testicular cancer

what is testicular cancer
testicular cancer is cancer of the testicles
types of testicular cancer
the different types of testicular cancer are classified by the type of cells the cancer first begins in:
– the most common type of testicular cancer is known as ‘germ cell testicular cancer’ which accounts for around 95% of all cancers.
– germ cells are a type of cell that the body uses to help create sperm.

there are two main subtypes of germ cell testicular cancer, they are:
– seminomas, 40%
– non seminomas, 60%
seminomas and non seminomas tend to respond well to chemotherapy.

causes of testicular cancer
The causes of testicular cancer are not fully understood. increased risks are:
– UNDERSCENDED TESTICLES = the babies testicles should have moved down by the age of 1, if not they may have a higher risk of getting testicular cancer.
– AGE AND RACE = testicular cancer is more common in young and middle aged men affecting those between 20 and 44 years of age, with 90% of cases affecting men under the age of 55.
– more common in white men.
– FAMILY HISTORY = having a close relative with a history of testicular cancer , this increases your risk of developing it.
– father = 4-6 times more likely
– brother = 8-10 times more likely.
– INFERTILITY = men who are infertile are three times more likely to develop testicular cancer than fertile men.
– SMOKING = long term smokers – 20 cigarettes a day for 12 years are twice more likely to develop testicular cancer.
– HIV AND AIDS = people who have had HIV and AID’s have an increased risk of testicular cancer.
symptoms of testicular cancer
– the most common symptom of testicular cancer is a lump or swelling in one or both of your testicles.
– the lump or swelling can be about the size of a pea or larger.
OTHER SYMPTOMS:
– a dull ache or sharp pain in the testicles or scrotum, which may come and go.
– a feeling of heaviness in the scrotum.
– a dull ache in the lower abdomen (stomach area)
– a sudden collection of fluid in the scrotum.
– feeling fatigue.
– a general feeling of being unwell.

METASTATIC CANCER: = if testicular cancer or other cancer has spread to other parts of the body.
– around 5% of people with testicular cancer will experience symptoms of metastatic cancer.
– most common place for testicular cancer to spread to is nearby lymph nodes in the abdomen or lungs.
– symptoms include:
. persistent cough
. coughing or spitting up blood
.shortness of breath

treatment
Treatment plan will depend on two factors:
– whether it is seminomas or non seminomas.
– the stage of cancer.

the first treatment option for all cases of testicular cancer, what ever the stage is to surgically remove the affected testicle (archidectomy).

how to stage cancer
cancer can be staged in two ways:
– TNM
– staged numerically
TNM STAGING SYSTEM:
T = indicates size of tumour
N = indicates whether cancer has spread to lymph nodes.
M = indicated whether cancer has spread to other parts of the body (metastasis).

NUMERICALLY STAGING SYSTEM:
stage 1 = cancer is inside testicles.
stage 2 = cancer spread from testicles to lymph nodes.
stage 3 = spread to lymph nodes and upper chest.
stage 4 = has spread to other organs, such as lungs.

treatment for stage one:
– seminomas = after the testicle has been removed, a single dose of chemotherapy is given to prevent cancer returning. sometimes a short course of radiotherapy is recommended.
– non seminomas = close follow up may be recommended and a short course of chemotherapy.
treatment for stage two and three:
– three to four cycles of chemotherapy are given using a combination of different medications.
– further surgery may be needed after chemotherapy to remove any affected lymph nodes.
treatment for stage four:
– a similar treatment plan is used to treat stage four cancer. additional surgery may also be required to remove tumours from other parts of the body, such as the lungs.
– MDT specialists will make recommendations, but final decision will be made by the patient.
patient care pathway:
1. the patient visits the GP, where the GP will ask the patient questions about personal history, family history and symptoms.
the GP will carry out a physical examination ( torch light test).
– shines a small light against the lump in the testicle to see if light shines through.
– cancerous lumps tend to be solid which means light cant pass through.
if lump is cancerous they will be referred to secondary care.

2. in secondary care, a scrotal ultra sound will be performed , which will detect the position and size of abnormality.
– if lump is filled with fluid it is known as a cyst and is harmless. a more solid lump may be a sign of cancer.

-blood tests will be performed to look for hormones which are known as markers.
-testicular cancer produces markers , markers in the blood will be tested for:
. AFP ( alpha feta protein)
. HCG ( human chronic gonadotrpin)
. LDH ( lactate dehydrogenate)

– biopsy:
. cells are taken from the lump and sent to the lab to be analysed.
– safest way is to remove testicle, this process is called orchidectomy.

3. cancer is staged either by TNM or numerically.
– if MDT think cancer has spread to lymph nodes and lungs, may require chest x ray, MRI scan or CT scan to check for signs of spreading cancer.

4. in cases of stage 2 and 3 cancer, three to four cycles of chemotherapy are given using a combination of medications.
– further surgery may sometimes be needed after chemotherapy to remove any affected lymph nodes.

5. a similar treatment plan is used to treat stage 4 cancer.
– additional surgery may also be required to remove tumours from other parts of the body such as the lungs.

6. follow up:
– around 25 – 30 % of people experience a return of cancer, usually within first two years after treatment has finished.
– regular checks-
– blood test for markers
– chest x ray
– CT scan.

health professionals involved / MDT
– GP = initial consultation
– a medical oncologist = specialist cancer doctor
– a pathologist = specialist in study of cancer cells
– urological surgeon = who performs operation.
– a radiologist = performs ultrasound scans.
– a pharmacist = provides chemotherapy drug
– a psychologist = provides psychological support
– a specialist cancer nurse
– a cancer counsellor = provides someone to discuss problems and financial advice and support.
patient centred approach
The patient will be placed at the centre of all care processes.
INDIVIDUALITY = the GP and MDT will ensure that the patient is put at the centre of the care by knowing their individual needs, problems, history and details.

RIGHTS= patients have the right to know everything that is going on and should be involved in all discussions and decision making.

PARTNERSHIP AND SUPPORT = patient will be given support from the MDT and cancer counsellor to help the patient to cope with what they are going through.

CHOICE = patient is given the choice of whether to go through treatment or not.

RESPECT = giving the patient all the information, advice, support and treatment they need.

social impact of testicular cancer
-reluctant to form intimate relationships with anyone.
– social relationships with others who have testicular cancer.
– more support and attention from family members and friends who want to support you through cancer.
physical impact of testicular cancer
– hair loss due to treatment
-pain in the testicle
-pain from surgery
– removal of testicle.
emotional impact of testicular cancer
– depression
– fear
– embarrassment of removal of testicle
– anxiety
intellectual impact of testicular cancer
– how to self check
– learn about signs and symptoms
financial impact of testicular cancer
– take time off work, impacting on family = loss in money.
– parking fees when going to hospital and clinics.
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