TSE; thus, the U.S. Preventive Services does not include this in their recommendations, nor have they since 2011 (NCI, 2014). The most common events that lead to a diagnosis of testicu- lar cancer is a mass found on examination by a health care provider and a young man noting a “heaviness” in the scrotal sac or a hardened area felt when taking a shower. Young men are the least likely to seek medical help at the first sign of something abnormal, which may lead to a delay in diagnosis. This creates a need to educate young men about the need for regular physi- cal checkups. Prognosis Testicular cancer has the highest survivability rate of all malignancies (Kim et al., 2011; NCI, 2012; Pettersson et al., 174 UROLOGIC NURSING / July-August 2014 / Volume 34 Number 4
SERIES Table 2. Diagnosis of Testicular Cancers Specifics Discussion Basic physical examination Palpation of scrotal/testicular mass could be cancer. Other causes that may present as a scro- tal mass: Epididymitis, orchitis, hydrocele, hematocele. Transillumination of scrotum Looking for darkened area that does not allow passage of light. Helps establish potential diagnosis and guide additional work-up. Imaging study Testicular ultrasonography - Used to differentiate among testicular masses. MRI and CT used to detect metastasis. Chest X-ray also used in staging. Laboratory evaluation CBC: to evaluate for possible infection or abcess. Tumor markers: Alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (phCG), lactic acid dehydrogenase (LDH). AFP - Normally present in fetal serum in high levels but should be only a trace beyond one year of age. phCG produced by the placenta in women during pregnancy, should not be present in the male in high amounts. LDH is found to correlate with mass of tumor cells, often elevated in widespread metastasis. Sources: Fischbach & Dunning, 2015; Van Leeuwen, Poelhuis-Leth, & Biadh, 2013. 2007). A multi-year study found that of 140,000 men diagnosed with this disease, a 95% survival rate past five years occurred in those who found and received treatment quickly. Even in those diagnosed late, there is a higher rate of survivability with this dis- ease than with any other malig- nancy (Kim et al., 2011; NCI, 2012). The diagnosis is made fol- lowing surgery; therefore, further treatment may be required. Radiation or chemotherapy may be necessary, which will require education for the patient and his significant other. There is no guarantee this treatment will have no effect on the uninvolved testicle’s ability to produce sperm, and in fact, could cause difficulty in child bearing for the couple. Therefore, advising young men about the possibility of sperm banking for the future is always advised (NCI, 2014). Factors associated with poor prognosis are the presence of metastasis to other organs, or a very high level of serum tumor markers, such as beta-hCH or AFP, are noted. The elevated alpha-fetoproteins (AFP) noted in non-seminoma tumors would be monitored as a marker for prognosis, as would a survey of other body organs to determine if metastasis has occurred. Even when these two prognostic signs
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- Fall '16
- zelda peters
- Nursing, testicular cancer, Testicular Cancers