Treatments for Testicular Cancer
Treatments for Testicular Cancer
The list of treatments mentioned in various sources
for Testicular Cancer
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Testicular Cancer: Marketplace Products, Discounts & Offers
Products, offers and promotion categories available for Testicular Cancer:
Testicular Cancer: Research Doctors & Specialists
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Testicular Cancer:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Testicular Cancer include:
Hospital statistics for Testicular Cancer:
These medical statistics relate to hospitals, hospitalization and Testicular Cancer:
- 0.043% (5,466) of hospital consultant episodes were for malignant neoplasm of testis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 98% of hospital consultant episodes for malignant neoplasm of testis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 100% of hospital consultant episodes for malignant neoplasm of testis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 10% of hospital consultant episodes for malignant neoplasm of testis required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 3.6 days was the mean length of stay in hospitals for malignant neoplasm of testis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Hospitals & Medical Clinics: Testicular Cancer
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Medical news summaries about treatments for Testicular Cancer:
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Scrotal Swelling:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Hydrocele
–Usually resolves spontaneously by 1 year of age
–Surgery is indicated at 6–12 months if stable, sooner if hydrocele is tense or progressively enlarging
-
Hernia
–Inguinal hernias must be repaired surgically to avoid incarceration
–Contralateral side is frequently explored surgically and closed if necessary
-
Varicocele: Can be associated with infertility and may need to be surgically repaired
-
Edema: Treatment of the cause of generalized edema
-
Tumor and leukemia: Management by pediatric oncologist
-
Men and teenage boys should be taught testicular self-examination to assist with early detection of testicular cancer
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Scrotal swelling:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If severe pain accompanies scrotal swelling, ask the patient when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hypogonadism:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment depends on the underlying cause and may consist of hormonal replacement, especially with testosterone, methyltestosterone, estrogen, progesterone, or human chorionic gonadotropin (hCG) for primary hypogonadism, and with hCG for secondary hypogonadism. Fertility can’t be restored after permanent testicular damage. However, eunuchism that results from hypothalamic-pituitary lesions can be corrected when administration of gonadotropins stimulates normal testicular function.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Testicular cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
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.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of spinal cord tumors generally includes decompression or radiation. Laminectomy is indicated for primary tumors that produce spinal cord or cauda equina compression; it isn't usually indicated for metastatic tumors. If the tumor is slowly progressive or if it's treated before the cord degenerates from compression, symptoms are likely to disappear, and complete restoration of function is possible. In a patient with metastatic carcinoma or lymphoma who suddenly experiences complete transverse myelitis with spinal shock, functional improvement is unlikely, even with treatment, and his outlook is ominous. If the patient has incomplete paraplegia of rapid onset, emergency surgical decompression may save cord function. Steroid therapy with dexamethasone minimizes cord edema and temporarily relieves symptoms until surgery can be performed. Partial removal of intramedullary gliomas, followed by radiation, may alleviate symptoms for a short time. Metastatic extradural tumors can be controlled with radiation, analgesics and, in the case of hormone-mediated tumors (breast and prostate), appropriate hormone therapy. Transcutaneous electrical nerve stimulation (TENS) may control radicular pain from spinal cord tumors and is a useful alternative to opioid analgesics. In TENS, an electrical charge is applied to the skin to stimulate large-diameter nerve fibers and thereby inhibit transmission of pain impulses through small-diameter nerve fibers. Chemotherapy generally hasn't proven effective against most spinal tumors, but may be recommended in some cases.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant brain tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment includes removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor's histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with diuretics, cortico-steroids, or possibly ventriculoatrial or ventriculoperitoneal shunting of CSF.
A glioma usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
Treatment of oligodendrogliomas and ependymomas includes resection and radiation therapy; for medulloblastomas, resection and possibly intrathecal infusion of methotrexate or another antineoplastic drug. Meningiomas require resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
For schwannomas, microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes the nitrosoureas that help break down the blood-brain barrier and allow other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug actions.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema; osmotic diuretics, such as urea and mannitol, to reduce brain swelling; analgesics to control pain; and antacids and histamine receptor antagonists for stress ulcers. These tumors and schwannomas may also require anticonvulsants such as phenytoin to reduce seizures.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Primary malignant bone tumors:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Excision of the tumor with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemo-therapy.
In some patients, radical surgery (such as hemipelvectomy or amputation) is necessary; however, surgical resection of the tumor (commonly with preoperative and postoperative chemotherapy) has saved limbs from amputation.
Intensive chemotherapy includes administration of doxorubicin, vincristine, cyclophosphamide, cisplatin, dacarbazine, and etoposide in various combinations. Chemotherapy may be infused intra-arterially into the long bones of the legs.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Benign tumors of the ear canal:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Generally, a benign tumor requires surgical excision if it obstructs the ear canal, is cosmetically undesirable, or becomes malignant.
Treatment for keloids may include surgery followed by repeated injections of long-acting steroids into the suture line. Excision must be complete, but even this may not prevent recurrence.
Surgical excision of an osteoma consists of elevating the skin from the surface of the bony growth and shaving the osteoma with a mechanical burr or drill.
Before surgery, a sebaceous cyst requires preliminary treatment with antibiotics, to reduce inflammation. To prevent recurrence, excision must be complete, including the sac or capsule of the cyst.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Bladder cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn't invaded the muscle.
Intravesicular chemotherapy is also used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with antineoplastic drugs — most commonly, thiotepa, doxorubicin, mitomycin, or Bacillus Calmette-Guérin immunotherapy.
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn't near the bladder neck or ureteral orifices. Bladder instillation of thiotepa, mitomycin-C, or doxorubicin after transurethral resection may also help control such tumors.
For infiltrating bladder tumors, radical cystectomy is the treatment of choice. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then wear an external pouch continuously. Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Treatment of patients with advanced bladder cancer includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as doxorubicin, methotrexate, vinblastine, and cisplatin. This combination sometimes is successful in arresting bladder cancer. Cisplatin is the most effective single agent.
Investigational treatments include photodynamic therapy and intravesicular administration of interferon-alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily absorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Breast cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Much controversy exists over breast cancer treatments. In choosing therapy, the patient and physician should take into consideration the stage of the disease, the woman's age and menopausal status, and the disfiguring effects of the surgery. Treatment of breast cancer may include one or any combination of the following:
❑Surgery involves either mastectomy or lumpectomy. A lumpectomy may be done on an outpatient basis and may be the only surgery needed, especially if the tumor is small and there's no evidence of axillary node involvement. In many cases, radiation therapy is combined with this surgery.
A two-stage procedure, in which the surgeon removes the lump and confirms that it's malignant and then discusses treatment options with the patient, is desirable because it allows the patient to participate in her plan of treatment. Sometimes, if the tumor is diagnosed as clinically malignant, such planning can be done before surgery. In lumpectomy and dissection of the axillary lymph nodes, the tumor and the axillary lymph nodes are removed, leaving the breast intact. A simple mastectomy removes the breast but not the lymph nodes or pectoral muscles. Modified radical mastectomy removes the breast and the axillary lymph nodes. Radical mastectomy, the performance of which has declined, removes the breast, pectoralis major and minor, and the axillary lymph nodes.
The spread of breast cancer to regional lymph nodes is considered a vital prognostic indicator. Sentinel lymph-node biopsy, a reliable and minimally invasive procedure, is used to identify and sample the sentinel lymph node closest to the breast tumor. During the patient's surgery, the axillary node is injected with dye to help with identification and then sent to the pathologist to assess for cancer spread. If the node is negative, the patient can be spared an axillary node dissection, which carries its own risks and the potential for long-term complications .
Reconstructive breast surgery can be performed at the same time as mastectomy or it can be planned for a later date. Several options are available for breast reconstruction, including the insertion of breast implants or a transverse rectus abdominis musculocutaneous flap.
❑Chemotherapy, involving various cytotoxic drug combinations, is used as either adjuvant or primary therapy, depending on several factors, including the TNM staging and estrogen receptor status. The most commonly used antineoplastic drugs are cyclophosphamide, fluorouracil, methotrexate, doxorubicin, vincristine, and paclitaxel. A common drug combination used in both premenopausal and postmenopausal women is cyclophosphamide, doxorubicin, and paclitaxel.
Tamoxifen, an estrogen antagonist, is the adjuvant treatment of choice for postmenopausal patients with positive estrogen receptor status. It's also been found to reduce the risk of breast cancer in women at high risk.
❑ Peripheral stem cell therapy is an option, but it's rarely used for advanced breast cancer.
❑ Primary radiation therapy before or after tumor removal is effective for small tumors in early stages with no evidence of distant metastasis; it's also used to prevent or treat local recurrence. Presurgical radiation to the breast in inflammatory breast cancer helps make tumors more surgically manageable.
❑ Estrogen, progesterone, androgen, or antiandrogen aminoglutethimide therapy may also be given to breast cancer patients. The success of these drug therapies — along with growing evidence that breast cancer is a systemic, not local, disease — has led to a decline in ablative surgery.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cancer of the vulva:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Depending on the stage of the disease, cancer of the vulva usually calls for radical or simple vulvectomy (or laser therapy, for some small lesions). Radical vulvectomy requires bilateral dissection of superficial and deep inguinal lymph nodes. Depending on the extent of metastasis, resection may include the urethra, vagina, and bowel, leaving an open perineal wound until healing — about 2 to 3 months. Plastic surgery, including mucocutaneous graft to reconstruct pelvic structures, may be done later.
Small, confined lesions with no lymph node involvement may require a simple vulvectomy or hemivulvectomy (without pelvic node dissection). Personal considerations (young age of patient, active sexual life) may also mandate such conservative management. However, a simple vulvectomy requires careful postoperative surveillance because it leaves the patient at higher risk for developing a new lesion.
Chemotherapy alone or in combination with radiation therapy can be used in advanced cases of vulvar cancer. Cisplatin, fluorouracil, bleomycin, and doxorubicin have shown some effectiveness as a palliative treatment option.
If extensive metastasis, advanced age, or fragile health rules out surgery, irradiation of the primary lesion can offer palliative treatment.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cervical cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Appropriate treatment depends on accurate clinical staging. Preinvasive lesions may be treated with total excisional biopsy, cryosurgery, laser destruction, conization (and frequent Pap smear follow-up) or, rarely, hysterectomy. Therapy for invasive squamous cell cancer may include radical hysterectomy and radiation therapy (internal, external, or both). Chemotherapy may be used alone or in combination with radiation therapy in treating cervical cancer. Cisplatin and fluorouracil are the agents used.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Colorectal cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The most effective treatment of colorectal cancer is surgery to remove the malignant tumor and adjacent tissues and any lymph nodes that may contain cancer cells. The type of surgery depends on the location of the tumor:
❑Cecum and ascending colon — right hemicolectomy (for advanced disease) may include resection of the terminal segment of the ileum, cecum, ascending colon, and right half of the transverse colon with corresponding mesentery
❑ Proximal and middle transverse colon — right colectomy to include transverse colon and mesentery corresponding to midcolic vessels, or segmental resection of transverse colon and associated midcolic vessels
❑ Sigmoid colon — surgery is usually limited to sigmoid colon and mesentery
❑ Upper rectum — anterior or low anterior resection (newer method, using a stapler, allows for resections much lower than were previously possible)
❑ Lower rectum — abdominoperineal resection and permanent sigmoid colostomy.
Chemotherapy is indicated for patients with metastasis, residual disease, or a recurrent inoperable tumor. Drugs used in such treatment commonly include fluorouracil with leucovorin, irinotecan, and oxaliplatin.
Radiation therapy induces tumor regression and may be used before or after surgery or combined with chemotherapy, especially fluorouracil.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Multimodal therapy is usually indicated. Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Chemotherapy with 5-fluorouracil or cisplatin may be used. Insertion of prosthetic tubes to bridge the tumor alleviates dysphagia. Other treatments to improve the patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent) and photodynamic therapy.
Treatment complications may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Fallopian tube cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of fallopian tube cancer consists of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy; chemotherapy with progestogens, cyclophosphamide, and cisplatin; and external radiation for 5 to 6 weeks. All patients should receive some form of adjunctive therapy (radiation or chemotherapy), even when surgery has removed all evidence of the disease.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gallbladder and bile duct cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Surgical treatment of gallbladder cancer is essentially palliative and includes various procedures, such as cholecystectomy, common bile duct exploration, T-tube drain-age, and wedge excision of hepatic tissue.
If the cancer invades gallbladder musculature, the survival rate is less than 5%, even with massive resection. Although some cases of long-term survival (4 to 5 years) have been reported, few patients survive longer than 6 months after surgery for gallbladder cancer.
Surgery is normally indicated to relieve obstruction and jaundice that result from extrahepatic bile duct cancer. The procedure used to relieve obstruction depends on the cancer site. Such procedures may include cholecystoduodenostomy or T-tube drainage of the common duct.
Other palliative measures for both kinds of cancer include radiation, radiation implants (mostly used for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, irinotecan, and gemcitabine). All of these treatment measures have limited effects.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gastric cancer:
Treatment
(Professional Guide to Diseases (Eighth Edition))
In many cases, surgery is the treatment of choice. Excision of the lesion with appropriate margins is possible in over one-third of patients. Even in patients whose disease isn't considered surgically curable, resection offers palliation and improves potential benefits from chemotherapy and radiation.
The nature and extent of the lesion determine what kind of surgery is most appropriate. Common surgical procedures include subtotal gastric resection (subtotal gastrectomy) and total gastric resection (total gastrectomy). When carcinoma involves the pylorus and antrum, gastric resection removes the lower stomach and duodenum (gastrojejunostomy or Billroth II). If metastasis has occurred, the omentum and spleen may also have to be removed.
If gastric cancer has spread to the liver, peritoneum, or lymph glands, palliative surgery may include gastrostomy, jejunostomy, or a gastric or partial gastric resection. Such surgery may temporarily relieve vomiting, nausea, pain, and dysphagia, while allowing enteral nutrition to continue.
Chemotherapy for GI cancers may help to control symptoms and prolong survival. Adenocarcinoma of the stomach has responded to several agents, including fluorouracil, paclitaxel, doxorubicin, cisplatin, methotrexate, and mitomycin. Antiemetics can control nausea, which increases as the cancer advances. In the more advanced stages, sedatives and tranquilizers may be necessary to control overwhelming anxiety. Opioids are commonly necessary to relieve severe and unremitting pain.
Radiation has been particularly useful when combined with chemotherapy in patients who have unresectable or partially resectable disease. It should be given on an empty stomach and shouldn't be used preoperatively because it may damage viscera and impede healing.
Treatment with antispasmodics and antacids may help relieve GI distress.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Scrotal swelling:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If severe pain accompanies scrotal swelling, ask when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Testicular cancer:
Treatment
(Handbook of Diseases)
The extent of surgery, radiation, and chemotherapy varies with tumor cell type and stage.
Surgery
Surgical procedures include 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
The retroperitoneal and homolateral iliac nodes may receive radiation after removal of a seminoma. All positive nodes receive radiation after removal of a nonseminoma. Patients with retro-peritoneal extension receive prophylactic radiation to the mediastinal and supraclavicular nodes.
Chemotherapy
Chemotherapy combinations are essential for tumors that have progressed beyond the preinvasive stage with evidence of lymph node metastasis and distant metastasis. Chemotherapy and radiation followed by autologous bone marrow transplantation may help unresponsive patients.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Treatment
(Handbook of Diseases)
❑ Excision of the tumor along with a 3"(7.6 cm) margin is the treatment of choice. It may be combined with preoperative chemotherapy.
❑ In some patients, radical surgery (such as hemipelvectomy or interscapulothoracic amputation) is necessary. However, surgical resection of the tumor (often with preoperative and postoperative chemotherapy) has saved limbs from amputation.
❑ Intensive chemotherapy includes administration of doxorubicin, ifosfamide, cisplatin, and high doses of methotrexate, alone or in various combinations for osteosarcomas. Additionally, vincristine, etoposide, and dactinomycin may be added if the patient has Ewing’s sarcoma. Chemotherapy may be infused intra-arterially into the long bones of the legs.
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Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Treatment
(Handbook of Diseases)
Remedial approaches include removing a resectable tumor; reducing a nonresectable tumor; relieving cerebral edema, increased ICP, and other signs and symptoms; and preventing further neurologic damage.
The mode of therapy depends on the tumor’s histologic type, radiosensitivity, and location and may include surgery, radiation, chemotherapy, or decompression of increased ICP with a diuretic, corticosteroid or, possibly, ventriculoatrial or ventriculoperitoneal shunting of CSF.
❑ Gliomas. Treatment usually requires resection by craniotomy, followed by radiation therapy and chemotherapy. The combination of nitrosoureas (carmustine [BCNU], lomustine [CCNU], or procarbazine) and postoperative radiation is more effective than radiation alone.
❑ Astrocytomas. Surgical resection of low-grade cystic cerebellar astrocytomas brings long-term survival. Treatment of other astrocytomas includes repeated surgery, radiation therapy, and shunting of fluid from obstructed CSF pathways. Some astrocytomas are highly radiosensitive, but others are radioresistant.
❑ Oligodendrogliomas and ependymomas. Treatment includes resection and radiation therapy.
❑ Medulloblastomas. Treatment involves resection and, possibly, intrathecal infusion of methotrexate or another antineoplastic.
❑ Meningiomas. Treatment requires resection, including dura mater and bone (operative mortality may reach 10% because of large tumor size).
❑ Schwannomas. Microsurgical technique allows complete resection of the tumor and preservation of facial nerves. Although schwannomas are moderately radioresistant, postoperative radiation therapy is necessary.
Chemotherapy for malignant brain tumors includes a nitrosourea to help break down the blood-brain barrier and permit other chemotherapeutic drugs to go through as well. Intrathecal and intra-arterial administration of drugs maximizes drug action.
Palliative measures for gliomas, astrocytomas, oligodendrogliomas, and ependymomas include dexamethasone for cerebral edema and an antacid and a histamine-receptor antagonist for stress ulcers. These tumors and schwannomas may also require an anticonvulsant.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Bladder cancer:
Treatment
(Handbook of Diseases)
Appropriate treatment for bladder cancer varies.
Superficial bladder tumors
Superficial bladder tumors are removed by transurethral (cystoscopic) resection and fulguration (electrical destruction). This procedure is adequate when the tumor hasn’t invaded the muscle.
Intravesicular chemotherapy is used for superficial tumors (especially those that occur in many sites) and to prevent tumor recurrence. This treatment involves washing the bladder directly with an antineoplastic — most commonly, thiotepa, doxorubicin, mitomycin, or bacille Calmette-Guérin (BCG).
If additional tumors develop, fulguration may have to be repeated every 3 months for years. However, if the tumors penetrate the muscle layer or recur frequently, cystoscopy with fulguration is no longer appropriate.
Tumors too large to be treated through a cystoscope require segmental bladder resection to remove a full-thickness section of the bladder. This procedure is feasible only if the tumor isn’t near the bladder neck or ureteral orifices. Bladder instillations of thiotepa after transurethral resection may also help control such tumors.
Under study Immunotherapy may be used to fight cancer. BCG is an immunomodulating agent commonly used in the treatment of superficial bladder cancer following surgery to remove the tumor. Biologic response modifiers — such as interferons, interleukins, colony-stimulating factors, monoclonal antibodies, and vaccines — may also be used to alter the interaction between the body’s immune defenses and the cancer cells. The goal is to boost, direct, or restore the body’s ability to fight the disease.
Infiltrating bladder tumors
Radical cystectomy is the treatment of choice for infiltrating bladder tumors. The week before cystectomy, treatment may include external beam therapy to the bladder. Surgery involves removal of the bladder with perivesical fat, lymph nodes, urethra, the prostate and seminal vesicles (in males), and the uterus and adnexa (in females). The surgeon forms a urinary diversion, usually an ileal conduit. The patient must then continuously wear an external pouch. (See Caring for a urinary stoma.) Other diversions include ureterostomy, nephrostomy, vesicostomy, ileal bladder, ileal loop, and sigmoid conduit.
Males are impotent following radical cystectomy and urethrectomy because these procedures damage the sympathetic and parasympathetic nerves that control erection and ejaculation. At a later date, the patient may desire a penile implant to make sexual intercourse (without ejaculation) possible.
Advanced bladder cancer
For patients with advanced bladder cancer, treatment includes cystectomy to remove the tumor, radiation therapy, and systemic chemotherapy with such drugs as cyclophosphamide, fluorouracil, doxorubicin, and cisplatin. This combination sometimes is successful in arresting bladder cancer.
Cisplatin is the single most effective agent.
Investigational treatments
Such treatments include photodynamic therapy and intravesicular administration of interferon alfa and tumor necrosis factor. Photodynamic therapy involves I.V. injection of a photosensitizing agent such as hematoporphyrin ether, which malignant cells readily ab
sorb. Then a cystoscopic laser device introduces laser energy into the bladder, exposing the malignant cells to laser light, which kills them. Because this treatment also produces photosensitivity in normal cells, the patient must totally avoid sunlight for about 30 days.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Breast cancer:
Treatment
(Handbook of Diseases)
Much controversy exists over breast cancer treatments. In choosing therapy, the patient and physician should consider the stage of the disease, the woman’s age and menopausal status, and the disfiguring effects of the surgery. Treatment for breast cancer may include one or any combination of the following.
Surgery
With breast cancer, surgery involves either lumpectomy or mastectomy. A lumpectomy may be done on an outpatient basis and may be the only surgery needed, especially if the tumor is small and there’s no evidence of axillary node involvement. Radiation therapy is often combined with this surgery.
A two-stage procedure, in which the surgeon removes the lump, confirms that it’s malignant, and discusses treatment options with the patient, is desirable because it allows the patient to participate in her treatment plan. Sometimes, if the tumor is diagnosed as malignant, such planning can be done before surgery. In lumpectomy and dissection of the axillary lymph nodes, the tumor and the axillary lymph nodes are removed, leaving the breast intact.
A simple mastectomy removes the breast but not the lymph nodes or pectoral muscles. A modified radical mastectomy removes the breast and the axillary lymph nodes. A radical mastectomy, the performance of which has declined, removes the breast, the pectoralis major and minor, and the axillary lymph nodes.
After a mastectomy, reconstructive surgery can create a breast mound if the patient desires it and doesn’t have evidence of advanced disease.
Chemotherapy, tamoxifen, and peripheral
stem cell therapy
Various cytotoxic drug combinations are used as either adjuvant or primary therapy, depending on several factors, including staging and estrogen receptor status. The most commonly used antineoplastics are cyclophosphamide, fluorouracil, methotrexate, doxorubicin, vincristine, paclitaxel, and prednisone. A common drug combination used in both premenopausal and postmenopausal women is cyclophosphamide, methotrexate, and fluorouracil.
Tamoxifen, an estrogen antagonist, is the adjuvant treatment of choice for postmenopausal patients with positive estrogen receptor status.
Peripheral stem cell therapy may be used for patients with advanced breast cancer.
Primary radiation therapy
Used before or after tumor removal, primary radiation therapy is effective for small tumors in early stages with no evidence of distant metastasis; it’s also used to prevent or treat local recurrence. Presurgical radiation to the breast in patients with inflammatory breast cancer helps make tumors more surgically manageable.
Other drug therapy
Breast cancer patients may also receive estrogen, progesterone, androgen, or antiandrogen aminoglutethimide therapy. The success of these drug therapies with growing evidence that breast cancer is a systemic, not local, disease has led to a decline in ablative surgery.
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Source: Handbook of Diseases, 2003
Cervical cancer:
Treatment
(Handbook of Diseases)
Appropriate treatment depends on accurate staging. Preinvasive lesions may be treated with a loop electrosurgical examination procedure, cryosurgery, laser destruction, conization (and frequent Pap test follow-up) or, rarely, hysterectomy. Therapy for invasive squamous cell carcinoma may include radical hysterectomy and radiation therapy (internal, external, or both). Radiation is effective for all stages, but surgery is preferable for some premenopausal women.
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Source: Handbook of Diseases, 2003
Colorectal cancer:
Treatment
(Handbook of Diseases)
The most effective treatment for colorectal cancer is surgery to remove the malignant tumor and adjacent tissues as well as any lymph nodes that may contain cancer cells. The type of surgery depends on the location of the tumor:
❑ Cecum and ascending colon: A right hemicolectomy (for advanced disease) is performed. It may include resection of the terminal segment of the ileum, cecum, ascending colon, and the right half of the transverse colon with corresponding mesentery.
❑ Proximal and middle transverse colon: A right colectomy is performed that includes the transverse colon and mesentery corresponding to midcolic vessels or segmental resection of the transverse colon and associated midcolic vessels.
❑ Sigmoid colon: Surgery is typically limited to the sigmoid colon and mesentery.
❑ Upper rectum: Anterior or low anterior resection is performed. A newer method, using a stapler, allows for resections much lower than were previously possible.
❑ Lower rectum: Abdominoperineal resection and permanent sigmoid colostomy is performed.
Chemotherapy is indicated for patients with metastasis, residual disease, or a recurrent inoperable tumor. Drugs used in such treatment commonly include fluorouracil with levamisole, leucovorin, methotrexate, or streptozocin. Patients whose tumor has extended to regional lymph nodes may receive fluorouracil and levamisole for 1 year postoperatively.
Radiation therapy induces tumor regression and may be used before or after surgery or combined with chemotherapy, especially fluorouracil.
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Source: Handbook of Diseases, 2003
Esophageal cancer:
Treatment
(Handbook of Diseases)
Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Lash palliation decreases tumor size. Other therapies consist of radiation, chemotherapy with cisplatin, and the insertion of prosthetic tubes to bridge the tumor and alleviate dysphagia.
Treatment complications
Complications of treatment may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.
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Source: Handbook of Diseases, 2003
Gallbladder and bile duct cancers:
Treatment
(Handbook of Diseases)
Surgical treatment of gallbladder cancer is essentially palliative and includes various procedures, such as cholecystectomy, common bile duct exploration, T-tube drainage, and wedge excision of hepatic tissue.
If the cancer invades gallbladder musculature, the survival rate is less than 5%, even with massive resection. Although some cases of long-term survival (4 to 5 years) have been reported, few patients survive longer than 6 months after surgery for gallbladder cancer.
Surgery is normally indicated to relieve the obstruction and jaundice that result from extrahepatic bile duct cancer. The type of procedure used to relieve obstruction depends on the site of the cancer. Such procedures may include cholecystoduodenostomy and T-tube drainage of the common duct.
Clinical tip Other palliative measures for both kinds of cancer include radiation therapy, radiation implants (used mostly for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, doxorubicin, and lomustine). All these treatment measures have limited effects.
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Source: Handbook of Diseases, 2003
Gastric cancer:
Treatment
(Handbook of Diseases)
Surgery is commonly the treatment of choice. Excision of the lesion with appropriate margins is possible in more than one-third of patients. Even in patients whose disease isn’t considered surgically curable, resection offers palliation and improves potential benefits from chemotherapy and radiation therapy.
Surgery
The nature and extent of the lesion determine what kind of surgery is most appropriate. Common surgical procedures include subtotal gastrectomy and total gastrectomy.
When cancer involves the pylorus and antrum, gastrectomy removes the lower stomach and duodenum (gastrojejunostomy or Billroth II). If metastasis has occurred, the omentum and spleen may also have to be removed.
If gastric cancer has spread to the liver, peritoneum, or lymph glands, palliative surgery may include gastro-stomy, jejunostomy, or a total or subtotal gastrectomy. Such surgery may temporarily relieve vomiting, nausea, pain, and dysphagia while allowing enteral nutrition to continue.
Other treatments
Chemotherapy for GI cancers may help to control symptoms and prolong survival. Adenocarcinoma of the stomach has responded to several agents, including fluorouracil, carmustine, doxorubicin, cisplatin, methotrexate, and mitomycin.
Antiemetics can control nausea, which increases as the cancer advances. In the more advanced stages, sedatives and tranquilizers may be necessary to control overwhelming anxiety. Narcotics are necessary in many cases to relieve severe and unremitting pain.
Radiation therapy has been particularly useful when combined with chemotherapy in patients who have unresectable or partially resectable disease. It should be given on an empty stomach and shouldn’t be used preoperatively because it may damage viscera and impede healing.
Treatment with antispasmodics and antacids may help relieve GI distress.
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Source: Handbook of Diseases, 2003
Kidney cancer:
Treatment
(Handbook of Diseases)
Radical nephrectomy, with or without regional lymph node dissection, offers the only chance of cure. Because the disease is radiation-resistant, radiation is used only if the cancer spreads to the perinephric region or the lymph nodes or if the primary tumor or metastatic sites can’t be fully excised. In such cases, high doses of radiation are used.
Chemotherapy has been only erratically effective against kidney cancer and includes various drugs. Interferons and hormones, such as medroxyprogesterone and testosterone, have also been used. Biotherapy (lymphokine-activated killer cells with recombinant interleukin-2) shows promise, but causes adverse reactions. Interferon is somewhat effective in advanced disease. Hormone therapy may be tried in advanced cases.
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Source: Handbook of Diseases, 2003
Laryngeal cancer:
Treatment
(Handbook of Diseases)
Early lesions are treated with surgery or radiation; advanced lesions, with surgery, radiation, and chemotherapy. Chemotherapeutic agents may include methotrexate, cisplatin, bleomycin, fluorouracil, and vincristine.
The treatment goal is to eliminate the cancer and preserve speech. If speech preservation is impossible, speech rehabilitation may include esophageal speech or prosthetic devices; surgical techniques to construct a new voice box are still experimental. Surgical procedures vary with tumor size and can include cordectomy, partial or total laryngectomy, supraglottic laryngectomy, or total laryngectomy with laryngoplasty.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Liver cancer:
Treatment
(Handbook of Diseases)
Because liver cancer is usually in an advanced stage at diagnosis, few hepatic tumors are resectable. A resectable tumor must be a single tumor in one lobe, without cirrhosis, jaundice, or ascites. Resection is done by lobectomy or partial hepatectomy.
Radiation therapy for unresectable tumors is usually palliative. However, because of the liver’s low tolerance for radiation, this therapy hasn’t increased survival.
Another treatment method is chemotherapy either I.V. or with regional infusion of a chemotherapeutic drug. (A catheter is placed directly into the hepatic artery or left brachial artery for continuous infusion for 7 to 21 days, or permanent implantable pumps are used on an outpatient basis for long-term infusion.)
Appropriate treatment for liver metastasis may include resection by lobectomy or chemotherapy. (The results are similar to those in hepatoma.) Liver transplantation is an alternative for some patients.
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Source: Handbook of Diseases, 2003
Lung cancer:
Treatment
(Handbook of Diseases)
Various combinations of surgery, radiation, and chemotherapy may improve the prognosis and prolong survival. Nevertheless, because treatment usually begins at an advanced stage, it’s largely palliative.
Surgery
Unless the tumor is nonresectable or other conditions rule out surgery, excision is the primary treatment for stage I, stage II, or selected stage III squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Surgery may include partial removal of a lung (wedge resection, segmental resection, lobectomy, radical lobectomy) or total removal (pneumonectomy, radical pneumonectomy).
Radiation
Preoperative radiation therapy may reduce tumor bulk to allow for surgical resection. Preradiation chemotherapy helps improve response rates. Radiation therapy is ordinarily recommended for stage I and stage II lesions, if surgery is contraindicated, and for stage III lesions when the disease is confined to the involved hemithorax and the ipsilateral supraclavicular lymph nodes.
Generally, radiation therapy is delayed until 1 month after surgery, to allow the wound to heal, and is then directed to the part of the chest most likely to develop metastasis. High-dose radiation therapy or radiation implants may also be used.
Chemotherapy
Another treatment is chemotherapy, including combinations of drugs, which produce a response rate of about 40%, but have a minimal effect on overall survival. Promising combinations for treating small cell carcinomas include cyclophosphamide with doxorubicin and vincristine; cyclophosphamide with doxorubicin, vincristine, and etoposide; and etoposide with cisplatin, cyclophosphamide, and doxorubicin.
Laser therapy
Some patients may undergo laser therapy, which involves direction of laser energy through a bronchoscope to destroy local tumors.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Ovarian cancer:
Treatment
(Handbook of Diseases)
Depending on the stage of the disease and the patient’s age, treatment of ovarian cancer requires varying combinations of surgery, chemotherapy and, in some cases, radiation. Cytoreductive surgery, in which the tumor nodules are reduced to as small a size as possible, may increase survival time.
Conservative treatment
Occasionally, in girls or young women with a unilateral encapsulated tumor who wish to maintain fertility, the following conservative approach may be appropriate:
❑ resection of the involved ovary
❑ biopsies of the omentum and the uninvolved ovary
❑ peritoneal washings for cytologic examination of pelvic fluid
❑ careful follow-up, including periodic chest X-rays to rule out lung metastasis.
Aggressive treatment
Ovarian cancer usually requires more aggressive treatment, including total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, lymph node biopsies with lymphadenectomy, tissue biopsies, and peritoneal washings.
Complete tumor resection is impossible if the tumor has matted around other organs or if it involves organs that can’t be resected. Bilateral salpingo-oophorectomy in a prepubertal girl necessitates hormone replacement therapy, beginning at puberty, to induce the development of secondary sex characteristics.
Chemotherapy extends survival time in most ovarian cancer patients. Unfortunately, it’s largely palliative in advanced disease, but some patients are achieving prolonged remissions and even cures.
Chemotherapeutic drugs may be used alone; however, they’re usually given in combination. They may be administered intraperitoneally. The preferred first-line regimen is paclitaxel and cisplatin (or carboplatin).
Radiation therapy is generally not used for ovarian cancer because the resulting myelosuppression would limit the effectiveness of chemotherapy. It also has limited efficacy.
Other treatments
Radioisotopes have been used as adjuvant therapy, but they cause small-bowel obstructions and stenosis.
In addition, I.V. administration of biological response modifiers — interleukin-2, interferon, and monoclonal antibodies — may be attempted.
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Source: Handbook of Diseases, 2003
Scrotal swelling:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Keep the patient on bed rest and administer an antibiotic. Provide adequate fluids, fiber, and stool softeners. Place a rolled towel between the patient’s legs and under the scrotum to help reduce severe swelling. Or, if the patient has mild or moderate swelling, advise him to wear a loose-fitting athletic supporter lined with a soft cotton dressing. For several days, administer an analgesic to relieve his pain. Encourage sitz baths, and apply heat or ice packs to decrease inflammation.
Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and computed tomography scan of the abdomen, to rule out malignant tumors.
Patient teaching
Encourage the patient to perform regular testicular self-examinations. Explain the importance of wearing a scrotal support for comfort and to decrease edema.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Scrotal swelling:
Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If severe pain accompanies scrotal swelling, ask when the swelling began. Using a Doppler stethoscope, evaluate blood flow to the testicle. If it’s decreased or absent, suspect testicular torsion and prepare the patient for surgery. Withhold food and fluids, insert an I.V. line, and apply an ice pack to the scrotum to reduce pain and swelling. An attempt may be made to untwist the cord manually, but even if this is successful, the patient may still require surgery for stabilization.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Scrotal swelling:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Place the patient on bed rest.
▪ Administer an antibiotic, if ordered.
▪ Provide adequate fluids, fiber, and stool softeners.
▪ Place a rolled towel between the patient's legs and under the scrotum for elevation to help reduce severe swelling.
▪ Apply ice packs to the scrotum.
▪ Administer an analgesic to relieve pain.
▪ Prepare the patient for needle aspiration of fluid-filled cysts and other diagnostic tests, such as lung tomography and a computed tomography scan of the abdomen, to rule out malignant tumors.
Patient teaching
▪ Explain the disorder and treatment plan.
▪ For mild or moderate swelling, advise the patient to wear a loose-fitting athletic supporter lined with a soft cotton dressing.
▪ Tell the patient to use a sitz bath and apply heat or ice packs to decrease inflammation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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