Testicular Cancer
Testicular cancer is a disease in which cancer cells are discovered in one or both testicles. Testicular cancers are malignant neoplasm of testicular tissue or germ cells.
Risk Factors
· An undescended testicle (cryptorchidism)
The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer in either testicle than are men whose testicles descended normally. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.
· Abnormal testicle development
Conditions that cause testicles to develop abnormally, such as Klinefelter's syndrome, may increase your risk of testicular cancer.
· Family history
If family members have had testicular cancer, you may have an increased risk.
· Age
Testicular cancer affects teens and younger men, particularly those between ages 15 and 34; however, it can occur at any age.
· Race and Ethnicity
Caucasian American men have a five times greater risk than that of African American men.
· An undescended testicle (cryptorchidism)
The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer in either testicle than are men whose testicles descended normally. The risk remains even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.
· Abnormal testicle development
Conditions that cause testicles to develop abnormally, such as Klinefelter's syndrome, may increase your risk of testicular cancer.
· Family history
If family members have had testicular cancer, you may have an increased risk.
· Age
Testicular cancer affects teens and younger men, particularly those between ages 15 and 34; however, it can occur at any age.
· Race and Ethnicity
Caucasian American men have a five times greater risk than that of African American men.
Signs and Symptoms
The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness in the scrotum, inguinal area, or lower abdomen. Enlargement of the testis without pain is a significant diagnostic finding.
In advanced stages, signs and symptoms include urethral obstruction, abdominal mass, cough, hemoptysis, and shortness of breath, weight loss, fatigue, pallor and lethargy.
The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness in the scrotum, inguinal area, or lower abdomen. Enlargement of the testis without pain is a significant diagnostic finding.
In advanced stages, signs and symptoms include urethral obstruction, abdominal mass, cough, hemoptysis, and shortness of breath, weight loss, fatigue, pallor and lethargy.
Causes
The cause is still isn’t known, but incidence (which peaks between ages 20 and 40) is higher in men with cryptorchidism (even when surgically corrected) and in men whose mothers used diethylstilbestrol during pregnancy. Exposure to certain chemicals, infection with human immunodeficiency virus and a family history of testicular cancer increases the risk.
Detection and Diagnosis of Testicular Cancer
Two effective means of decting a testicular tumor are regular self examinations and testicular palpation during a routine physical examination.
The cause is still isn’t known, but incidence (which peaks between ages 20 and 40) is higher in men with cryptorchidism (even when surgically corrected) and in men whose mothers used diethylstilbestrol during pregnancy. Exposure to certain chemicals, infection with human immunodeficiency virus and a family history of testicular cancer increases the risk.
Detection and Diagnosis of Testicular Cancer
Two effective means of decting a testicular tumor are regular self examinations and testicular palpation during a routine physical examination.
Transillumination, differentiates between a tumor (will not transilluminate; this is the process of passing a light through the wall of a bodily cavity, membrane, etc, in order to detect fluid, lesions, any abnormalities etc) and a hydrocele or spermatocele (which will transilluminate). Follow up measures should include an examination for gynecomastia and abdominal masses.
Diagnostic
tests: includes excretory urography to detect urethral deviation resulting from
para-aortic node involvement, urinary or serum luteinizing hormone levels, ultrasound
and abdominal compound tomography scan. Serum alpha-ferprotein and beta-human
chorionic gonadotropin level, indicators of testicular activity, provide a
baseline for measuring response to therapy and determining the prognosis.
Surgical excision and biopsy, of the tumor and the testis permits histological verification for effective treatment.
Inguinal exploration determines the extent of nodal involvement.
Surgical excision and biopsy, of the tumor and the testis permits histological verification for effective treatment.
Inguinal exploration determines the extent of nodal involvement.
Pictures of Testicular Cancer
Treatment
Testicular cancer is one of the most curable solid tumors. The goals of management are to eradicate the disease and achieve a cure. Treatment selection is based on the cell type and the anatomic extent of the disease. The testis is removed by orchiectomy through an inguinal incision with a high ligation of the spermatic cord. A gel-filled prosthesis is implanted. After unilateral orchiectomy of the testicular cancer patients may have decreased hormonal levels, suggesting that the unaffected testis is not functioning at normal levels.
Retroperitoneal lymph node dissection to prevent lymphatic spread of the cancer may be performed after orchiectomy. Patients may develop complications such as ejaculatory dysfunction with resultant infertility.
Testicular carcinomas are highly responsive to chemotherapy. Chemotherapy with cisplatin-based regimens results in a high percentage of complete remissions.
Postoperative irradiation of the lymph nodes from the diaphragm to the iliac region is used in treating seminomas. Radiation is delivered only to the affected side; the other testis is shielded from radiation to preserve fertility. Radiation is also used for patients whose disease does not respond chemotherapy or for whom lymph node surgery is not recommended. Lymph angiograms and Computed Tomography (CT) scans are used to determine spread of the disease to the lymph nodes.
Good results may be obtained by combining different types of treatment, including surgery, radiation therapy, and chemotherapy.
Long-term side effects associated with treatments for testicular cancer include kidney damage, hearing problems, gonad damage, and neurological changes.
Testicular cancer is one of the most curable solid tumors. The goals of management are to eradicate the disease and achieve a cure. Treatment selection is based on the cell type and the anatomic extent of the disease. The testis is removed by orchiectomy through an inguinal incision with a high ligation of the spermatic cord. A gel-filled prosthesis is implanted. After unilateral orchiectomy of the testicular cancer patients may have decreased hormonal levels, suggesting that the unaffected testis is not functioning at normal levels.
Retroperitoneal lymph node dissection to prevent lymphatic spread of the cancer may be performed after orchiectomy. Patients may develop complications such as ejaculatory dysfunction with resultant infertility.
Testicular carcinomas are highly responsive to chemotherapy. Chemotherapy with cisplatin-based regimens results in a high percentage of complete remissions.
Postoperative irradiation of the lymph nodes from the diaphragm to the iliac region is used in treating seminomas. Radiation is delivered only to the affected side; the other testis is shielded from radiation to preserve fertility. Radiation is also used for patients whose disease does not respond chemotherapy or for whom lymph node surgery is not recommended. Lymph angiograms and Computed Tomography (CT) scans are used to determine spread of the disease to the lymph nodes.
Good results may be obtained by combining different types of treatment, including surgery, radiation therapy, and chemotherapy.
Long-term side effects associated with treatments for testicular cancer include kidney damage, hearing problems, gonad damage, and neurological changes.
References:
Braun, C. A., & Anderson, C. M. (2007). Alterations in Cellular Profileration Differientation. Pathophysiology: Functional Alterations in Human Health (p. 180). USA: Lippincot Williams & Wilkins.
Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2003). Brunner & Suddarth's textbook of medical-surgical nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Hansen, M. (1998). Disorders of the Male Reproductive System . Pathophysiology Foundations of Disease and Clinical Intervention (p. 877). Philadelphia: W.B. Company.
Yuan, S. Y. (2004). Testicular Cancer. Handbook of Diseases (pp. 841-842). Philadelphia: Lippincott Williams & Wilkins. (Original work published 2001)