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26 Cards in this Set

  • Front
  • Back
Health promotion/Maintenance
Review A&P male reproduction-testicles produce sperm and manufacture testosterone (male hormone).
-Two testes are contained in scrotum
-Referred to as gonads
<1% malignancies in men
Most common type of CA in men 15-35 years of age
Early dx. & tx. can result in 95% cure rate
In 2006 ACS est. 8,250 new cases & 370 deaths (rare)
Risk Factors
AGE - Most occur between the ages of 15-35 years old
Cryptorchidism (Failure of the testicles to descend into the scrotum.)
Family Hx
Occupation - A recent study = increase risk of nonseminomas
Previous Testicular Cancer
Multiple atypical nevi
Risk Factors
History of Orchitis (inflammation of a testis due to trauma, ischemia, metastasis, mumps, or infection elsewhere in the body.)
Race - white men 5x's more likely than blacks, 3x's Asians
More common in the right testicle
Body size
Risk Factors
Maternal hormone use - DES not a significant risk factor
Vasectomy - not a risk factor
Pathophysiology - dictates treatment
*90% from germ cells (Cells produce sperm)
-Seminomas = grow slowly and don't usually metastasize (much more curable)
-Nonseminomas = tend to be more aggressive and metastasize - (several types by rx is same, usually men in 20's)
*10% are from non-germ cells
Clinical manifestations
*Lump on testicle usually painless (#1 sign)
*Testicular enlargement/edema
*Heaviness/ache in testes or lower abdomen
*Breast tenderness r/t HCG secretion
Late Clinical Manifestations
*Metastatic Disease
-Back pain
-Altered MS
Detection: TSE
*Testicular Self Exam: every male at puberty should be taught
*Examine every month, same time
*Purpose is not to identify a problem but know what's "baseline" normal
*Use ACS and scientific websites for more information
*90% of cases have a painless lump on testicle
*Examine each testicle separately
*Gently roll testicle between thumb and fingers
*Look for hard lumps or change in size or shape
*After or during warm shower
Diagnosis: Urologist will make diagnosis
*1st step: palpation of the scrotum
*Ultrasound of the testes
*Biopsies are NOT done (blood work will be done)
Diagnostic Tests
Blood Tests:
-Human Chorionic Gonadotropin (HCG)
-Alpha-fetoprotein (AFP)only in seminomas
-Lactate dehydrogenase (LDH)
CXR (rule out metastasis)
*Stage 1: limited to the testes
*Stage 2: Spread to the retroperitoneal lymph nodes
*Stage 3: spread beyond retroperitoneal nodes to lung, liver and bone
*Stage I Seminoma: 99% cure rate
*Stage I Nonseminoma: 98% cure rate
*Stage II tumors: 90% cure rate
*Stage III tumors: 50-80% cure rate
**Can be all three or just surgery and chemotherapy
*Orchiectomy - removal of affected testicle, done to diagnose cancer as well as remove tumor (definitive diagnosis)
*Lymph nodes in abdomen may be removed for staging at this time
*Inguinal orchiectomy: remove of testicle and lymph nodes
Major S/E: infertility and retrograde ejaculation into bladder
*Seminomas only (highly radiosensitive)
*NONseminomas=NO radiation
*External beam radiation used
*No implants (brachytherapy)
*Abdomen also in field for lymph nodes
*Like in breast cancer is "adjuvant" treatment
*Main reason Testicular Cancer TC is considered curable
*May or may not result in sterility, should be counseled to sperm bank if applicable
*Critical to have close monitoring
*3% chance remaining testicle will develop cancer
*Blood tests every month x2 years to follow tumor marker - alpha-fetoprotein (AFP), BHCG
*Monthly Testicular Self Exam TSE
*Impaired fertility
*Retrograde ejaculation - seminal fluid discharges into bladder
*Post Op complications for abdominal surgery - recall
Nursing Role/Process
-Physiological tests, S&S etc.
-Psychological - fear of demasculination, loss of sexuality, loss of life (huge crisis for a young man)
Nursing Process
*Diagnosis, Planning, Implementation
-Grieving r/t loss of body part, fertility
-Pain r/t trauma, scrotal edema: ice and elevate scrotum with face cloth or sling
More Nursing Diagnoses
*Fear r/t cancer dx.
*Ineffective coping
*Low self esteem
*Alteration in nutrition <body req.
*Family process: interrupted
*Ineffective role performance
*Stress monthly testicular exams for all men over 15 years old (see handout and table 53-9 in text)
Research/Current Trends
*High Dose Chemo followed by stem cell transplantation
*Studies re: treatment of HIV poitive patients = using standard rx can experience an improved quality of life
*New drugs and new drug combinations
*See article