Testicular Cancer: Difference between revisions
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== Associated Co-morbidities == | == Associated Co-morbidities == | ||
No co-morbidities found in our two books. Will research further. <br> | |||
== Medications == | == Medications == | ||
Revision as of 00:26, 8 March 2010
Original Editors - Brandon Davis from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Definition/Description[edit | edit source]
-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[edit | edit source]
-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[edit | edit source]
-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[edit | edit source]
No co-morbidities found in our two books. Will research further.
Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
-A thorough urologic history and physical examination are the basis for making a diagnosis of testicular cancer.1
-A painless testicular mass is highly suggestive of testicular cancer.1
-Transillumination of the scrotum may also reveal a testicular mass.1
-Serum tumor markers (e.g., alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH)) are increased in 40% to 60% of all cases and may be used to guide treatment and follow-up.1
-Testicular ultrasound is used to differentiate a variety of scrotal disorders besides cancer (e.g., epididymitis, orchitis, hydrocele, or hematocele).1
-The modalities used to assess metastatic spread include CT scans and MRI.1
-MR lymphography may replace the currently used tomography scanning or MRI used to noninvasively stage retroperitoneal lymph nodes.1
-Biopsy with microscopic examination of testicular tissue by a pathologist is the best way to make a definitive diagnosis.1
-The American Cancer Society recommends monthly self-exam of the testicles for adolescents and men, starting at age 15.2 -Testicular self-examination is an effective way of getting to know this area of the body and thus detecting testicular cancer at a very early, curable stage.2
-The self-exam is best performed once each month or after a warm bath or shower when the heat has relaxed the scrotum.2
Causes/Risks[edit | edit source]
-The etiology of testicular cancer is not well understood.1
-Although the cause is unknown, hormonal balance at various life stages appear to be related.1
-Congenital and acquired factors have been associated with the development of testicular cancer; familial clustering has been observed particularly among siblings.1
-The first susceptibility gene for testicular cancer has been located and named TGCT1 on the long arm of chromosome X, inherited from the mother; its presence increases a man’s risk of testicular cancer by up to 50 times.1
-There is some evidence that cancer stem cells are derived from normal stem cells that have gradually accumulated various genetic defects; a group of tumor-specific antigens known as cancer/testis antigens (CTAs) may be expressed at early stages during embryogenesis in germ cell precursors eventually leading to testicular cancer.1
-The most significant factor in testicular cancer is the association of cryptorchidism (the testes not descending into the scrotum).1
-The incidence of testicular cancer is 35 times higher in males with a cryptoid testis.1
-Risk is higher than average for boys born with an undescended testicle (cryptorchidism).2 The cancer risk for boys with this condition is increased even if surgery is done to move the testicle to the scrotum.2
-In the case of unilateral cryptorchidism, the risk of testicular cancer is increased in the normal testicle as well.2 This fact suggests testicular cancer is due to whatever caused the undescended testicle.2
-Having a brother or father with testicular cancer also increases an individual’s risk.2
-There is now strong evidence that prenatal or postnatal environmental estrogen exposures (e.g., endocrine-mimicking environmental pollutants, pesticides, industrial chemicals, or chemical contaminants in drinking water) contributes to testicular cancer; this remains under further investigation.1
-Other risk factors still under investigation may include mothers who took exogenous estrogen during pregnancy (diethylstilbestrol), scrotal trauma, exposure to high levels of radiofrequency/microwave radiation in radar technicians, first-born sons, and nonidentical twins.1
-Other risk factors may include occupation (e.g., miners, oil and gas workers, leather workers, food and beverage processing workers, janitors, firefighters, utility workers) and HIV infection.2
-Men with Kleinfelter’s syndrome (a sex chromosome disorder characterized by low levels of male hormones, sterility, breast enlargement, and small testes) are also at greater risk of developing testicular cancer.1
-Lifestyle and occupational exposures occurring later in life may play a role in promoting the disease, but they are not likely involved in the initiation of the cancer development.1
-A previous history of testicular cancer and history of infertility and poor semen quality or infection have been associated with an increased risk of developing testicular cancer.1
-A causal relationship has not been established between infertility and infection and testicular cancer.1
-The risk of testicular cancer among white American men is about 5 to 10 that of African American men and more than twice that of Asian American men.2
-The risk for Hispanics is between that of Asians and non-Hispanic whites.2 The reason for this difference is unknown.2
-The testicular cancer rate has more than doubled among white Americans in the past 40 years but has not changed for African Americans.2
-Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among African and Asian men.2
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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