Case Study – Testicular Cancer

This case study examines the diagnosis and treatment of testicular cancer in a young adult, Tyson Perry. It discusses the clinical signs, staging, treatment options, and potential post-treatment challenges, including infertility and the importance of sperm banking. The study highlights the need for comprehensive patient care and family discussions regarding treatment impacts.

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Case Study – Testicular Cancer
Student’s name
Institution

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Case Study – Testicular Cancer
Part 1
a) The following are suggestive of testicular cancer in Tyson Perry:
 Age: Tyson is a 29 year old. Testicular cancer is a common cancer in young
adults, and men between 15 to 34 years have been reported to develop
testicular cancer [1, 2].
 Clinical signs: Tyson developed a lump in the testicles. Testicular cancer
commonly presents as a testicular mass. In young adults, testicular cancer is
one of the most common causes for testicular mass, lump, or swelling [3, 4].
Testicular cancer may present with abdominal pain [5]. In the case described,
Tyson complains of lower abdominal pain. This pain could be due to the
pulling effect of the testicular lump.
 Family history: In the case described, Tyson has a positive family history of
cancer as his dad too was diagnosed with testicular cancer. Some types of
testicular cancers, for example germ cell cancers, are reported to be familial
cancers [6].
b) Stage 2 testicular cancer: Staging of testicular cancer is done to estimate the size and
spread of the tumour. The following explanation will help the patient to understand
the status of the cancer and can aid in decision making for treatment:
 Staging: For the purpose of staging, the TNM criteria are used. TNM implies
tumour, nodes, and metastasis. According to these criteria, the size of the
tumour and spread of the tumour to the adjoining lymph nodes and distant
organs are key to staging the tumour. Stage 2 testicular cancer implies that the
tumour cells are no longer only confined the testicle. The tumour cells have
spread to the draining lymph nodes in the pelvis and/or abdomen. Stage 2
cancer is further classified as stage IIA, IIB, and IIC depending upon the size
of the involved lymph nodes.
 Anatomy: The tissue fluid form the testis is returned to circulation by a
drainage system called the lymphatic system. Lymph nodes are scattered
through the course of the lymphatic vessels and serve as gatekeepers against
infection in this system. Lymph from testes drains into the pelvic and lower
abdominal lymph nodes.

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 Correlation with symptoms: The lower abdominal pain could be because of
an enlarged lymph node in the pelvis and/or the lower abdomen.
Part 2
Seminomas, the most common type of testicular cancer in young adults, are treated by
orchidectomy (removal of testicle) followed by radiotherapy and/or chemotherapy [7]. Since
Tyson has a unilateral testicular mass, only one testicle will be removed surgically. The
removal of the testicle will be done through a groin incision to ensure the testicle is removed
along with the draining blood vessels and lymph channels. The surgical procedure may be
followed by one or more sessions of radiotherapy and/or multi-agent chemotherapy.
Post-treatment challenges: Infertility is an anticipated challenge following treatment of
testicular cancer, be it surgery, radiotherapy, or chemotherapy [8, 9, 10]. This can impact the
emotional and psychological health of the patient and the family. This concern should be
discussed with the patient, in specific with patients in the reproductive years. It is also
important to discuss the effect of treatment with the family.
1. Removal of only one testicle does not impact the reproductive capabilities or sperm
count in the patient. To preserve the shape of the scrotum, an artificial testis can be
used. This option should be discussed with the patient for aesthetic purposes.
2. Testicular cancer, depending upon the type and stage, may recur later in life. In this
circumstance, it may be required to remove the other testicle.
3. Removal of the testis may be followed by chemotherapy and/or radiotherapy. The
detailed treatment plan should be discussed with the patient and the family. The sperm
count may fall after surgery due to the added chemotherapy and/or radiotherapy.
4. After chemotherapy, a second surgery (retroperitoneal lymph node dissection) may be
needed to remove any residual lymph nodes in the abdomen. In this case, the erectile
function may be impacted. This may interfere with reproduction despite the preserved
sperm production in the testicle.
Sperm Banking
The option of sperm banking should be discussed with the patient. The following should be
discussed in specific [11]:
1. Sperm banking should be considered early in course of treatment planning.

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2. Sperm counts should be adequate to enable cryopreservation of sperms.
3. Sperm banking should be done either before or after orchidectomy. It should however
be done before any chemotherapy or radiotherapy is administered after surgery.

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Bibliography
1. Aparicio, J. et al. 2016. SEOM clinical guidelines for the management of germ cell
testicular cancer (2016), Clin Transl Oncol., Vol. 18, pp. 1187-1196.
2. Moreno, C., et al. 2015. Testicular tumors: what radiologists need to know--
differential diagnosis, staging, and management, Radiographics. Vol. 35, pp. 400-
415.
3. Kozlowski, P. et al., 2016. [Epidemiology and risk factors of testicular tumours], Pol
Merkur Lekarski. Vol. 40, pp. 211-215.
4. O’Reilly, P., et al., 2016. Evaluating scrotal masses, JAAPA. Vol. 29, pp. 26-32.
5. Rottenstreich, M. et al., 2016. The clinical findings in young adults with acute scrotal
pain, Am J Emerg Med. Vol. 34, pp. 1931-1933.
6. Greene, M. H., et al., 2015. Familial testicular germ cell tumors (FTGCT) - overview
of a multidisciplinary etiologic study, Andrology. Vol. 3, pp. 47-58.
7. Paly, J. J., et al. 2016. Management and outcomes of clinical stage IIA/B seminoma:
Results from the National Cancer Data Base 1998-2012, Pract Radiat Oncol. Vol.
6(6), pp. e249-e258
8. NCCN . 2014. NCCN Guidelines Index Testicular Cancer, NCCN Guidelines Version
1.2014 Panel Members, Available at
http://www.cus.cz/wp-content/uploads/2012/10/NCCN-C62-2014.pdf[Accessed 4
may 2017].
9. Hashibe, M. 2016. Long-term health effects among testicular cancer survivors, J
Cancer Surviv. Vol. 10, pp. 1051-1057.
10. Vakalapoulos, I., et al., 2015. Impact of cancer and cancer treatment on male fertility,
Hormones (Athens). Vol. 14, pp. 579-89.
11. Mackenna, A., et al., 2017. Semen quality before cryopreservation and after thawing
in 543 patients with testicular cancer, JBRA Assist Reprod. Vol. 21, pp. 31-34.