02.07 Testicular Cancer

Hey there, it's Meg again. Today we're going to cover testicular cancer. Let's go ahead and dive in. So the thing to remember about testicular cancer is that it affects young males. The other thing I want you to know is that cure is very common in these patients. We're talking about a 99% lifetime survival. That's pretty much unheard of with any other cancer. Now, like I said, it involves young meals, which I know is a little opposite, most other solid tumor cancers, but it's more common in men under 50 years old because we're under 50 years old. We're talking about men that are um, likely in child-rearing phase. So we want to make sure that we're addressing fertility with them. Treatment is often motor multi-modal for these patients. So we're talking surgery, chemo and radiation, all things that men with testicular cancer could go under. And then we'll also talk about testicular self exam because while testicular cancer has a high cure rate, there's actually very few ways it can be prevented.

So the key here is going to be catching it early enough so that it's less disruptive to your patient. So first, let's talk about those risk factors. As you can see, our top four risk factors right here, there's nothing the patient can do about that. They can't control their age, their family or personal history or whether they were born with an undescended testicle. In fact, in terms of undescended testicle, it's very common that a man might not even know he had an undescended testicle at birth. Now there are also some myths about testicular cancer that I want to just dispel right now. Really quick. Horseback riding, bicycle riding, riding a motorcycle, and uh, pelvic trauma. Those are not causes of testicular cancer. You might hear people say that they are, I can assure you they are not. So back to our risk factors, um, because it's difficult to prevent and because we can't do anything about these risk factors, it's so important to catch it early. 

So let's talk about how we can do that. Qe've got testicular self exam. This is the key to catching it in our early stages. And we want men to start doing this in puberty. We want men, we want all patients to really understand their own anatomy in their own body. So we're going to have them start it in puberty and we're going to have them do it after showering. And this is similar to breast self exam and that we do it after showering because the tissue is warm, the tissue is more relaxed, it's softer, and it's easier to get a really full comprehensive exam. We want our patients doing this once monthly, and I do also want to say that sometimes it's patients doing this. Other times it's partners. It's just as common that a patient's sexual partner finds an abnormality in their testicle than it is that a patient finds it. And then big thing right here is it should be painless if there's any in the testicle, the epididymis, or in the vast deference along the back side of this [inaudible], the patient needs to seek medical attention. So this could mean that it's tumor growth or lymph node swelling, or it could be something else going on in the testicle like epispadius or testicular torsion. Regardless, the patient needs to come see a provider because they're going to need an ultrasound to figure out exactly what's going on.

Okay,  so here's some more things that we might discover on an a to a testicular exam, whether it's a patient or a provider doing the exam. Unilateral lump is going to be an early symptom of testicular cancer. Now, in later stages, the patient might feel fullness or ache and that could be from the tumor or it could be from lymph nodes because if you've ever had swollen lymph nodes in your neck when you had a cold, you know that lymph nodes can be really uncomfortable and achy when they're swollen. And then we have signs of metastasis, common signs of Mets and patients with testicular cancer is going to be cough with lung Mets and weight loss with some GI mats as well. So we want to make sure that our patient doesn't have those symptoms when they come in with any abnormality in their testicles. So then you're a provider and your patient has come in to say that they had an abnormal testicular self-exam. We want to assess the normal testicle first because that is going to give us a better frame of reference for the abnormal testicle. We're also going to palpitate gently but firmly the inguinal lymph nodes because that's a common spot of first spread. And then we're gonna follow that up with radiology and lab values specifically, we're going to want an ultrasound of the testicles to get a better look at what's going on.

So treatment, so remember any cancer treatment is going to be highly patient-specific. Remember it's also highly curable but it's likely to be less disruptive if we catch it early. Surgical intervention is often going to be an orchiectomy and I do want to mention, and that is the removal of the testicle. I do want to mention that sometimes we perform an orchiectomy and in order to do the biopsy, so what that means is sometimes we remove the patient's testicle and it comes back benign. So it's very important that we get a very thorough assessment done on the patient before we move forward to surgery. Then, um, when we talk about medical treatment, that's likely going to be chemotherapy and then radiation to the area as well. The thing that all things three of these things have in common is that they impact fertility. So we need to be very deliberate in how we treat our patients for testicular cancer.

Okay. So I really want to stress survivorship for this patient population because it is highly curable and because it affects mostly younger men. So what that means is there are lots of men living long lives after testicular cancer and we need to take good care of them. So first we have coping cancer diagnosis alters the way the patient copes. It just does. That's going to be a highly individualized response. The other thing of coping that I want you to remember is the patient's family. These patients are often young and then any partners they have because this involves intimate reproductive organs or these patients, it's going to have, um, an impact on both the patient's family and on their partners. Then we've got body image because remember, oftentimes we're doing an orchiectomy, which means that we're removing a patient's testicle and then we have reproduction and sexuality.

Now these are two very different things. The thing to know about reproduction is that patients often have low sperm counts and sometimes that is irreversible, so sometimes it can really negatively affect their ability to conceive with their partner. Sexuality is different in that sexuality is about the relationship that that patient has with their partner and that the patient has with their body. Now, all of these concepts are interconnected and they're all equally important, so we need to make sure that we're addressing each of them individually so that we can assess the whole patient. Okay, so let's do our priority nursing concepts for a patient with testicular cancer. Remember, with any cancer diagnosis, we need to focus on coping. We need to see how the patient feels about the diagnosis, address any changes in body image, and make sure that we're meeting all of their needs and then reproduction. This could disrupt the patient's fertility and it could mean that they need a consult to something like onco fertility. That's becoming more and more common. Then we have sexuality. Remember we're again, we're changing the way the patient's body looks in a really intimate, vulnerable way. They may also have changes in sex drive or just in their relationship with their sexual partner. So it's important that we are assessing the whole patient. 

Okay, let's wrap it up with some key points. Remember, testicular cancer is most common in young men under age 50 but it is highly curable, which is wonderful. We have the best chance of cure with early detection, which we can achieve through the testicular self-exam, so empowering our patients to be aware of their own bodies is so, so important. Then we have fertility and sexuality. It affects our patient sex organs. It affects the way they feel about their bodies and we need to make sure that we are very deliberately assessing their patient's needs. And then finally, survivorship. This is always a priority. Our patients are young, which means we need to figure out the best way that we can prepare this patient for the rest of his life after cancer.

Okay. That is all for our lesson on testicular cancer. Now, go out and be your best selves today, and as always, happy nursing.