THEERTHA P KRISHNA

1. TESTICULAR CANCER
PREPARED BY
MS THEERTHA P KRISHNA
2ND YEAR MSC NURSING
MIMS CON

2. INTRODUCTION
• Testicular cancer is the most common cancer among men about the age of 15
& 35.
• Testicular cancer almost always occur in just one testis rather than both.
• Testicular germ cell tumors (GCTs) account for 98% of all testicular
malignancies and are the most common solid malignancy in men age 15 to 35.

3. EPIDEMIOLOGY
• Testicular cancer accounts for approximately 1% of all male cancers.
• About 1 of every 250 males will develop testicular cancer at some point during
their lifetime.
• About 6% of cases occur in children and teens and 8% occur in men over the
ages of 55.
• The largest proportion of testicular cancer cases occur in descended testes, with
a smaller proportion in undescended testis.

4. DEFINITION
• Cancer that develops in a testicle is called testicular cancer or cancer of testis.
• Testicular cancer is malignant tumour of the male sex organ that normally
produces the hormone testosterone.
• Testicular cancer that forms in tissues of one or both testicles.

5. RISK FACTORS
Orchipexy
Age: young adults 20-40 years.
Race: whites are 6 times more likely to develop testicular cancer.
Vasectomy
Testicular trauma
Orchitis
History of hernia
Infertility
Cryptorchidism

6. ETIOLOGY
Personal history
Undescended testis
Family history
Infertility
HIV & AIDS
Some congenital defects

7. CLASSIFICATION OF CA TESTIS
SEMINOMA
NON SEMINOMA
CARCINOMA INSITU
STROMAL TUMORS
SECONDARY TESTICULAR TUMORS

8. SEMINOMA
• A seminoma is a germ cell tumor of the testicle or, more rarely,
the mediastenum or other extra-gonadal locations.
• Testicular seminoma originates in the germinal epithelium of the seminiferous
tubules.

9. SEMINOMA TYPES
Classic seminoma: more than 95% of seminomas are classical. These usually
occur in men between 25 & 45 years.
Spermatocytic seminoma: this type of seminoma tends to occur in older men;
average age is about 65. Spermatocytic tumors tends to grow more slowly and
are less likely to spread to other parts of body than classical seminomas.

10. NON SEMINOMAS
Cells which are more mature and specialized than the germ cells, give rise to non
seminomas.
Types:
Embryonal seminomas carcinoma
Yolk sac carcinoma
Choriocarcinoma
Teratoma

11. NON SEMINOMAS TYPES
Embryonal carcinoma: this type of non seminomas tends to grow rapidly and
spread outside the testicle. Embryonal carcinoma can increase blood levels of a
tumour marker protein called alpha fetoprotein and human chorionic
gonadotropin.
Yolk sac carcinoma: cells look like the yolk sac of an early human embryo.
Choriocarcinoma: likely to spread rapidly to other parts of the body.
Teratomas: they are germ cell tumors,looks like a developing embryo.

12. TERATOMA TYPES
Mature teratoma: tumors formed by cells a lot like the celss of adult tissues.
Immature teratomas: less well developed cancers with celss that look like
those of an early embryo.
Teratoma with somatic type of malignancy.

13. CARCINOMA INSITU
• Testicular germ cells cancers can start as a non invasive form of the disease
called carcinoma insitu or intracellular germ cell neoplasia.

14. STROMAL TUMORS
Tumors can also start in the supportive and hormone producing or stroma, of
the testicles. These tumors are known as gonal stromal tumors.
Types:
Leydig cell tumors
Sertoli cell tumors

15. LEYDIG CELL TUMORS
These tumors start in the Leydig cells in the testicle that normally make male sex
hormones.

16. SERTOLI CELL TUMORS
These tumors start in the normal sertoli cells; which support and nourish the
sperm making germ cells.

17. SECONDARY TESTICULAR CANCER
Cancer that start in another organ & then spread to the testicle are called
secondary testicular cancer.
Cancers of prostate, lung, skin, kidney and other organ also can spread to the
testicles.

18. AJCC TESTICULAR CANCER STAGING
• Primary tumor (T)
TX The primary tumor cannot be assessed
T0 There is no evidence of primary tumor
Tis Carcinoma in situ
T1 The tumor has not spread beyond the testicle and the narrow tubules next to the testicles where
sperm undergo final maturation
T2 Similar to T1 except that the cancer has spread to blood or lymph vessels near the tumor, or the
tunica vaginalis
T3 The tumor invades the spermatic cord
T4 The tumor invades the skin surrounding the testicles

19. AJCC TESTICULAR CANCER STAGING
• Regional lymph nodes (N)
NX Regional (nearby) lymph nodes cannot be assessed
N0 No spread to regional lymph nodes is seen on x-rays
N1 There is spread to at least 1 lymph node, but no lymph node is larger than 2 cm
N2 There is spread to at least 1 lymph node that is larger than 2 cm but is not bigger than 5 cm
N3 There is spread to at least 1 lymph node that is larger than 5 cm in any dimension

20. AJCC TESTICULAR CANCER STAGING
• Distant metastasis
MX Distant metastasis cannot be assessed
M0 There is no distant metastasis
M1 Distant metastasis is present
M1a The tumor has metastasized to distant lymph nodes or to the lung
M1b The tumor has metastasized to other organs, such as the liver, brain, or bone

21. AJCC TESTICULAR CANCER STAGING
• Serum tumor markers (S)
LDH (U/liter) HCG (mIU/ml) AFP (ng/ml)
SX Marker studies not available or not
performed
S0 Normal Normal Normal
S1 < 1.5 × Normal < 5000 < 1000
S2 1.5–10 × Normal 5000–50,000 1000–10,000
S3 > 10 × Norma > 50,000 > 10,000

22. CLINICAL FEATURES
A hard, painless, pea-sized swelling or enlargement of the testis.
Testicular ache/discomfort
 Enlargement or firmness of testis
Heaviness of scrotum
 Asymmetry Dull ache in lower abdomen or groin
 Sudden collection of fluid in scrotum

24. CLINICAL FEATURES : Metastatic effects
Back pain (para-aortic lymphadenopathy)
 Breathlessness or hemoptysis (pulmonary metastasis)
 Chest pain
Coughing

25. CLINICAL FEATURES : Hormonal effects
Breast growth
Tender or swollen breasts
Reduced or loss of sex drive
 Growth of hair on face and/or body before puberty

26. DIAGNOSIS
• Physical examination: epididymis is located in the back of the scrotum and
will normally possess a spongy texture, symmetry of the testicles, their size,
body hair growth, and lung sounds, Lymph nodes should be examined,
breasts should also be examined for gynecomastia.
• Ultrasound: show the size, location, & solidness of the tumor.
• Serum tumor markers:
The alphafetoprotein (AFP):
Beta human chorionic gonadotropin (beta-HCG)
Lactate Dehydrogenase
Placental alkaline phosphatase (PLAP)

27. DIAGNOSIS
X-ray
CT Scan
MRI Scan
PET Scan
Biopsy
Testicular self examination

28. MANAGEMENT
SURGERY
RADICAL
INGUINAL
ORCHIECTOMY
RECONSTRUCTIVE
SURGERY AFTER
ORCHIECTOMY
RETROPERITONEAL LYMPH
NODE DISSECTION

29. SURGERY
• Surgery for cancer involves the removal of the tumor and sometimes some
surrounding healthy tissues during an operation.
• Radical orchiectomy also called inguinal orchiectomy is the most common treatment
for testicular cancer.
• Other types includes the following:
Reconstructive surgery after orchiectomy
Retroperitoneal Lymph Node Dissection (RPLND)

30. RADICAL INGUINAL ORCHIECTOMY
During the surgery the entire testicle and most of the spermatic cord are
removed.
The spermatic cord contains the blood supply to the testicle and the channel
through which sperm travel from the testicle towards the penis.

31. RECONSTRUCTIVE SURGERY AFTER ORCHIECTOMY
Men decide if they want an artificial or prosthetic testicle implanted in the
scrotum.
A prosthetic testicle implanted in the scrotum.
A prosthetic testicle generally has a weight and texture.

32. RETROPERITONEAL LYMPH NODE DIESECTION (RPLND)
Surgery to remove the retroperitoneal lymph node that lie at the back of the
abdomen.
RPLND is performed as an open operation with an incision down the middle of
the abdomen.

33. CHEMOTHERAPY
Bleomycin
Carboplatin
Etoposide
Gemicitabine
Ifosfamide
Oxaliplatin
Paclitaxel
Vinblastine

34. Chemotherapy regimens may be used for
testicular cancer
BEP: bleomycin, etoposide, and cisplatin
Carboplatin (for stage I pure seminoma only)
EP: etoposide and cisplatin
TIP: paclitaxel, ifosfamide, and cisplatin
VeIP: vinblastine, ifosfamide, and cisplatin
VIP: etoposide, ifosfamide, and cisplatin
High-dose carboplatin and etoposide

35. RADIATION THERAPY
Most common type of radiation treatment is external beam radiation therapy.
For testicular cancer the radiation is generally directed at lymph node in the
abdomen for men with stage I and II pure seminoma.

36. TREATMENT BY STAGE OF TESTICULAR CANCER:
NONSEMINOMA TUMORS
• Stage I:
Surveillance: Physical examinations and tumor marker tests to measure beta-hCG and AFP
are done every 1 to 2 months for the first 12 months, every 2 to 3 months in the second year,
every 3 to 4 months in the third and fourth years, every 6 months in the fifth year, and then
yearly.
RPLND
Chemotherapy: The most commonly used approach has been to give 1 cycle of BEP
chemotherapy that lasts 3 weeks.

37. TREATMENT BY STAGE OF TESTICULAR CANCER:
NONSEMINOMA TUMORS
• STAGE II NON-SEMINOMA TESTICULAR CANCER
Chemotherapy: A combination of drugs is usually given after surgery to remove
the testicle in the following situations: If serum tumor markers remain high,
there are more than 5 enlarged lymph nodes, or there are lymph nodes larger
than 2 cm.
RPLND (Retroperitoneal Lymph Node Dissection)

38. TREATMENT BY STAGE OF TESTICULAR CANCER:
NONSEMINOMA TUMORS
• Stage III non-seminoma testicular cancer
Chemotherapy: The most common regimen given is BEP, which is a
combination of bleomycin, etoposide and cisplatin.
Surgery after chemotherapy

39. TREATMENT BY STAGE OF TESTICULAR CANCER:
SEMINOMA
• STAGE I SEMINOMA TESTICULAR CANCER
Surveillance: he following tests are done at each visit: a CT scan of the abdomen and
pelvis, a chest radiograph, and a physical examination. Blood tests to measure the
serum tumor markers beta-hCG and AFP may be done at the same time.
Adjuvant radiation therapy
Adjuvantchemotherapy

40. TREATMENT BY STAGE OF TESTICULAR CANCER:
SEMINOMA
• STAGE II SEMINOMA TESTICULAR CANCER
Chemotherapy
Radiation therapy

41. TREATMENT BY STAGE OF TESTICULAR CANCER:
SEMINOMA
• STAGE III SEMINOMA TESTICULAR CANCER
Chemotherapy:generally treated with 4 cycles of BEP.
Surgery after chemotherapy/radiation therapy

42. SPERM BANKING
This is where a sample of sperm is frozen so it can be used at a later date to
impregnate the partner during artificial insemination.
Not all men are suitable for sperm banking, the sperm has to be of a
reasonably high quality.
Sperm banking prior to initiation of treatment may be an option depending
on the stage of disease and sperm count at diagnosis.

43. NURSING MANAGMENT
• Careful explanations of the nature of the disease, its treatment, goals of
therapy, and side effects are essential.
• Information must be provided and reinforced at various intervals along the
treatment continuum.
• Monitoring of the patient response to and possible effects of surgery,
chemotherapy and radiation therapy.
• Also explain importance of TSE.

44. CONCLUSION
Although testicular cancer is a rare and devastating disease to the young
population it affects, it is also one of the most highly curable malignancies.
Testicular self-examination remains the best available tool for early diagnosis
and treatment.