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26 Cards in this Set
- Front
- Back
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Health promotion/Maintenance
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Review A&P male reproduction-testicles produce sperm and manufacture testosterone (male hormone).
-Two testes are contained in scrotum -Referred to as gonads |
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Incidence
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<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) |
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Risk Factors
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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 |
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Risk Factors
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History of Orchitis (inflammation of a testis due to trauma, ischemia, metastasis, mumps, or infection elsewhere in the body.)
HIV Race - white men 5x's more likely than blacks, 3x's Asians More common in the right testicle Body size |
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Risk Factors
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Maternal hormone use - DES not a significant risk factor
Vasectomy - not a risk factor |
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Pathophysiology - dictates treatment
KNOW THIS SLIDE |
*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 |
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Clinical manifestations
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*Lump on testicle usually painless (#1 sign)
*Testicular enlargement/edema *Heaviness/ache in testes or lower abdomen *Breast tenderness r/t HCG secretion |
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Late Clinical Manifestations
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*Metastatic Disease
-Back pain -Cough -Dyspnea -Dysphagia -Papilledema -Altered MS -Seizures |
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Detection: TSE
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*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 |
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TSE
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*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 |
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Diagnosis: Urologist will make diagnosis
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*1st step: palpation of the scrotum
*Ultrasound of the testes *Biopsies are NOT done (blood work will be done) |
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Diagnostic Tests
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Blood Tests:
-Human Chorionic Gonadotropin (HCG) -Alpha-fetoprotein (AFP)only in seminomas -Lactate dehydrogenase (LDH) CT Scan/MRI CXR (rule out metastasis) |
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Staging
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*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 |
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Prognosis
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*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 |
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Treatment
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*Surgery
*Radiation *Chemotherapy **Can be all three or just surgery and chemotherapy |
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Surgery
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*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 |
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Radiation
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*Seminomas only (highly radiosensitive)
*NONseminomas=NO radiation *External beam radiation used *No implants (brachytherapy) *Abdomen also in field for lymph nodes |
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Chemotherapy
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*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 |
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Follow-Up
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*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 |
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Sequelae
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*Impaired fertility
*Retrograde ejaculation - seminal fluid discharges into bladder *Post Op complications for abdominal surgery - recall |
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Nursing Role/Process
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*Assessment
-Physiological tests, S&S etc. -Psychological - fear of demasculination, loss of sexuality, loss of life (huge crisis for a young man) |
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Nursing Process
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*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 |
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More Nursing Diagnoses
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*Fear r/t cancer dx.
*Ineffective coping *Low self esteem *Fatigue *Alteration in nutrition <body req. *Family process: interrupted *Ineffective role performance *Powerlessness *Hopelessness |
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Evaluate
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*Outcomes
*Interventions *Adaptation |
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Remember
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*Stress monthly testicular exams for all men over 15 years old (see handout and table 53-9 in text)
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Research/Current Trends
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*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 |
