a lymph nodenot near his prostate. he looks to have his cancer spread to nearhis arm pit. he scores m1a next a far more common case. if prostate cancer spreads we say metastasisesit prefers bone 90% of the time. if prostate cancer gets to the bone, it scoresm1b. the final m score is for a cancer that isgrowing in soft tissue away from the prostate. looks like this man might have prostate cancerin the pancreas, spleen, liver ...
i don't know enough about the body to tell. anyway - prostate cancer spread to soft tissueaway from the prostate - he scores m1c. i should clear up something here. wherever prostate cancer spreads, it is stillprostate cancer. prostate cancer in the bone is still prostatecancer, not bone cancer. under the microscope, your pathologist cansee the difference. prostate cancer in the liver is still prostatecancer, not liver cancer. prostate cancer in the lung is still prostatecancer, not lung cancer. and so on ...
so now we have a t rating, an n rating andan m rating. they are combined. if a man has cancer growing through the prostatewall into a seminal vesicle, that's t3b. with no cancer in lymph nodes near the prostate,that's n0. with no cancers yet found distant from theprostate that's m0. so thats t3b n0 m0, or t3 for short, or locallyadvanced in common language. just in case there is a newly diagnosed manwith a locally advanced cancer, a t3, listening to this who is wondering whetherhe has 2 weeks or 2 months ahead of him, it may help him to know this.
my prostate cancer was large. it filled the right side of my prostate, itspilled into the left side. it was growing through the wall of the prostatein two places, including up and around a nearby organ, the seminal vesicles. the gleason score of six out of six of thebiopsy samples on the right side was 5+4=9. in all a large, locally advanced, aggressivecancer. as i make this video, that was almost sixyears ago, and my psa is currently undetectable - so don't panic. if you are a man with advanced prostate cancer- locally advanced, like me,
metastatic, that is spread to other parts, or recurrent, returned after your first treatment, there is a group of men helping each otherunderstand the disease. the advanced prostate cancer support groupoffers information and online forums at jimjim jimjim dot com. that's the word jim four times, no spaces,dot com. nothing else - just dot com. thank you.
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