Causes of Testicular Cancer
Testicular Cancer Causes: Book Excerpts
Testicular Cancer as a complication of other conditions:
Other conditions that might have
Testicular Cancer as a complication may,
potentially, be an underlying cause of Testicular Cancer.
Our database lists the following as having
Testicular Cancer as a complication of that condition:
Testicular Cancer as a symptom:
Conditions listing Testicular Cancer
as a symptom may also be potential underlying causes of Testicular Cancer.
Our database lists the following as having
Testicular Cancer as a symptom of that condition:
Medical news summaries relating to Testicular Cancer:
The following medical news items are relevant to causes of Testicular Cancer:
Related information on causes of Testicular Cancer:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Testicular Cancer may be found in:
Causes of Testicular Cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Testicular Cancer.
Scrotal Swelling:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Hydrocele
–Fluid surrounding the testicle
–Typically seen in infancy
–Results from remnant of testicular descent from the abdomen through the inguinal canal into the scrotum
–May be communicating or noncommunicating; communicating hydroceles have retained patency of the tract of descent, and noncommunicating hydroceles do not
–Communicating hydroceles may be reducible and are likely to fluctuate in size depending on the amount of fluid within the scrotal sac; crying or any increase in intra-abdominal pressure results in an increase in size
–Usually is noncommunicating; i.e., not reducible, and does not change in size with crying
–Testes may be difficult to palpate because surrounded by the hydrocele
- Hernia
–Protrusion of a loop of bowel into the scrotum
–Direct hernias represent a channel directly through the musculature of the pelvic floor; indirect hernias have proceeded through the inguinal canal
–Usually painless unless incarcerated
–Usually reducible and changes in size with changes in intra-abdominal pressure
–Testes usually palpable below the hernia
-
Varicocele
–A collection of dilated veins in the scrotum
–Usually painless, but patients may complain
of heaviness
-
Edema
–Generalized edema often is accompanied by scrotal edema
-
Tumor
–Presents as painless nodule on testes
–May be accompanied by sexual precocity or
gynecomastia secondary to hormone production by the tumor
-
Leukemia
–Patients may present with unilateral scrotal swelling (common site for relapse)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scrotal swelling:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Epididymal cysts
Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have a high fever, malaise, an urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; a fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
Spermatocele is a usually painless cystic mass that lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hypogonadism:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Primary hypogonadism results directly from interstitial (Leydig’s cell) cellular or seminiferous tubular damage due to faulty development or mechanical damage. This causes increased secretion of gonadotropins by the pituitary in an attempt to increase the testicular functional state and is therefore termed hypergonadotropic hypogonadism. This form of hypogonadism includes Klinefelter syndrome, Reifenstein’s syndrome, Turner syndrome, Sertoli-cell-only syndrome, anorchism, orchitis, and sequelae of irradiation.
Secondary hypogonadism is due to faulty interaction within the hypothalamic-pituitary axis, resulting in failure to secrete normal levels of gonadotropins, and is therefore termed hypogonadotropic hypogonadism. This form of hypogonadism includes hypopituitarism, isolated follicle-stimulating hormone deficiency, isolated luteinizing hormone deficiency, Kallmann’s syndrome, and Prader-Willi syndrome. Depending on the patient’s age at onset, hypogonadism may cause eunuchism (complete gonadal failure) or eunuchoidism (partial failure).
Medications, such as exogenous testosterone or anabolic steroids, can also cause of hypogonadism, resulting in infertility.
Hypogonadism is rare, and it has no racial predilection.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Testicular cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
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.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Primary tumors of the spinal cord may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extramedullary tumors may be intradural (meningiomas and schwannomas), which account for 60% of all primary malignant spinal cord neoplasms, or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas), which account for 25% of these malignant neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively rare, accounting for only about 10%. In children, they're low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4). They occur equally in men and women, with the exception of meningiomas, which occur mostly in women. Spinal cord tumors can occur anywhere along the length of the cord or its roots.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant brain tumors:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of most brain tumors is unknown, but exposure to ionizing radiation is a known environmental risk. Additionally, most malignant tumors of the brain are of metastatic origin; 20% to 40% of patients with cancer develop brain metastasis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Primary malignant bone tumors:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Causes of primary malignant bone tumors are unknown. Some researchers suggest that primary malignant bone tumors arise in areas of rapid growth because children and young adults with such tumors seem to be much taller than average. Additional theories point to heredity, trauma, and excessive radiotherapy.
For incidence information, see Comparing primary malignant bone tumors.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Bladder cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Certain environmental carcinogens, such as 2-naphthylamine, benzidine, tobacco, and nitrates, predispose people to transitional cell tumors. Thus, workers in certain industries (rubber workers, weavers and leather finishers, aniline dye workers, hair-dressers, petroleum workers, and spray painters) are at high risk for such tumors. The period between exposure to the carcinogen and development of symptoms is about 18 years.
Squamous cell cancer of the bladder is most common in geographic areas where schistosomiasis is endemic. It's also associated with chronic bladder irritation and infection (for example, from renal calculi, indwelling urinary catheters, and cystitis caused by cyclophosphamide).
Bladder tumors are most prevalent in men older than age 50 and are more common in densely populated industrial areas.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Breast cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of breast cancer isn't known, but its high incidence in women implicates estrogen.
Certain predisposing factors are clear; women at high risk include those who have a family history of breast cancer, particularly first-degree relatives (mother, sister, and maternal aunt).
Other women at high risk include those who:
❑have long menstrual cycles or began menses early (before age 12) or menopause late (after age 55)
❑have taken hormonal contraceptives
❑used hormone replacement therapy for more than 5 years
❑who took diethylstilbestrol to prevent miscarriage
❑have never been pregnant
❑were first pregnant after age 30
❑have had unilateral breast cancer
❑have had ovarian cancer — particularly at a young age
❑were exposed to low-level ionizing radiation.
Recently, scientists have discovered the BRCA1 and BRCA2 genes. Mutations in these genes are thought to be responsible for less than 10% of breast cancers. However, these discoveries have made genetic predisposition testing an option for women at high risk for breast cancer.
Women at lower risk include those who:
❑were pregnant before age 20
❑have had multiple pregnancies
❑are Native American or Asian.
Most breast cancer deaths occur in women age 50 and older (84% of cases), and 77% of new breast cancer cases occur in this age-group. However, it may develop any time after puberty. It occurs in men, but rarely; male cases of breast cancer account for less than 1% of all cases.
The 5-year survival rate for localized breast cancer has improved because of earlier diagnosis and the variety of treatments now available. According to the most recent data, mortality rates continue to decline in White women and, for the first time, are also declining in younger Black women. Lymph node involvement is the most valuable prognostic predictor. With adjuvant therapy, 70% to 75% of women with negative nodes will survive 10 years or more compared with 20% to 25% of women with positive nodes.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cancer of the vulva:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Although the cause of cancer of the vulva is unknown, several factors seem to predispose women to this disease:
❑chronic pruritus of the vulva, with friction, swelling, and dryness
❑ chronic vulvar granulomatous disease
❑ diabetes
❑ hypertension
❑ irradiation of the skin such as nonspecific treatment for pelvic cancer
❑ leukoplakia (white epithelial hyperplasia) — in about 25% of patients
❑ obesity
❑ pigmented moles that are constantly irritated by clothing or perineal pads
❑ sexually transmitted diseases (herpes simplex, condyloma acuminatum caused by human papilloma virus).
Cancer of the vulva accounts for approximately 4% of all gynecologic malignancies. It can occur at any age, even in infants, but its peak incidence is in the mid-60s. The most common vulval cancer is squamous cell cancer. Early diagnosis increases the chance of effective treatment and survival. Lymph node dissection allows 5-year survival in 85% of patients if it reveals no positive nodes; otherwise, the survival rate falls to less than 75%.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cervical cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Although the cause is unknown, several predisposing factors have been related to the development of cervical cancer: frequent intercourse at a young age (younger than age 16), multiple sexual partners, multiple pregnancies, exposure to sexually transmitted diseases (particularly genital human papillomavirus), and smoking.
In almost all cases of cervical cancer (95%), the histologic type is squamous cell cancer, which varies from well-differentiated cells to highly anaplastic spindle cells. Only 5% are adenocarcinomas. Usually, invasive cancer occurs between ages 30 and 50; rarely, in patients younger than age 20.
In 2000, 12,800 women were diagnosed with cervical cancer and there were 4,600 deaths from this disease.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Colorectal cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The exact cause of colorectal cancer is unknown, but studies showing concentration in areas of higher economic development suggest a relationship to diet (excess saturated animal fat). Other factors that magnify the risk of developing colorectal cancer include:
❑other diseases of the digestive tract
❑age (older than age 40)
❑history of ulcerative colitis (average interval before onset of cancer is 11 to 17 years)
❑familial polyposis (cancer almost always develops by age 50).
There are more than 130,000 cases of colorectal cancer diagnosed in the United States each year. It's the second-leading cause of cancer-related death, accounting for more than 50,000 per year. However, in almost all cases, it's treatable if caught early by colonoscopy.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of esophageal cancer is unknown, but among predisposing factors are chronic irritation caused by heavy smoking and excessive use of alcohol, stasis-induced inflammation, nutritional deficiency, and diets high in nitrosamines. A genetic link has been proposed concerning an overexpression and mutation of the p53 tumor suppressor gene. Esophageal tumors are usually fungating and infiltrating. Most arise in squamous cell epithelium. However, the number of adenocarcinomas is greatly rising in the United States. Melanomas and sarcomas are few.
Regardless of type, esophageal cancer is usually fatal, with a 5-year survival rate of approximately 10% and regional metastasis occurring early via submucosal lymphatics. Metastasis produces such serious complications as tracheoesophageal fistulas, mediastinitis, and aortic perforation. Common sites of distant metastasis include the liver and lungs. (See Staging esophageal cancer.)
Esophageal cancer most commonly develops in men older than age 60 and is nearly always fatal. This disease occurs worldwide, but incidence varies geographically. It's most common in Japan, China, the Middle East, and parts of South Africa.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Fallopian tube cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The causes of fallopian tube cancer aren't clear, but this disease appears to be linked with nulliparity. In fact, over one-half of the women with this disease have never had children.
Fallopian tube cancer usually occurs in postmenopausal women in their 50s and 60s but occasionally is found in younger women.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gallbladder and bile duct cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Gallbladder cancer may result from a complication of gallstones. However, this inference rests on circumstantial evidence from postmortem examinations: 60% to 90% of gallbladder cancer patients also have gallstones, but postmortem data from patients with gallstones show gallbladder cancer in only 0.5%.
The predominant tissue type in gallbladder cancer is adenocarcinoma, 85% to 95%; squamous cell, 5% to 15%. Mixed-tissue types are rare.
Lymph node metastasis is present in 25% to 70% of patients at diagnosis. Direct extension to the liver is common (in 46% to 89%); direct extension to both the cystic and the common bile ducts, stomach, colon, duodenum, and jejunum also occurs and produces obstructions. Metastasis also spreads by portal or hepatic veins to the peritoneum, ovaries, and lower lung lobes.
The cause of extrahepatic bile duct cancer isn't known; however, statistics report an unexplained increased incidence of this cancer in patients with ulcerative colitis. This association may be due to a common cause — perhaps an immune mechanism, or chronic use of certain drugs by the colitis patient.
Extrahepatic bile duct cancer is the cause of approximately 3% of all cancer deaths in the United States. It occurs in both males and females (incidence is slightly higher in males) between ages 60 and 70. The usual site is at the bifurcation in the common duct. Cancer at the distal end of the common duct is commonly confused with cancer of the pancreas. Characteristically, metastatic spread occurs to local lymph nodes, the liver, lungs, and the peritoneum.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gastric cancer:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of gastric cancer is unknown. It's commonly associated with gastritis with gastric atrophy, which may result from gastric cancer and may not be a precursor state. Predisposing factors include environmental influences, such as smoking and high alcohol intake. Genetic factors have also been implicated because this disease occurs more commonly among people with type A blood than among those with type O; similarly, it's more common in people with a family history of gastric cancer. Dietary factors also seem related, including types of food preparation, physical properties of some foods, and certain methods of food preservation (especially smoking, pickling, or salting). There's a strong correlation between infection with Helicobacter pylori and distal gastric cancer.
Gastric cancer is common throughout the world and affects all races; however, unexplained geographic and cultural differences in incidence occur — for example, a higher mortality in Japan, Iceland, Chile, and Austria. In the United States, during the past 25 years, incidence has decreased by 50% and the resulting death rate is one-third what it was 30 years ago. Incidence is higher in males older than 40. Hispanic, Native, and African Americans are twice as likely to develop gastric cancer than Whites. The prognosis depends on the stage of the disease at the time of diagnosis; however, the overall 5-year survival rate is approximately 19%.
The decrease in gastric cancer in the United States has been attributed, without proof, to the balanced American diet and to refrigeration, which reduces nitrate-producing bacteria in food.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Scrotal swelling:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Elephantiasis of the scrotum
With this disorder (common in some tropical countries), infection by a filaria worm obstructs lymphatic drainage, causing chronic gross scrotal edema and pain. Associated findings include other areas of pitting and, eventually, brawny edema (especially the legs), thickened subcutaneous tissue, hyperkeratosis, and skin fissures.
Epididymal cysts
Located in the head of the epididymis, these cysts produce painless scrotal swelling.
Epididymal tuberculosis
This disorder produces an enlarged scrotal mass separated from the testicle. Other findings include palpable beading along the vas deferens, induration of the prostate or seminal vesicles, and pus or tubercle bacilli in the urine.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Gumma
This rare, painless nodule—usually associated with benign tertiary syphilis—can affect any bone or organ. If it affects the testicle, it causes edema.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with this disorder and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate this disorder, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal burns
Burns cause swelling within 24 hours of injury. Depending on the burn’s severity, associated findings may include severe pain, erythema, chafing, tissue sloughing, and maceration with a weeping exudate.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
This usually painless cystic mass lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, this urologic emergency causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of this small, pea-sized cyst severs its blood supply, causing a hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Scrotal Pain/Swelling:
Differential Overview
(Field Guide to Bedside Diagnosis)
Pain Predominant
❑ Epididymitis
❑ Testicular torsion
❑ Prostatitis
❑ Referred pain
❑ Trauma
❑ Orchitis
❑ Torsion of the appendix testis
❑ Inguinal hernia/incarcerated
Swelling Predominant
❑ Varicocele
❑ Inguinal hernia
❑ Hydrocele
❑ Spermatocele
❑ Sebaceous cyst
❑ Testicular cancer
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Source: Field Guide to Bedside Diagnosis, 2007
Testicular cancer:
Causes
(Handbook of Diseases)
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. Exposure to certain chemicals, infection with human immunodeficiency virus, and a family history of testicular cancer increase risk. (Testicular cancer accounts for 1% of all cancers in men.)
Testicular cancer spreads through the lymphatic system to the para-aortic, iliac, and mediastinal lymph nodes and may metastasize to the lungs, liver, viscera, and bone.
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Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Causes
(Handbook of Diseases)
Although some cases of osteosarcoma are associated with genetic abnormalities (retinoblastoma, Rothmund Thomson syndrome) or exposure to carcinogens (such as ingested radium in watch dial painters), most cases have no immediately apparent cause. Ewing’s sarcoma cells demonstrate a characteristic translocation of genetic material from chromosome 22 to chromosome 11. Additional theories point to heredity, trauma, and excessive radiation therapy.
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Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Causes
(Handbook of Diseases)
Some tumors are congenital, whereas others are hereditary. The cause of most brain tumors is unknown.
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Source: Handbook of Diseases, 2003
Bladder cancer:
Causes
(Handbook of Diseases)
Certain environmental carcinogens — such as 2-naphthylamine, benzidine, tobacco, and nitrates — predispose people to transitional cell tumors. Thus, workers in certain industries (rubber workers, weavers, leather finishers, aniline dye workers, hairdressers, petroleum workers, and spray painters) are at high risk for such tumors. The period between exposure to the carcinogen and development of symptoms is about 18 years.
Squamous cell carcinoma of the bladder is most common in geographic areas where schistosomiasis is endemic. It’s also associated with chronic bladder irritation and infection (for example, from kidney stones, indwelling urinary catheters, and cystitis caused by cyclophosphamide).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Breast cancer:
Causes
(Handbook of Diseases)
The cause of breast cancer is unknown, but its high incidence in women implicates estrogen. Certain predisposing factors are clear; women at high risk include those who:
❑ have a family history of breast cancer
❑ have long menses; began menses early or menopause late
❑ have never been pregnant
❑ were first pregnant after age 31
❑ have had unilateral breast cancer
❑ have had endometrial or ovarian cancer
❑ have been exposed to low-level ionizing radiation.
Many other predisposing factors have been investigated, including estrogen therapy, antihypertensives, high-fat diet, obesity, and fibrocystic disease of the breasts.
Women at lower risk include those who:
❑ were pregnant before age 20
❑ have had multiple pregnancies
❑ are Indian or Asian.
Pathophysiology
Breast cancer is more common in the left breast than in the right and more common in the upper outer quadrant. Growth rates vary. Theoretically, slow-growing breast cancer may take up to 8 years to become palpable at 1 cm in size. It spreads by way of the lymphatic system and the bloodstream, through the right side of the heart to the lungs and, eventually, to the other breast, the chest wall, liver, bone, and brain.
Many refer to the estimated growth rate of breast cancer as doubling time, or the time it takes the malignant cells to double in number. Survival time for breast cancer is based on tumor size and spread; the number of involved nodes is the single most important factor in predicting survival time.
Classified by histologic appearance and location of the lesion, breast cancer may be:
❑ adenocarcinoma — arising from the epithelium
❑ intraductal — developing within the ducts (includes Paget’s disease)
❑ infiltrating — occurring in parenchymatous tissue of the breast
❑ inflammatory (rare) — reflecting rapid tumor growth, in which the overlying skin becomes edematous, inflamed, and indurated
❑ lobular carcinoma in situ — reflecting tumor growth involving lobes of glandular tissue
❑ medullary or circumscribed — a large tumor with a rapid growth rate.
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Source: Handbook of Diseases, 2003
Cervical cancer:
Causes
(Handbook of Diseases)
The human papillomavirus (HPV) is accepted as the cause of virtually all cervical dysplasias and cervical cancers. Certain strains of the HPV (16, 18, 31) are associated with an increased risk of cervical cancer. Several predisposing factors have been related to the development of cervical cancer: intercourse at a young age (younger than age 16), multiple sexual partners, and herpesvirus 2 and other bacterial or viral venereal infections.
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Source: Handbook of Diseases, 2003
Colorectal cancer:
Causes
(Handbook of Diseases)
The exact cause of colorectal cancer is unknown, but studies showing concentration in areas of higher economic development suggest a relation to diet (excess animal fat, particularly beef, and low fiber). Other factors that increase the risk of developing colorectal cancer include:
❑ other diseases of the digestive tract
❑ age (older than 40)
❑ history of ulcerative colitis (the average interval before onset of cancer is 11 to 17 years)
❑ familial polyposis (cancer almost always develops by age 50).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Esophageal cancer:
Causes
(Handbook of Diseases)
The cause of esophageal cancer is unknown, but predisposing factors include chronic irritation caused by heavy smoking and excessive use of alcohol, stasis-induced inflammation, and nutritional deficiency. Esophageal tumors are usually fungating and infiltrating. Most arise in squamous cell epithelium, a few are adenocarcinomas, and fewer still are melanomas and sarcomas.
Esophageal cancer has a 5-year survival rate below 10%, and regional metastasis occurs early by way of submucosal lymphatics. Metastasis produces such serious complications as tracheoesophageal fistulas, mediastinitis, and aortic perforation. Common sites of distant metastasis include the liver and lungs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Gallbladder and bile duct cancers:
Causes
(Handbook of Diseases)
Many consider gallbladder cancer a complication of gallstones. This inference rests on circumstantial evidence from postmortem examinations: 60% to 90% of all gallbladder cancer patients also have gallstones. Postmortem data from patients with gallstones show gallbladder cancer in only 0.5%.
Adenocarcinoma accounts for 85% to 95% of all cases of gallbladder cancer; squamous cell carcinoma accounts for 5% to 15%. Mixed-tissue types are rare.
Lymph node metastasis is present in 25% to 70% of patients at diagnosis. Direct extension to the liver is common (46% to 89% of patients); direct extension to the cystic and the common bile ducts as well as the stomach, colon, duodenum, and jejunum produces obstructions. Metastasis also occurs through the portal or hepatic veins to the peritoneum, ovaries, and lower lung lobes.
The cause of extrahepatic bile duct cancer isn’t known, but statistics reveal an unexplained increased incidence of this cancer in patients with ulcerative colitis. This association may be attributed to a common cause — perhaps an immune mechanism or chronic use of certain drugs by the patient with colitis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Gastric cancer:
Causes
(Handbook of Diseases)
The cause of gastric cancer is unknown. This cancer is commonly associated with gastritis, chronic inflammation of the stomach, gastric ulcers, Helicobacter pylori bacteria, and gastric atrophy. Predisposing factors include environmental influences, such as smoking and high alcohol intake.
Genetic factors have also been implicated because this disease occurs more frequently among people with type A blood than among those with type O; similarly, it’s more common in people with a family history of such cancer.
Dietary factors include types of food preparation, physical properties of some foods, and certain methods of food preservation (especially smoking, pickling, and salting).
Classification
According to gross appearance, gastric cancer can be classified as polypoid, ulcerating, ulcerating and infiltrating, or diffuse. The parts of the stomach affected by gastric cancer, listed in order of decreasing frequency, are the pylorus and antrum (50%), the lesser curvature (25%), the cardia (10%), the body of the stomach (10%), and the greater curvature (2% to 3%).
Metastasis
Gastric cancer metastasizes rapidly to the regional lymph nodes, omentum, liver, and lungs by the following routes: walls of the stomach, duodenum, and esophagus; lymphatic system; adjacent organs; bloodstream; and peritoneal cavity.
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Source: Handbook of Diseases, 2003
Kidney cancer:
Causes
(Handbook of Diseases)
The cause of kidney cancer is unknown. However, the incidence of this cancer is rising, possibly as a result of exposure to environmental carcinogens as well as increased longevity. Even so, kidney cancer accounts for only about 2% of all adult cancers. It’s twice as common in men as in women and usually affects patients older than age 40.
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Source: Handbook of Diseases, 2003
Laryngeal cancer:
Causes
(Handbook of Diseases)
With laryngeal cancer, major predisposing factors include smoking and alcoholism; minor factors include chronic inhalation of noxious fumes and familial tendency.
Laryngeal cancer is classified according to its location:
❑ supraglottis (false vocal cords)
❑ glottis (true vocal cords)
❑ subglottis (downward extension from the vocal cords [rare]).
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Source: Handbook of Diseases, 2003
Liver cancer:
Causes
(Handbook of Diseases)
The immediate cause of liver cancer is unknown, but it may be a congenital disease in children. Adult liver cancer may result from environmental exposure to carcinogens, such as the chemical compound aflatoxin (a mold that grows on rice and peanuts), thorium dioxide (a contrast medium formerly used in liver radiography), Senecio alkaloids, androgens, or oral estrogens.
Risk factors
Roughly 30% to 70% of patients with hepatomas also have cirrhosis. (Hepatomas are 40 times more likely to develop in a cirrhotic liver than in a normal one.) Whether cirrhosis is a premalignant state or alcohol and malnutrition predispose the liver to develop hepatomas is still unclear. Another risk factor is exposure to the hepatitis B virus, although this risk will probably decrease with the availability of the hepatitis B vaccine.
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Source: Handbook of Diseases, 2003
Lung cancer:
Causes
(Handbook of Diseases)
Most experts agree that lung cancer is attributable to inhalation of carcinogenic pollutants by a susceptible host. Most susceptible are those persons who smoke or who work with or near asbestos.
Pollutants in tobacco smoke cause progressive lung cell degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers; indeed, 80% of lung cancer patients are or were smokers.
Cancer risk is determined by the number of cigarettes smoked daily, the depth of inhalation, how early in life smoking began, and the nicotine content of the cigarettes. Two other factors also increase susceptibility: exposure to carcinogenic industrial and air pollutants (asbestos, uranium, arsenic, nickel, iron oxides, chromium, radioactive dust, and coal dust), and familial susceptibility.
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Source: Handbook of Diseases, 2003
Ovarian cancer:
Causes
(Handbook of Diseases)
The exact cause of ovarian cancer is unknown, but its incidence is noticeably higher in women of upper socioeconomic levels between the ages of 20 and 54. However, it can occur during childhood. Certain genes, including BRCA1 and BRCA2, may increase risk. Other contributing factors include age at menopause; infertility; celibacy; high-fat diet; exposure to asbestos, talc, and industrial pollutants; nulliparity; familial tendency; and history of breast or uterine cancer.
Primary epithelial tumors arise in the müllerian epithelium; germ cell tumors, in the ovum itself; and sex cord tumors, in the ovarian stroma (the ovary’s supporting framework).
Ovarian tumors spread rapidly intraperitoneally by local extension or surface seeding and, occasionally, through the lymphatics and the bloodstream. Generally, extraperitoneal spread is through the diaphragm into the chest cavity, which may cause pleural effusions. Other types of metastasis are rare.
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Source: Handbook of Diseases, 2003
Scrotal swelling:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Elephantiasis of the scrotum
With elephantiasis of the scrotum (common in some tropical countries), infection by a filaria worm obstructs lymphatic drainage, causing chronic gross scrotal edema and pain. Associated findings include other areas of pitting and, eventually, brawny edema (especially the legs), thickened subcutaneous tissue, hyperkeratosis, and skin fissures.
Epididymal cysts
.Located in the head of the epididymis, these cysts produce painless scrotal swelling.
Epididymal tuberculosis
Epididymal tuberculosis produces an enlarged scrotal mass separated from the testicle. Other findings include palpable beading along the vas deferens, induration of the prostate or seminal vesicles, and pus or tubercle bacilli in urine.
Epididymitis
Key features of inflammation are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Gumma
Gumma is a rare, painless nodule — usually associated with benign tertiary syphilis — that can affect any bone or organ. If it affects the testicle, it causes edema.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum.
Hydrocele
Fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema
Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate acute orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum accompanied by fever of up to 104° F (40° C), chills, lower abdominal pain, nausea, vomiting, and extreme weakness. Urinary signs are usually absent.
Scrotal burns
Burns cause swelling within 24 hours of injury. Depending on the burn’s severity, associated findings may include severe pain, erythema, chafing, tissue sloughing, and maceration with a weeping exudate.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele
This usually painless cystic mass lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common between ages 12 and 25 years, testicular torsion — a urologic emergency — causes scrotal swelling with sudden, severe pain and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni
Torsion of a hydatid of Morgagni — a small, pea-sized cyst — severs its blood supply, causing hard, painful swelling on the testicle’s upper pole.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Scrotal swelling:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Epididymal cysts
Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling. Most men, however, are asymptomatic and discover the cyst on self-examination.
Epididymitis
Key features of epididymitis are inflammation, pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have high fever, malaise, urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hernia
Herniation of bowel into the scrotum can cause swelling and a soft or unusually firm scrotum. Occasionally, bowel sounds can be auscultated in the scrotum. If bowel obstruction occurs, anorexia, nausea, vomiting, and reduced bowel sounds may occur.
Hydrocele
With hydrocele, fluid accumulation produces gradual scrotal swelling that’s usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Orchitis (acute)
Mumps, syphilis, or tuberculosis may precipitate acute orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma
Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish. Nausea, vomiting, and difficulty urinating might also occur.
Spermatocele
A spermatocele, a usually painless cystic mass, lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it’s movable and may be transilluminated.
Testicular torsion
Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. Testicular torsion may also cause nausea and vomiting.
Testicular tumor
Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum. With ureteral obstruction, the patient may have urinary complaints.
Other causes
Surgery
An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Scrotal swelling:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Epididymal cysts. Located in the head of the epididymis, epididymal cysts produce painless scrotal swelling.
Epididymitis.Key features of epididymitis are pain, extreme tenderness, and swelling in the groin and scrotum. The patient waddles to avoid pressure on the groin and scrotum during walking. He may have a high fever, malaise, a urethral discharge and cloudy urine, and lower abdominal pain on the affected side. His scrotal skin may be hot, red, dry, flaky, and thin.
Hydrocele.With a hydrocele, fluid accumulation produces gradual scrotal swelling that's usually painless. The scrotum may be soft and cystic or firm and tense. Palpation reveals a round, nontender scrotal mass.
Idiopathic scrotal edema.Swelling occurs quickly with idiopathic scrotal edema and usually disappears within 24 hours. The affected testicle is pink.
Orchitis (acute).Mumps, syphilis, or tuberculosis may precipitate orchitis, which causes sudden painful swelling of one or, at times, both testicles. Related findings include a hot, reddened scrotum; a fever of up to 104° F (40° C); chills; lower abdominal pain; nausea; vomiting; and extreme weakness. Urinary signs are usually absent.
Scrotal trauma.Blunt trauma causes scrotal swelling with bruising and severe pain. The scrotum may appear dark or bluish.
Spermatocele.Spermatocele is a usually painless cystic mass that lies above and behind the testicle and contains opaque fluid and sperm. Its onset may be acute or gradual. Less than 1 cm in diameter, it's movable and may be transilluminated.
Testicular torsion.Most common before puberty, testicular torsion is a urologic emergency that causes scrotal swelling; sudden, severe pain; and, possibly, elevation of the affected testicle within the scrotum. It may also cause nausea and vomiting.
Testicular tumor.Typically painless, smooth, and firm, a testicular tumor produces swelling and a sensation of excessive weight in the scrotum.
Torsion of a hydatid of Morgagni.Torsion of this small, pea-size cyst severs its blood supply, causing a hard, painful swelling on the testicle's upper pole.
Other causes
Surgery.An effusion of blood from surgery can produce a hematocele, leading to scrotal swelling.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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