Post-Conference Session Summaries

“A Testicular Cancer Primer”

Instructional Session 23, presented Friday, April 27

The session's coordinator and first speaker, Diana Doyle, MS, APRN, BC, AOCN^®, provided information on the epidemiology of testicular cancer, its risk factors, its classifications, presenting symptoms, and diagnosis and staging. As Doyle explained, testicular cancer comprises about 1% of all male cancers and arises from germ cells that develop in the testes. Germ cell tumors can be benign, malignant, or mixed. Most testicular cancer (95%) occurs in the testes. Greater than 95% of men survive five years or more, which makes testicular cancer one of the most curable of all cancers.

Doyle stated that testicular cancer is the most common solid tumor affecting men ages 15-35. The incidence of testicular cancer peaks at infancy, at early adulthood (ages 25-40), and then again at age 60. The disease also is five times more common in white males than in African Americans. Risk factors include cryptorchid testis (i.e., undescended testicle), positive family history, the chromosomal abnormality of Klinefelter syndrome, and prior history of testicular cancer. Doyle stressed the importance of testicular self examination in spotting testicular cancer in the early stages.

According to Doyle, most men present with local disease, including painless swelling, enlargement of testis, and abnormal fluid collection. Disseminated disease can present with dyspnea, cough, back pain, abdominal discomfort, and urinary obstruction. Most cases can be diagnosed with a physical exam, ultrasonography, serum tumor marker testing, or diagnostic studies such as chest radiography, computed tomography, or magnetic resonance imaging. Dolye concluded by reviewing prognostic factors (stage, type, size, and lymph node involvement) and the three staging classifications of the disease.

Jackie Barnes, RN, BSN, began her presentation by discussing the history of testicular cancer treatment and explaining how dramatically success rates have improved since the 1960s, when the cure rate was only about 5%. In emphasizing the importance of cisplatin in the treatment of testicular cancer, Barnes cited the first cisplatin/vinblastine/bleomycin (PVB) study in 1974 as a landmark in the history of treatment. One-hundred percent of the study's participants who received the PVB regimen achieved either complete remission (70%) or partial remission (30%).

Barnes also reviewed the most common chemotherapy regimens used today to treat testicular cancer, including bleomycin/etoposide/cisplatin, etoposide/cisplatin, and etoposide/ifosfamide/cisplatin, as well as instances where surgery and radiation therapy are needed to supplement chemotherapy. Barnes emphasized the vital importance of treating patients as soon as possible after diagnosis and of staying on schedule. She also focused on the side effects of chemotherapy (e.g., nausea and vomiting, renal complications, hair loss, neutropenia) and offered suggestions for managing them. Barnes touched on how important proper surveillance is for testicular cancer survivors and why some survivors fail to monitor themselves properly, including fear of recurrence, lack of time, insurance restrictions, and fear of missing work.

The final speaker, Jane Williams, MSN, RN, FNP , BC , began by discussing follow-up issues and needs. As Williams stated, follow-up protocols vary by institution and the type, stage, and treatment of the disease. She emphasized that CT scans, because of radiation exposure, should not be taken lightly and should be used only if needed. She also discussed the use of tumor marker monitoring in indicating residual cancer.

As Williams stated, the long-term sequelae of testicular cancer need to be addressed, including nephrotoxicity from cisplatin therapy and pulmonary toxicity from bleomycin sulfate. She also discussed how “Reynaud's Phenomenon” affects survivors. This vascular disorder is marked by recurrent spasm of the capillaries, especially in the fingers and toes, and has been reported to occur in 10%-49% of patients. In addition, patients also need to be monitored for cardiovascular complications, secondary malignancies, and contralateral testicular cancer.

Williams also discussed that nurses need to be cognizant of issues related to sexuality, infertility, and mental health. Impaired sexual function and infertility often lead to psychosocial problems. In addition, men on surveillance for recurrence can experience higher anxiety, and frequent exams can remind them of their cancer history and ongoing risk of recurrence. Williams concluded the session by emphasizing the need for long-term survivors to continue to monitor for relapse, including annual physical exams, checking for pigmented skin lesions, regular lymph node exams, and checking the remaining testicle.

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