Testicular cancer

Diagnostic Test Results-Diagnostic Procedures

A biopsy confirms the diagnosis and can be used to stage the disease.

Nursing Considerations-Nursing Diagnoses

Acute pain Anxiety Disturbed body image Fear Impaired oral mucous membrane Ineffective coping Ineffective role performance Risk for infection Sexual dysfunction

Patient Teaching-Discharge Planning

Refer the patient to available resource and support services. Refer the patient to home health care services if indicated.

Nursing Considerations-Expected Outcomes

report feeling less pain express feelings of decreased anxiety express positive feelings about himself express concerns and fears related to his diagnosis and condition maintain intact oral mucous membranes demonstrate positive coping mechanisms continue to function in his usual roles to the greatest degree possible avoid infection and other complications express feelings and perceptions about changes in sexual performance.

Treatment-Surgery

Radical inguinal orchiectomy Retroperitoneal node dissection for residual disease

Overview-Complications

Back or abdominal pain from retroperitoneal adenopathy Metastasis Ureteral obstruction Treatment-related toxicities affecting any body organ Infertility Secondary malignancy

Nursing Considerations-Associated Nursing Procedures

Blood pressure assessment Chemotherapeutic drug administration Chemotherapeutic drug preparation and handling Implanted port access, top-entry Implanted port bolus injection Implanted port continuous infusion Intake and output assessment Nutritional screening Postoperative care Preoperative care Preparing a patient for urologic surgery, OR Pulse assessment Radiation therapy, external Respiration assessment Temperature assessment Venipuncture

Treatment-Medications

Chemotherapy, such as carboplatin, bleomycin sulfate, etoposide, and cisplatin or vinBLAStine, ifosfamide, mesna, and cisplatin as salvage chemotherapy

Overview-Risk Factors

Cryptorchidism (see Cryptorchidism and testicular cancer) Mumps orchitis Hypospadias Inguinal hernia in childhood Family history Infertility Maternal use of diethylstilbestrol (DES) or other estrogen-progestin combinations during pregnancy Testicular trauma

Diagnostic Test Results-Laboratory

Elevated levels of the proteins human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP), which are tumor markers, suggest testicular cancer and can differentiate a seminoma from a nonseminoma. Elevated HCG and AFP levels indicate a nonseminoma. Elevated HCG and normal AFP levels indicate a seminoma. Elevated HCG and AFP levels indicate a nonseminoma. Elevated HCG and normal AFP levels indicate a seminoma. Lactate dehydrogenase levels may be elevated.

Nursing Considerations-Nursing Interventions

Encourage verbalization of feelings and provide support, such as offering positive reinforcement about the patient's body and sexuality. Reinforce the use of positive coping strategies. Encourage patient participation in care and decision making. Administer drug therapy, and assist with the chemotherapy regimen as appropriate. Prepare the patient physically and emotionally for surgery, including informing him about what to expect after surgery. Apply an ice pack to the scrotum postoperatively if ordered. Provide operative site care as indicated. Assist with managing the adverse effects of chemotherapy. Provide adequate nutrition and hydration and frequent mouth care.

Assessment-Physical Findings

Enlarged testes or swelling Gynecomastia (with metastasis) Lethargic, thin, and pallid appearance (later stages) Palpable, firm, smooth testicular mass that can't be transilluminated (see Testicular cancer) Enlarged lymph nodes in surrounding areas

Overview-Causes

Exact cause unknown

Assessment-History

Previous injury to the scrotum Viral infection, such as mumps Use of DES or other estrogen-progestin drugs by the patient's mother during pregnancy Feeling of heaviness or a dragging sensation in the scrotum Painless swelling of the testicle Weight loss (late sign) Fatigue and weakness (late sign) Acute pain

Overview

Proliferation of cancerous cells in the testicles Most originate from germinal cells, and about 40% becoming seminomas Prognosis depends on cancer cell type and stage; with treatment, the survival rate is greater than 5 years

Overview-Incidence

Testicular cancer is most common in men ages 15 to 35 years. It's rare in nonwhite men. It is the most common solid malignant tumor in men between the ages of 20 and 35, accounting for approximately 1% of male cancers.

Overview-Pathophysiology

Testicular cancer spreads through the lymphatic system to the iliac, para-aortic, and mediastinal nodes. Metastases affect the lungs, liver, viscera, and bone.

Diagnostic Test Results-Imaging

Ultrasonography is the gold standard and shows a hypoechoic area within the tunica albuginea. Chest X-rays, computed tomography scanning, and magnetic resonance imaging are used to stage the disease.

Treatment-General

Varies with tumor cell type and stage Radiation therapy Autologous bone marrow transplantation for patients unresponsive to standard therapy

Nursing Considerations-Monitoring

Vital signs Postoperative status, including the surgical site Fluid balance Nutritional status Pain level and management Adverse effects of chemotherapy Postoperative complications Body image Role performance

Treatment-Diet

Well-balanced diet

Patient Teaching-General

disorder, diagnosis, and treatment, including the fact that testicular cancer is one of the most curable solid organ cancers sperm-banking procedures before the patient begins treatment, especially if he'll be having bilateral orchiectomy fact that infertility and impotence usually don't follow unilateral orchiectomy testicular self-examination positive coping strategies prescribed chemotherapy regimen, including drug names, dosages, routes and frequency of administration, duration of therapy, and possible adverse effects, such as hair loss, anorexia, fatigue, nausea, vomiting, and immunosuppression importance of maintaining adequate nutritional intake signs and symptoms of infection, such as fever, sore throat, and malaise, and the need to notify a health care provider if any occur infection prevention measures, such as avoiding people with infections and crowds measures to foster a positive self-image postoperative care measures, including surgical site care and dressing changes if indicated possibility of retrograde ejaculation after retroperitoneal lymph node dissection, but preservation of libido and erectile function. importance of adhering to follow-up care, including appointments and laboratory tests, to evaluate the response to treatment.