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Testicular Cancer Case Studies
A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. Thisfinding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old.
Studies
Results
Routine laboratory studies
Within normal limits (WNL)
Ultrasound the testicle
Solid mass, right testicle associated with calcifications
HCG (human chorionic gonadotropin)
550mIU/mL (normal: <5)
CT scan of the abdomen
Enlarged retroperitoneal lymph nodes
CT scan of the chest
Multiple pulmonary nodules
Diagnostic Analysis
At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes.
Critical Thinking Questions
- What impact did an undescended testicle have on this young man’s risk for developingtesticular cancer?
- What might be the side effects of cytotoxic chemotherapy?
- What was the purpose of preserving his sperm before chemotherapy?
- Is this young man’s age typical for the development of testicular carcinoma?
Expert Solution Preview
Introduction:
Testicular cancer is a rare but serious form of cancer that primarily affects young men. Early detection and treatment are crucial for successful outcomes. In this case study, a 21-year-old male presented with pain in his right testicle and was subsequently diagnosed with testicular cancer. This case study raises important questions regarding the potential impact of an undescended testicle on the development of testicular cancer, the potential side effects of cytotoxic chemotherapy, the purpose of preserving sperm before chemotherapy, and the typical age for the development of testicular carcinoma.
1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer?
An undescended testicle refers to a condition wherein one or both testicles fail to move from the abdomen into the scrotum before birth. This condition significantly increases the risk of testicular cancer. Studies have shown that individuals with a history of undescended testicle have a higher chance of developing testicular cancer than those with normally descended testicles. The risk is even higher if the undescended testicle is not surgically corrected. In this case, the young man’s delayed descent of the right testicle until the age of 1 year old suggests that he had an undescended testicle, which likely contributed to his increased risk for testicular cancer.
2. What might be the side effects of cytotoxic chemotherapy?
Cytotoxic chemotherapy is a widely used treatment modality for various types of cancer, including testicular cancer. While it can be effective in killing cancer cells, it also has the potential to cause side effects due to its toxic effects on normal cells in the body. Some common side effects of cytotoxic chemotherapy include nausea and vomiting, hair loss, fatigue, increased susceptibility to infections, decreased blood cell counts (leading to anemia, increased risk of bleeding, and increased risk of infections), and fertility problems. The specific side effects can vary depending on the chemotherapy drugs used and the individual patient.
3. What was the purpose of preserving his sperm before chemotherapy?
Preserving sperm before chemotherapy is known as sperm cryopreservation or sperm banking. The purpose of this procedure is to ensure that the young man has the opportunity to have biological children in the future, despite the potential fertility issues that may arise as a result of chemotherapy. Cytotoxic chemotherapy agents can damage sperm production and affect fertility. By preserving his sperm before undergoing chemotherapy, the young man can have a higher likelihood of successfully fathering children through assisted reproductive technologies such as in vitro fertilization (IVF) or intrauterine insemination (IUI) after completing treatment.
4. Is this young man’s age typical for the development of testicular carcinoma?
Testicular carcinoma primarily affects young adult males, with the peak incidence occurring between the ages of 20 and 35. Therefore, the age of 21 is within the typical range for the development of testicular carcinoma. However, it is vital to note that this condition can occur at any age, including in adolescents and older men, although less frequently. Regular testicular self-examinations and awareness of the signs and symptoms of testicular cancer are essential for early detection and prompt medical intervention.
