Testicular cancer

Testicular cancer: Excerpt from Professional Guide to Diseases (Eighth Edition)

Malignant testicular tumors primarily affect young to middle-aged men and are the most common solid tumor in this group. (In children, testicular tumors are rare.) Most testicular tumors originate in gonadal cells. About 40% are seminomas — uniform, undifferentiated cells resembling primitive gonadal cells. The remainder are nonseminomas — tumor cells showing various degrees of differentiation. The prognosis varies with the cell type and disease stage, but testicular cancer is considered curable. When treated with surgery and radiation, almost all patients with localized disease survive beyond 5 years.

Causes and incidence

The cause of testicular cancer 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. Testicular cancer is rare in nonwhite males and accounts for fewer than 1% of male cancer deaths. Testicular cancer spreads through the lymphatic system to the iliac, para-aortic, and mediastinal lymph nodes and may metastasize to the lungs, liver, viscera, and bone.

Signs and symptoms

The first sign is usually a firm, painless, and smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness. When such a tumor causes chorionic gonadotropin or estrogen production, gynecomastia and nipple tenderness may result. In advanced stages, signs and symptoms include ureteral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor, and lethargy.

Diagnosis

Two effective means of detecting a testicular tumor are regular self-examinations and testicular palpation during a routine physical examination. Transillumination can distinguish between a tumor (which doesn't transilluminate) and a hydrocele or spermatocele (which does). Follow-up measures should include an examination for gynecomastia and abdominal masses.

Diagnostic tests include excretory urography to detect ureteral deviation resulting from para-aortic node involvement, urinary or serum luteinizing hormone levels, blood tests, lymphangiography, ultrasound, and abdominal computed tomography scan. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels — indicators of testicular tumor activity — provide a baseline for measuring response to therapy and determining the prognosis.

Surgical excision and biopsy of the tumor and testis permits histologic verification of the tumor cell type — essential for effective treatment. Inguinal exploration determines the extent of nodal involvement. (See Staging testicular cancer.)

Treatment

The extent of surgery, radiation, and chemotherapy varies with tumor cell type and stage. Surgery includes orchiectomy and retroperitoneal node dissection. Most surgeons remove the testis, not the scrotum (to allow for a prosthetic implant). Hormone replacement therapy may be needed after bilateral orchiectomy.

Radiation of the retroperitoneal and homolateral iliac nodes follows removal of a seminoma. All positive nodes receive radiation after removal of a nonseminoma. Patients with retroperitoneal extension receive prophylactic radiation to the mediastinal and supraclavicular nodes.

Essential for tumors beyond stage 0, chemotherapy combinations include bleomycin, etoposide, and cisplatin; etoposide and cisplatin; and cisplatin. Chemotherapy and radiation followed by autologous bone marrow transplantation may help unresponsive patients.

Special considerations

Develop a care plan that addresses both the patient's psychological and physical needs.

Before orchiectomy:

❑Reassure the patient that sterility and impotence need not follow unilateral orchiectomy, that synthetic hormones can restore hormonal balance, and that most surgeons don't remove the scrotum. In many cases, a testicular prosthesis can correct anatomic disfigurement.

After orchiectomy:

❑For the first day after surgery, apply an ice pack to the scrotum and provide analgesics, as ordered.

❑Check for excessive bleeding, swelling, and signs of infection.

❑Provide a scrotal athletic supporter to minimize pain during ambulation.

During chemotherapy:

❑Give antiemetics, as needed, for nausea and vomiting. Encourage small, frequent meals to maintain oral intake despite anorexia. Establish a mouth care regimen and check for stomatitis. Watch for signs of myelosuppression. If the patient receives vinblastine, assess for neurotoxicity (peripheral paresthesia, jaw pain, and muscle cramps). If he receives cisplatin, check for ototoxicity. To prevent renal damage, encourage increased fluid intake and provide I.V. fluids, a potassium supplement, and diuretics, as ordered.

Pictures

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

More About Testicular Cancer

• Back to disease: Testicular Cancer: Introduction
• Next Book Extract About Testicular Cancer: Malignant spinal neoplasms (Professional Guide to Diseases (Eighth Edition))
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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