Testicular Cancer Med. Surg/B3E5

What are risk factors for testicular CA?

*Undescended testes (cryptorchidism) Family h/o testicular cancer Other factors: Orchitis (inflammation of one or both of the testicles) HIV infection Maternal exposure to exogenous estrogen *The exact cause of testicular cancer is not known. *There is no link between vasectomy and testicular cancer.

Testicular cancer is the most common type of cancer in young men between _____ and _____ years of age.

15 and 35 years of age *But Testicular cancers are not a common malignancy when considering all types of cancers.

Education on testicular self examinations:

Best done during a shower Palpate each testicle separately Should feel round and smooth Check for lumps, irregularities, pain or dragging sensation Perform TSE consistently every month

What is the prognosis for testicular CA?

If detected early and treated, 95% achieve complete remission Surveillance and regular PE Assessment of AFP and hCG Probable Infertility Cryopreservation of sperm in sperm bank Ejaculatory dysfunction from retroperitoneal LN dissection *In the past, metastatic testicular cancer was usually fatal, but advances in treatment, including high-dose chemotherapy and stem cell rescue, have considerably improved the prognosis. Testicular cancers are very sensitive to chemotherapy and are curable even when metastatic. Cure rates for good-risk disease cure rates are 90-95%. However, patients cured of testicular cancer have approximately a 2% cumulative risk of developing a cancer in the opposite testicle during the 15 years after initial diagnosis.

What is used to diagnose testicular CA?

Palpation Cancerous mass - firm and does not trans illuminate Scrotal ultrasound Elevated Alpha fetoprotein (AFP) Lactate dehydrogenase (LDH), human chorionic gonadotropin (hCP)

Management/treatment for testicular CA?

Radical Orchiectomy: (Removal of affected testis, spermatic cord, and regional lymph nodes) Post Orchiectomy: (surveillance, radiation, chemotherapy) Chemotherapy more sensitive to germ cell tumors- Bleomycin, Etoposide, Cisplatin

What are the 2 types of testicular cancer?

Seminoma:: This is a slow-growing form of testicular cancer usually found in men in their 30s and 40s The cancer is usually just in the testes, but it can spread to the lymph nodes Seminomas are very sensitive to radiation therapy. Nonseminoma: This more common type of testicular cancer tends to grow more quickly than seminomas Nonseminoma tumors are often made up of more than one type of cell. *These cancers grow from germ cells, the cells that make sperm. *Nonseminoma is more aggressive than seminoma.

What are clinical manifestations of testicular CA?

Slow or rapid depending on the type of tumor Painless lump in scrotum - non-tender and firm Dull ache in pelvis or scrotum Scrotal swelling Weight loss and fatigue

Azathrioprine

To treat testicular Immunosuppressant

What are complications of testicular CA?

Treatment - related Toxicity Pulmonary - Bleomycin: cause pneumonitis and pulmonary fibrosis; therefore, pulmonary function tests are done before starting chemotherapy that includes this agent Renal - Cisplatin: a reduction in glomerular filtration rate. Cisplatin can also cause hypomagnesemia, hypophosphatemia, and hypokalemia CVS - Etoposide, Radiotherapy: Cardiovascular disorders are late complications of radiation therapy and/or chemotherapy (particularly platinum based). They include hypertension, dyslipidemia, coronary artery disease, thromboembolic events, and Raynaud phenomenon Infertility - with LN excision Hematological: Anemia, leukopenia/neutropenia, and thrombocytopenia may occur. Prophylactic treatment with hematopoietic growth factors is recommended to avoid the need for dose attenuation or treatment delays. Neurological - Cisplatin: Cisplatin and oxaliplatin can cause neuropathy. Secondary Malignancy: Secondary malignancies are the most common cause of death in testicular cancer survivors. A second testicular cancer develops in 1% to 2% of testicular cancer survivors

What is testicular cancer?

Unregulated growth of abnormal cells within the testicles.

________ ______ are more likely than African American and Asian American men to develop this type of cancer (testicular CA).

White men