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COPYRIGHT 2004 Jannetti Publications, Inc.
Testicular cancer (TC) strikes men between the ages of 15 and 35. If detected early, this disease can be irradicated in virtually every patient. Unfortunately, several hundred men will die from this disease each year. Research has shown that men do not know the importance of testicular self-examination, and they are not knowledgeable about TC. Nurses should be able to discuss treatment modalities, sideeffect management related to those treatments, and special issues dealing with sexuality, body image perception, and infertility.
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Case Study I
Alex is a 27-year-old man who presented to his health care provider with an enlarging testicular mass that had been present for 1 year. He also complained of left leg pain, as well as weakness and numbness in the left lower extremity for 6 months. For the past month, Alex has needed crutches to assist with ambulation. He noted a 20-pound weight loss over the last year. Abnormalities on physical examination were tenderness over the left iliac crest and an 8 cm nontender mass in the right testis. Radiographic findings included multiple 0.5 to 2 cm nodules to the lung. CT scans of the abdomen showed a mass eroding the left side of the pelvis and involving gluteal muscles and a pathologic fracture of the left femoral head. A right radical orchiectomy was performed. The patient was diagnosed with Stage III nonseminomatous testicular cancer. The patient verbalized that he never knew he was supposed to inspect his own testicles for tumors and noted he never was educated by health care providers about testicular self-examination (TSE). Alex died approximately 2 months after the initial diagnosis.
Epidemiology
Cancer of the testicle is a relatively uncommon disease, accounting for only 1% of neoplasms in men (Kinkade, 1999). In the literature, testis tumors have been reported to occur from infancy to age 89 years (Rowland, Foster, & Donohue, 1996). Testicular cancer (TC) is the most common malignancy in males between the ages of 15 and 35 (Loehrer, Ahlering, & Pollack, 2001; Rowland et al., 1996). TC is the second most common cancer in men from 35 to 39 years of age and the third most common from 15 to 19 years of age. In men over 50 years, testicular masses are usually caused by lymphoma, not TC (Dodd & Kelly, 2001). It is estimated that 7,500 new cases of TC in the United States occurred in 2002. Although TC is very treatable if detected early, the American Cancer Society (2003) estimates that approximately 400 men will die from the disease each year, and approximately 7,600 new cases will be diagnosed.
For unknown reasons, the incidence of TC in the United States has nearly doubled since the 1930s and continues to rise (Ries, Kosary, Hankey, Miller, & Edwards, 1998). Friman and Finney (1990) noted that TC in young men in the United States rose 205% between 1947 and 1981. In Canada, TC rates increased over 59% in the last 3 decades (Weir, Marrett, & Moravan, 1999). A study of active duty service members over a 9-year period between 1988 and 1996 revealed a 78% increase in testicular cancer (Thompson, Optenberg, Byers, & Dove, 1999). While no specific rationale was offered for this dramatic increase in the past decade, Thompson and colleagues hypothesized the increased incidence could be due to environmental endocrine disrupters, genetic factors, and/or cryptorchidism.
Several genes have been associated with TC. Qiao, Zeeman, Deng, Looijenga, and Lin (2002) recently discovered significantly higher levels of the hiwi gene in men who developed TC. There is no known function of this gene. In their research, they discovered that the hiwi gene was 16 times more active in patients with TC than in healthy males. In the future, this overactive gene and other genes associated with TC could be turned off, hopefully eliminating the partial or complete threat of this disease.
Risk Factors
Populations at high risk for TC include white males and those with either a familial history, prior history of testicular cancer, cryptorchidism, or Klinefelter's syndrome (Henderson, Benton, Jing, Yu, & Pike, 1979; Loehrer et al., 2001). TC is 4 to 5 times more likely to be seen in white men than African-American men (Bosl, Bajorin, Scheinfeld, Motzer, & Chaganti, 2001), with intermediate incidence rates among Native Americans, Hispanics, and Asians (Henderson et al., 1979). Siblings of men with testicular cancer have a 6 to 10-fold greater chance of developing TC (Dearnaley et al., 2001). Males with a history of an undescended testicle have a 20 to 40-fold increased risk of developing germ-cell tumors (Loehrer et al., 2001). Incidence rates fluctuate around the world, with higher rates in Scandinavia and Germany and lower rates in...
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