Testicular Cancer

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -  Brandon Davis from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

-Testicular cancer occurs when cells in one or both testicles become malignant.¹
-There are three stages of testicular cancer.²
-Stage I-the cancer is refined to the testicle²
-Stage II-The cancer has spread to the retroperitoneal lymph nodes, located in the posterior abdominal cavity below the diaphragm and between the kidneys.²
-Stage III-The cancer has spread beyond the lymph nodes to remote sites in the body, including the lungs, brain, liver, and bones.²
-Germ cell tumors (origin in the primordial germ cells) make up more than 95% of testicular tumors, whereas the remaining neoplasms are mostly tumors of stromal or sex cord origin.¹

-Carcinoma in situ usually becomes an invasive germ cell tumor in a median period of
approximately 5 years.¹
-The neoplastic transformation of a germ cell results in either a seminoma, an undifferentiated tumor, or a nonseminomatous tumor comprised of embryonal carcinoma teratoma, choriocarcinoma, or yolk-sac carcinoma (endodermal-sinus tumor).¹
-Primary testicular tumors are divided into two histogenic categories: seminoma and nonseminoma.¹

-Seminomas are the most common testicular cancers, accounting for approximately 40% to 50% of germ cell tumors and most often appearing in the fourth decade of life.¹
-Seminomas appear as a solid, grey-white growth and are rarely necrotic or cystic.¹  The entire testis can be replaced by the tumor.¹
-The incidence of nonseminomas peaks in the third decade of life, hemorrhage, necrosis, or cystic changes are more common.¹
-Yolk-sac tumors are the most common germ cell tumors of infants.¹  These tumors result in enlarged testes, which appear grossly as poorly defined lobulated masses.¹  Focal areas of hemorrhage are common.¹
-Metastatic tumors to the testis from primary neoplasm elsewhere in the body are uncommon, although involvement by lymphoma may occur in older men.¹

Prevalence

-Testicular cancer is relatively rare and occurs most often in young men between the ages of 15 and 35 years old, although any male can be affected at any time (including infants).¹
-Testicular cancer in the most common solid organ tumor in young men.²
-Testicular cancer is the second most common malignancy from age 35 to 39 years with a white-to-black incidence ratio of 5 to 1.²
-According to the National Cancer Institute’s Surveillance, about 8,000 men are diagnosed with testicular cancer each year (390 deaths annually).¹
-The incidence of testicular cancer around the world has doubled in the past 30 to 40 years.¹
-There are considerable geographic and ethnic variations in the global incidence of  testicular cancer.²
-The disease mainly affects Western populations, with an increasing incidence since the middle of the twentieth century.²
-Average rates in developed areas of the world are six times higher than those in developing areas.²
-Approximately 79,200 new cases of testicular cancer were estimated to occur in the United States in 2007.²

Characteristics/Clinical Presentation

-A lump in either testicle²
-Any enlargement, swelling, or hardness of a testicle²
-Significant loss of size in one of the testicles²
-Feeling of heaviness in the scrotum and/or lower abdomen²
-Dull ache in the lower abdomen or in the groin²
-Sudden collection of fluid in the scrotum²
-Pain or discomfort in a testicle or in the scrotum²
-Enlargement or tenderness of the breasts²
-Unexpected fatigue or malaise²
-Infertility²
-Low back pain (metastases to retroperitoneal lymph nodes)²

-The most common initial sign of testicular cancer is enlargement of the testis with diffuse testicular pain, swelling, hardness, or some combination of these findings.¹
-The condition may go undetected if no pain is experienced and the male is not periodically performing testicular self-examination.¹
-The enlargement may be accompanied by an ache in the abdomen or scrotum or a sensation of heaviness in the scrotum.¹
-Metastasis, with little or no local change, is noted in the scrotum.¹
-Retroperitoneal primary tumors may present with back pain and/or groin or pelvic pain (psoas muscle invasion).¹
-Metastatic testicular cancer can present as back pain (may be the primary presenting complaint), abdominal mass, hemoptysis, or neck or supraclavicular adenopathy.¹
-Up to 21% of men with testicular germ cell cancer have back pain as the primary presenting symptoms.¹
-Pain may be the sole presenting symptom in metastasis to the retroperitoneal, cervical, and supraclavicular lymphatic chains.¹
-Approximately 20% of all cases have involved lymph nodes.¹
-Bone metastasis is a late event, often combined with metastasis to the retroperitoneal lymph nodes, lung, and liver.¹
-Occurring during the prime of life for most men and potentially affecting sexual and reproductive capabilities, testicular cancer has a major emotional impact and can affect overall quality of life.¹

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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