Testicular Cancer Flashcards
What is the pathophysiology of testicular cancer?
Testicular cancer, which can occur in one or both testicles, is a rare cancer that most often affects men between 20 and 35 years of age but can affect men of any age. It usually strikes men at a productive time of life and thus has significant economic, social, and psychological impact on the patient and his family and/or partner. With early detection by testicular self-examination (TSE) (see the Patient and Family Education:
Primary testicular cancers fall into two major groups:
- Germ cell tumors (GCTs) arising from the sperm-producing cells (account for most testicular cancers)
- Non–germ cell tumors arising from the stromal, interstitial, or Leydig cells that produce testosterone (account for a very small percentage of testicular cancers)
Testicular germ cell tumors are classified into two broad categories: germ cell tumors (GCTs) and others (Table 67.3). The most common type of testicular tumor is seminoma. Patients with seminomas have the most favorable prognoses because the tumors are usually localized, metastasize late, and respond to treatment. They often are diagnosed when they are still confined to the testicles and retroperitoneal lymph nodes.
The risk for testicular tumors is higher in males who have an undescended testis (cryptorchidism); human immune deficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS [HIV-III]); frequent use of marijuana; or history of testicular cancer.
What information should the nurse gather when taking a history of the patient?
- When taking a history from a patient with a suspected testicular tumor, assess for risk factors including a history or presence of an undescended testis and a family history of testicular cancer.
- The most common report is a painless, hard swelling or enlargement of the testicle, although a small portion of patients do report pain. Patients with testicular pain, lymph node swelling, bone pain, abdominal masses or aching, sudden hydrocele (fluid in the scrotum), or gynecomastia may have metastatic disease.
Determine and document how long any signs and symptoms have been present. - Questions about sexuality and reproduction are important. If the man has one healthy testis, he can function sexually. If he has a retroperitoneal lymph node dissection (RPLND) or chemotherapy, he may become sterile because of treatment effects on the sperm-producing cells or surgical trauma to the sympathetic nervous system resulting in retrograde ejaculation. Therefore, collect information regarding whether the patient is sexually active, whether he wishes to have children in the future, and if so, if he would be interested in learning about sperm storage in a sperm bank.
What is included in the physical assessment/ signs and symptoms?
The testes, lymph nodes, and abdomen should be examined thoroughly. Patients may feel embarrassed about having this examination. Provide privacy and explain the procedure to the patient. Inspect the testicles for swelling or a lump that the patient reports is painless. A health care provider will palpate the testes for lumps and swelling that are not visible.
What is included in the psychosocial assessment?
Because testicular cancer and its treatment can lead to sexual dysfunction, pay close attention to the psychosocial aspects of the disease. Sexuality is likely to be a prime concern for any patient, yet it may be even concerning for younger men who may have a fear of not being able to perform sexually, or father children. Assess the man’s support systems, and refer to community support resources as necessary.
What are diagnostics that can be done?
Common serum tumor markers and other diagnostic methods that are used when formulating a diagnosis of testicular cancer are:
- Alpha fetoprotein (AFP)
- Beta human chorionic gonadotropin (hCG)
- Lactate dehydrogenase (LDH)
- Scrotal ultrasound
- Chest x-ray
- CT of the chest (if metastasis is suspected)
- CT scan of the abdomen and pelvis
- MRI of the brain (if metastasis is suspected)
What are some nonsurgical management options?
Chemotherapy or radiation therapy may be used depending on the tumor staging, whether surgery is performed, and based on the degree of adherence to treatment that is anticipated. The specific treatment, including frequency, cycling, and duration, will vary from patient to patient, depending on the extent of the disease and the protocol being followed.
What surgical procedures can be done?
Surgery is the main treatment for testicular cancer. For localized disease, the surgeon performs a unilateral orchiectomy to remove the affected testicle, which is usually curative.
What preoperative care is included with surgical management?
Like most patients with cancer, the man with testicular cancer may be very apprehensive. Offer support and reinforce the teaching provided by the surgeon. Teach the patient and his family or partner about what to expect after surgery.
What happens during the surgical procedure?
Most patients with seminoma have only one surgery to remove the diseased testicle through the groin (inguinal) for a cure. A frozen section of the tumor is examined to confirm the type and stage of the cancer. A saline-filled silicone prosthesis may be surgically implanted into the scrotum at the time of the orchiectomy or later if the patient desires. This type of reconstructive surgery gives the appearance of having two testes. With one functioning testicle, the man is still able to achieve an erection for sexual intercourse.
Some men have more advanced disease or tumor types that are more aggressive. The preferred method to address this is laparoscopic retroperitoneal lymph node dissection (RPLND), which is a minimally invasive surgery (MIS). This technique is much shorter than the traditional open-surgical approach, which is much more complicated and requires more postoperative hospital recovery time. In laparoscopic RPLND, very small skin incisions in the abdomen are made by a laparoscope, through which the nodes are dissected for examination. Bleeding, postoperative pain, and postoperative complications are minimized. The patient who has had laparoscopic RPLND can still achieve an erection, yet if there has been nerve damage during surgery, he may experience retrograde ejaculation. Newer nerve-sparing surgeries have shown to be very successful when performed by experienced surgeons.
What is included in postoperative care?
Nursing care for the patient after surgery depends on the type of surgical procedure that was performed and the extent of the disease process. The patient is usually hospitalized for multiple days after an open radical retroperitoneal lymph node dissection. The patient having the laparoscopic procedure may have a urinary catheter in place following the procedure, which is removed before discharge 1 to 2 days later.
What care coordination and transition management should be considered?
- After an open orchiectomy, the patient is discharged without a dressing on the inguinal incision (as long as there is no wound complication). A scrotal support may be needed for several days. He may want to wear a dry dressing to prevent clothing from rubbing on the sutures and causing irritation. Tell him that the sutures will be removed in the health care provider’s office 7 to 10 days after surgery.
- Patients who also had an open RPLND recover even more slowly. They should not lift anything over 15 lb (6.8 kg), should avoid stair climbing, and should not drive a car for several weeks. Be sure that bathroom facilities are on the first floor of the house where he can easily access them.
- Teach the patient who had a laparoscopic procedure that he will be able to resume most of his usual activities within 1 week after discharge. He can take a shower 1 or 2 days after surgery, but be sure that he does not remove the wound closure tape. These strips of tape will loosen and fall off about a week after surgery.
- Explain the importance of performing monthly testicular self-examination (TSE) on the remaining testis and scheduling follow-up examinations with the health care provider. A patient who has had testicular cancer should be seen regularly by his healthcare provider for follow-up care and testing.
