NCM 106 SY 2020-2021

Union Christian College

School of Health and Sciences
City of San Fernando
La Union

C ASE STUDY:
TESTICULAR CANCER

Submitted by:
OREIRO, Michael Anthony B.
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INTRODUCTION
Cancer starts when cells in the body change (mutate) and grow out of control. Your body is
made up of tiny building blocks called cells. Normal cells grow when your body needs them
and die when your body does not need them any longer. Cancer is made up of abnormal cells
that grow even though your body doesn't need them. In most cancers, the abnormal cells
grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they
can grow into (invade) nearby areas. They can even spread to other parts of the body
(metastasize). Cancer that starts in the cells that make up a testicle is called testicular cancer.
It's one of the most curable forms of cancer. The testicles are the male sex glands and are part
of the male reproductive system. Testicles are also called testes or gonads. They're behind
and below the penis in a pouch of skin called the scrotum. The testicles make sperm. Sperm
are the male cells needed to fertilize a female egg cell and make a baby. The testicles also
make male hormones, including testosterone. These hormones control the development of the
reproductive organs. They also control other things, like body and facial hair and a lower
voice. Most types of testicular cancer develop in the sperm-producing cells known as germ
cells and are referred to as germ cell tumors. Germ cell tumors in men can start in several
parts of the body:

 The testicles, which is the most common location

 The back of the abdomen near the spine, called the retroperitoneum
 The central portion of the chest between the lungs, called the mediastinum
 The lower spine
 Very rarely, a small gland in the brain called the pineal gland

Testicular cancer is almost always curable if found early, and it is usually curable even when
found at a later stage.

Germ cell tumors

More than 9 in 10 testicular cancers start in a type of cell in the testicles called a germ cell.
These are the cells that make sperm. There are 2 main types of germ cell tumors (GCTs):
seminomas and nonseminomas. These 2 types occur almost equally. Many testicular cancers
have both seminoma and nonseminoma cells. These are called mixed germ cell tumors.

Seminomas

Seminomas tend to grow slower than nonseminomas. They often respond very well to
treatment. There are 2 types:

 Classical (typical). More than 9 in 10 seminomas are classical. These are often found
in men between ages 25 and 45. 
 Spermatocytic. These tend to occur later in life. The average age at diagnosis is 65.

Nonseminomas

These grow faster than seminomas. They tend to occur in men between their late teens and
early 30s.
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There are 4 main subtypes:

 Embryonal carcinomas. This type tends to grow and spread quickly. Under a

microscope, these tumors look like tissue in early embryos.
 Yolk sac carcinomas. This is the most common form of testicular cancer in infants
and boys. These are usually treated successfully when found in children. They can be harder
to treat in adults.
 Choriocarcinomas. This type is very rare and tends to grow fast. It often spreads
quickly to other parts of the body, link the bones, lungs, and brain.
 Teratomas. Under a microscope these tumors look like the 3 layers of tissue in a
growing embryo. They are rarely the only type of cancer cell in a nonseminoma.
Most nonseminomas are a mix of different subtypes. Sometimes seminoma cells are mixed in
as well.

Stromal tumors

The stroma are tissues in the testicles that make hormones or support other tissues. Stromal
tumors start in these tissues. There are 2 main types: 

 Leydig cell tumors. These tumors start in cells that normally make hormones. They
are usually not cancer (benign).
 Sertoli cell tumors. These tumors develop from cells that support and nourish the
germ cells that make sperm. They're usually benign.
Overall, stromal cell tumors make up less than 5% of all adult cases of testicular cancer. But
they are found in up to 1 in 5 childhood cases.

Secondary testicular tumors

Secondary testicular tumors are tumors made from cancer cells that started in another part of
your body and spread to your testicles. For example, some kinds of lymphoma, a cancer of
the lymph nodes, can spread to the testicles. In men ages 50 and older, secondary testicular
cancer that starts as lymphoma is more common than tumors that start in the testicles. Other
cancers that may spread to the testicles include lung, melanoma, kidney, and prostate cancer.

ANATOMY & PHYSIOLOGY

Scrotum

The testes are located in a skin-covered, highly pigmented, muscular sack called
the scrotum that extends from the body behind the penis. This location is important in sperm
production, which occurs within the testes, and proceeds more efficiently when the testes are
kept 2 to 4°C below core body temperature.
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The dartos muscle makes up the subcutaneous muscle layer of the scrotum. It continues
internally to make up the scrotal septum, a wall that divides the scrotum into two
compartments, each housing one testis. Descending from the internal oblique muscle of the
abdominal wall are the two cremaster muscles, which cover each testis like a muscular net.
By contracting simultaneously, the dartos and cremaster muscles can elevate the testes in cold
weather (or water), moving the testes closer to the body and decreasing the surface area of the
scrotum to retain heat. Alternatively, as the environmental temperature increases, the scrotum
relaxes, moving the testes farther from the body core and increasing scrotal surface area,
which promotes heat loss. Externally, the scrotum has a raised medial thickening on the
surface called the raphae.

Testes
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The testes (singular = testis) are the male gonads—that is, the male reproductive organs.
They produce both sperm and androgens, such as testosterone, and are active throughout the
reproductive lifespan of the male.

Paired ovals, the testes are each approximately 4 to 5 cm in length and are housed within the
scrotum. They are surrounded by two distinct layers of protective connective tissue. The
outer tunica vaginalis is a serous membrane that has both a parietal and a thin visceral layer.
Beneath the tunica vaginalis is the tunica albuginea, a tough, white, dense connective tissue
layer covering the testis itself. Not only does the tunica albuginea cover the outside of the
testis, it also invaginates to form septa that divide the testis into 300 to 400 structures called
lobules. Within the lobules, sperm develop in structures called seminiferous tubules. During
the seventh month of the developmental period of a male fetus, each testis moves through the
abdominal musculature to descend into the scrotal cavity. This is called the “descent of the
testis.” Cryptorchidism is the clinical term used when one or both of the testes fail to descend
into the scrotum prior to birth.

The tightly coiled seminiferous tubules form the bulk of each testis. They are composed of
developing sperm cells surrounding a lumen, the hollow center of the tubule, where formed
sperm are released into the duct system of the testis. Specifically, from the lumens of the
seminiferous tubules, sperm move into the straight tubules (or tubuli recti), and from there
into a fine meshwork of tubules called the rete testes. Sperm leave the rete testes, and the
testis itself, through the 15 to 20 efferent ductules that cross the tunica albuginea.

Inside the seminiferous tubules are six different cell types. These include supporting cells
called sustentacular cells, as well as five types of developing sperm cells called germ cells.
Germ cell development progresses from the basement membrane—at the perimeter of the
tubule—toward the lumen. Let’s look more closely at these cell types.
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PATHOPHYSIOLOGY

Embryonic Germ Cell

Primordial Germ cell

KIT gene activation

Gonocyte

DNA demethylation

Intratubular germ-cell
neoplasia

Gain of 12p mutations in

RAS, KIT other genes

Low-level DNA methylation Intermediate-level methylation

Invasive germ-cell
tumor

Persist Intratubular Embryonal

germ-cell neoplasia Carcinoma

Choriocarcinoma Yolk-sac tumor Teratoma

Secondary
tumor
LABORATORY AND DIAGNOSTIC TESTS
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Clinical Evaluation

The process of diagnosing testicular cancer begins with a medical history and physical exam.
During the physical exam, a healthcare practitioner will:

 Examine the patient's testicles for signs of swelling, tenderness or hardening

 Press on the lymph nodes that lie beneath the skin in the groin, abdomen, upper chest,
and neck to check for swelling or hardness
 Examine the patient's abdomen for signs of liver enlargement
 Examine the patient's breasts and nipples for signs of enlargement and tenderness

Non-Laboratory Tests

 An ultrasound exam of the scrotum and testicles is often the first diagnostic test
performed when testicular cancer is suspected. Ultrasound uses sound waves to create
images of organs and tissues. Those images, called sonograms, can be viewed on a
monitor while the exam is being performed. Ultrasound can detect the presence, size,
and consistency of a testicular tumor, and it can be used to help differentiate cancer
from other conditions, such as infection or structural abnormalities within the testicle.

Laboratory Tests

 AFP (alpha-fetoprotein)—Nonseminoma germ cell tumors often make AFP.

Seminoma germ cell tumors do not. Therefore, if someone's AFP level is elevated, his
health care team will know that his tumor is composed, at least in part, of
nonseminoma cells and the cancer should be treated as a nonseminoma.
AFP normal value is 10ng/ml to 20ng/ml
AFP of >400ng/ml indicates tumor or cancer
 hCG (human chorionic gonadotropin)—Both seminomas and non-seminomatous
germ cell tumors (nonseminomas) can cause hCG blood levels to rise.

Stromal tumors (Leydig cell tumors and Sertoli cell tumors) do not make AFP or hCG, so
they will not cause blood levels of these tumor markers to rise.

 Lactate dehydrogenase (LD or LDH) levels can rise in the presence of most types of
testicular cancer. LD is an enzyme found in many body tissues that is released into the
bloodstream when cellular damage occurs. It is not specific for testicular cancer;
many other health conditions can cause LD levels to rise. When testicular cancer is
present, high LD levels may indicate that the cancer is widespread.
 LDH normal value ranges 140 units per liter (U/L) to 280 (U/L)
 LDH value of >1000(U/L) indicates cancer

Imaging tests:
Once a diagnosis of testicular cancer has been made, additional procedures may be
recommended to find out whether the cancer has spread.

 A chest X-ray may be done to look for masses in the lungs.

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 CT scans of the abdomen, pelvis, and possibly the chest may be done to determine
whether the cancer has spread to lymph nodes, organs, or tissues in any of those areas.
 MRI scan of the brain and spinal cord is typically done only if the healthcare
practitioner has reason to believe that the cancer might have spread to this area.
 A PET scan, which can help spot smaller collections of cancer cells, such as in the
lymph nodes, might be done, but it is more useful for seminomas than for non-
seminomas.
 A bone scan could be done if there is bone pain, which suggests the cancer may
possibly have spread to the bones.
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I. Evaluation

After rendering holistic care, the patient and the nurse will be able to achieve the
specific objectives. It is important to monitor progress toward outcomes, working with both
the client and the family. Continuing medications even after symptoms abate is
recommended. Continue encouraging the client to verbalizes and express his feelings, this
would always be effective and therapeutic to the client.

II. Implication

Nursing Practice

This case study would make a contribution to the practice of medical nursing as it
would serve as a documentation that would then contribute to the appropriate plan of care in
patients with Bronchitis. This would also provide information about Bronchitis and nursing
interventions and therapeutic techniques used with patients who have this condition. It also
provides information about the plan of care for patients who have this condition for efficient
nursing care.

Nursing Education

To nursing education, this case study would help by providing information about the
disease condition, Bronchitis. The student nurses, as well as the clinical instructors could
gain additional information about this condition, so that it could better equip them for
efficient nursing care in the future. This study would explain the future nurses’ adequate
background knowledge regarding medical nursing before one is to be exposed to the clinical
setting. This would help expand knowledge regarding the disease and would correct
misconceptions toward this case. It would then promote awareness.

Nursing Research

Research is now an integral part of nursing. Through research, betterment or

improvement of nursing education to be practiced competitively in the clinical setting will be
achieved. In Nursing Research, this case study may broaden the scope or extent of research
done previously for Bronchitis. This may lead to another breakthrough study in the details of
 NCM 106 SY 2020-2021

the condition. This can also contribute in upgrading and updating the interventions made for
this condition.

III. Recommendations
 Change your body position or move around often. Move and stretch in your seat
several times each hour if you travel by car or work at a desk. In an airplane, get up
and walk every hour.

 Stay away from. Or try to reduce your time around things that irritate your airway
(nose, throat, and lungs). Irritants can include dust, mold, pet dandler, air pollution,
smoke, and cleaners.

 Maintain a healthy weight. Ask your healthcare provider how much you should
weigh. Ask him or her to help you create a weight loss plan if you are overweight.

 Don’t smoke. Tobacco damages your lung’s ability to fight off infection, and
smokers have been found to be at higher risk of getting pneumonia. Smokers are
considered one of the high risk groups that are encouraged to get the pneumococcal
vaccine

 Good Health Habits. A healthy diet, rest, regular exercise etc. Helps you from
getting sick from viruses and respiratory illnesses. They also help promote fast
recovery when you do get a cold, the flu or other respiratory illness.
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REFERENCES:
https://www.cancer.net/cancer-types/testicular-cancer/introduction#:~:text=Testicular
%20cancer%20begins%20when%20healthy,testicular%20cancer%20is%20testis%20cancer
https://www.ncbi.nlm.nih.gov/books/NBK563159/
https://labtestsonline.org/conditions/testicular-cancer#:~:text=Histologic%20examination
%3A,testicular%20tissue%20under%20a%20microscope
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=34&contentid=18186-1