TESTICULAR CANCER
Testicular cancer is a disease that occurs in younger men, between 15 and 35 years of age.
Causes
Causes are Unknown, but there is a relationship between cryptorchidism (failure of the testes descend in to the scrotum) and tumor occurrence.
Pathophysiology: Testicular tumors metastasize to the retroperitoneal lymph nodes with subsequent involvement of the mediastinal lymph nodes, lungs and liver.
Clinical Manifestation
1. Painless swelling or enlargement of the testis; accompanied by sensation of heaviness in scrotum.
2. Pain in the testis [if patient has epididymitis of bleeding in to tumor]
3. Symptoms of metastatic disease: cough, lymphadenopathy, back pain, GI symptoms, lower extremity edema or bone pain.
Diagnostic evaluation
1. Elevated serum markers of human chorionic gonadotropin (HCG) and fetoprotien (AFP); [assay of tumor markers also used for diagnosis detection of early recurrence staging and monitoring response to therapy]
2. Scrotal ultrasonography [identifies location of lesion and differentiates between solid and cystic lesion.
3. Chest film to seek pulmonary or mediastinal metastasis.
4. CT scanning of chest, abdomen and pelvis to evaluate retroperitoneal lymph nodes and to follow progress to therapy.
Medical Management
1. Inguinal orchiectomy-removal of testis and its tunica and spermatic cord.
2. Retroperitoneal lymph node dissection (RPLND) [is usually performed after orchiectomy in non-seminomas for staging a therapeutic purposes).
3. Radiation therapy to lymphatic drainage pathways [(after orchiectomy is seminomas), cure is 99%] other testicle is shielded to preserve fertility.
4. Cisplatin combination therapy treatment of non-seminomatous I tumour and regional lymphatic metastasis and in distant metastatic disease.
Complications
1. Infertility loss of testicle.
2. Retrograde ejaculation after retroperitoneal lymphadenectomy.
3. Death from metastatic disease.
Nursing interventions
1. [Explore with patient the desire to deposit sperm in sperm bank before surgery]. 1
2. Provide realistic information about impending surgery or treatment, [dispel. myths associated with testicular disease, emphasize +ve cure rates].
3. Reassure patient that orchiectomy will not diminish verility, and retroperitoneal lymph node dissection will after fertility a ejaculation but note libido, erection and sensation.
4. Advise patient that testicular prosthesis can preserve look and feel of scrotum.
5. Provide routine post-op care, including early ambulation respiratory care and administration of pain medications.
6. [After RPLND, monitor for paralytic ileus, which is common after extensive resection.
a. Auscultate bowel sounds frequently and observe for abdominal distention.
b. Withhold oral fluids until bowel sounds have returned.
c. Report complaints of nausea and vomiting.
d. Begin NG decompression if indicated].
7. Teach all young men to perform monthly testicular self- examination orchiectomy. Patient should examine remaining testicle monthly.
8. Review schedule for radiation Treatment and or chemotherapy; teach patient possible side effects; discuss expectations for Treatment period.
