Chapter 53- Testicular Cancer

Risk Factors for testicular cancer include: SATA A) Cryptorchidism (undescended testicles) B) Family history of testicular cancer C) Personal history of testicular cancer D) Caucasian American men = 5x greater than African American men E) 2-3x greater than Asian, Native American, and Hispanic American men F) HIV positive males G) Occupational hazards- exposure to chemicals w/mining, oil, and gas production, and leather processing H) Late onset of puberty

A) Cryptorchidism (undescended testicles) B) Family history of testicular cancer C) Personal history of testicular cancer D) Caucasian American men = 5x greater than African American men E) 2-3x greater than Asian, Native American, and Hispanic American men F) HIV positive males G) Occupational hazards- exposure to chemicals w/mining, oil, and gas production, and leather processing

Treatments of testicular cancer include which of the following? A) Removal of affected testis by orchiectomy B) Radiation therapy C) Chemotherapy D) Hormonal therapy

ALL BUT D! o Primary treatment: Removal of affected testis by orchiectomy through an inguinal incision w/ a high ligation of the spermatic chord o Radiation therapy - more effective with seminomas than non-seminomas o Chemotherapy- may be used for seminomas, non-seminomas, and advanced metastatic disease

Diagnostic Test for testicular cancer include: SATA A) Testicular self-examination should be performed MONTHLY B) Annual testicular examination by a clinician C) Chest x-ray to assess metastasis in lungs D) Trans-scrotal testicular ultrasound E) Retroperitoneum F) Abdominal/pelvic CT scan and chest CT scan H) MRI

ALL BUT H A) Testicular self-examination should be performed MONTHLY B) Annual testicular examination by a clinician C) Chest x-ray to assess metastasis in lungs D) Trans-scrotal testicular ultrasound E) Retroperitoneum F) Abdominal/pelvic CT scan and chest CT scan

A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

Ans: A A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him emasculated and a shell of a man. The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

Ans: A Disturbed Body Image Related to Effects of Surgery Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

Ans: A Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

Ans: A Provide empathy and encouragement in an effort to foster a positive outlook. Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.

Ans: A Testicular cancer is a highly curable type of cancer. Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

Ans: C Permanent vascular damage Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, My father died of prostate cancer at age 48. The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

Ans: C The patient should have PSA levels drawn regularly. Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

Ans: D It is highly responsive to treatment. Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

A nurse is reviewing testicular self-examination with a client. Which of the following client statements indicates understanding? A) It's best to examine the testicles before bathing B) It's not necessary to report small lumps, unless they're painful C) I will examine one testicle at a time D) I will use my palms to feel for abnormalities

C) I will examine one testicle at a time

A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.

D) The patient should avoid close contact with his daughter for 2 months. Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

Prognosis for testicular cancer

GOOD prognosis o With early detection = 95% cure rate

What type of cancer is..? o Most common in males 15-35 years old o Rare

Testicular Cancer

Protocol for what type of screening? During or after a bath or shower when scrotum is relaxed o Move penis to side, and examine one testicle at a time o Hold testicle between thumb and fingers of both hands, and roll gently between fingers o Look and feel for any hard lumps; smooth rounded bumps; or change in shape, size, or consistency of testicle o Normal for one to be larger than the other or hang lower than the other

Testicular self-examination should be performed MONTHLY