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Each year there are approximately 9,000 new cases of testicular cancer in the United States (Sachdeva, 2011). Generally testicular cancer accounts for only 1% of all neoplasms in men, however, it is the most common malignancy in men between the ages of 15 and 35 years (Huether & McCance, 2011 p. 825); African American men only represent 3% of patients, whereas 90% of them are Caucasian (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 2). 95% of testicular cancers are germ cell tumors (GCTs) and arise from the spermatogenic cells of the seminiferous tubules (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 1).
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Testicular cancer can be broadly classified into two types seminomas and nonseminomas. Seminomas tend to occur in an older population with an average age of 40.5 years (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 6). The tumor can range in size anywhere from a small to large mass that can almost replace the testicle. They are hard to mistake with their characteristic sheets or cells, fibrous bands and lymphocytic infiltrate. However there are non GCTs that can mimic seminomas such as Steroli and Leydig cell tumors. In order to differentiate from one another seminomas are identified by immunochemistry for placental alkaline phosphatase (PLAP) and c-kit (CD117) (Berney, 2005 p. 153).
Nonseminomas are a group of cancers that usually occur in combination with one another, they include choriocarcinoma, embryonic carcinoma (EC), teratoma, and yolk sac tumors (Bosl & Motzer, 1997 p. 1). Embroynal carcinoma is the original type of nonseminoma (Berney, 2005 p. 154). It resembles early embryonic cells and is present in 87% of mixed GCTs; in its pure form EC accounts for only 2-3% of all testicular tumors. At the time of presentation EC is often smaller than seminomas nonetheless it tends to be more aggressive (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 10).
There are many symptoms of testicular cancer; the most common indicator is a painless scrotal mass. Due to a rapid growth in the tumor resulting in hemorrhage and necrosis, acute pain may sometimes occur (Huether & McCance, 2011 p. 825). Pain is a less common symptom, presenting in less than 10% of patients. Many patients complain of heaviness or fullness in their lower abdomen or scrotum and swelling. Some of these symptoms can be caused by other conditions such as orchitis which can lead to a misdiagnosis (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 2). Orchitis is the inflammation of the testes caused by bacteria or virus such as the mumps, an infection of the prostate or epididymis, or a STD (Unknown, 2010). Some patients at the time of presentation have normal or small testes due to the tumor regressing, necrosis and scarring. Sometimes this particular group of patients may present with metastases (Woodward, Sohaey, O'Donoghue & Green, 2002 p. 2).
Embryonal carcinoma is known to have one of the highest rates of lymphovascular invasion and extension into the paratesticular tissue (Tavora, 2011 p. 6-7). At the time of diagnosis approximately 10-40% of patients have metastases. The retroperitoneal, lung and liver are the most common sites of metastases (Tavora, 2011 p. 2). Symptoms of metastases can include lumbar pain (retroperitoneal), cough, dyspnea, and hemoptysis (lungs), dysphagia and neck swelling (supraclavicular node), alterations in vision or mental status, papilledema, and sometimes seizures (CNS) (Huether & McCance, 2011 p. 825).
The Tumor, Node, Metastasis (TNM) classification of tumors is based on 2 main features: the extension of the tumor outside the testicular...