Testicular cancer

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  • Harrison's Internal Medicine Chapter 92. Testicular Cancer Testicular Cancer: Introduction Primary germ cell tumors (GCTs) of the testis, arising by the malignant transformation of primordial germ cells, constitute 95% of all testicular neoplasms. Infrequently, GCTs arise from an extragonadal site, including the mediastinum, retroperitoneum, and, very rarely, the pineal gland. This disease is notable for the young age of the afflicted patients, the totipotent capacity for differentiation of the tumor cells, and its curability; about 95% of newly diagnosed patients are cured.

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  • The regional draining lymph nodes for the testis are in the retroperitoneum, and the vascular supply originates from the great vessels (for the right testis) or the renal vessels (for the left testis). As a result, the lymph nodes that are involved first by a right testicular tumor are the interaortocaval lymph nodes just below the renal vessels. For a left testicular tumor, the first involved lymph nodes are lateral to the aorta (para-aortic) and below the left renal vessels. In both cases, further nodal spread is inferior, contralateral, and, less commonly, above the renal hilum.

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  • Fertility Infertility is an important consequence of the treatment of GCTs. Preexisting infertility or impaired fertility is often present. Azoospermia and/or oligospermia are present at diagnosis in at least 50% of patients with testicular GCTs. Ejaculatory dysfunction is associated with RPLND, and germ cell damage may result from cisplatin-containing chemotherapy. Nerve-sparing techniques to preserve the retroperitoneal sympathetic nerves have made retrograde ejaculation less likely in the subgroups of patients who are candidates for this operation.

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  • Postchemotherapy Surgery Resection of residual metastases after the completion of chemotherapy is an integral part of therapy. If the initial histology is nonseminoma and the marker values have normalized, all sites of residual disease should be resected. In general, residual retroperitoneal disease requires a modified bilateral RPLND. Thoracotomy (unilateral or bilateral) and neck dissection are less frequently required to remove residual mediastinal, pulmonary parenchymal, or cervical nodal disease.

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  • Tumor Markers Careful monitoring of the serum tumor markers AFP and hCG is essential in the management of patients with GCT, as these markers are important for diagnosis, as prognostic indicators, in monitoring treatment response, and in the detection of early relapse. Approximately 70% of patients presenting with disseminated nonseminomatous GCT have increased serum concentrations of AFP and/or hCG. While hCG concentrations may be increased in patients with either nonseminoma or seminoma histology, the AFP concentration is increased only in patients with nonseminoma.

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  • Stages I and II Seminoma Inguinal orchiectomy followed by retroperitoneal radiation therapy cures ~98% of patients with stage I seminoma. The dose of radiation therapy (2500– 3000 cGy) is low and well tolerated, and the in-field recurrence rate is negligible. About 2% of patients relapse with supradiaphragmatic or systemic disease. Surveillance has been proposed as an option, and studies have shown that about 15% of patients relapse. The median time to relapse is 12–15 months, and late relapses (5 years) may be more frequent than with nonseminoma.

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  • Tham khảo tài liệu 'guidelines on - testicular cancer', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • Some people believe that if cancer has spread to other parts of the body (called metastatic cancer), it is the same as advanced cancer. This is not necessarily true. You can have widespread cancer, but it can still be treatable and sometimes curable. Examples of this are testicular cancer and certain types of leukemia and lymphoma.

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  • The idea of this book grew out of the awareness of the need for a better answer to the frequent query: "Where can I learn about the psychological problems of cancer patients and how to treat them?" . . . There were many books and journals that an interested reader could turn to, but no summary of the broad range of issues that one needed to know to be informed was available. We began to conceive of a small book that would serve as an introduction to this emerging area of oncology. Using a developmental model, we sought to understand...

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  • Tham khảo sách 'disorders and diseases: cancer', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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  • Staging As noted in Chap. 77, an important component of patient management is defining the extent of disease. Radiographic and other imaging tests can be helpful in defining the clinical stage; however, pathologic staging requires defining the extent of involvement by documenting the histologic presence of tumor in tissue biopsies obtained through a surgical procedure.

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  • Primary germ cell tumors (GCTs) of the testis, arising by the malignant transformation of primordial germ cells, constitute 95% of all testicular neoplasms. Infrequently, GCTs arise from an extragonadal site, including the mediastinum, retroperitoneum, and, very rarely, the pineal gland. This disease is notable for the young age of the afflicted patients, the totipotent capacity for differentiation of the tumor cells, and its curability; about 95% of newly diagnosed patients are cured.

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  • Synthetic hyaluronan oligosaccharides with defined structures and their pyridylaminated derivatives were used to investigate the mechanism of hydrolysis of hyaluronan by bovine testicular hyaluronidase. The products of the hydrolysis were analyzed by HPLC and ion-spray mass spectroscopy (MS).

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  • Diethylstilbestrol (DES) acting as an estrogen at the level of the hypothalamus to downregulate hypothalamic luteinizing hormone (LH) production results in decreased elaboration of testosterone by the testicle. For this reason, orchiectomy is equally as effective as moderate-dose DES, inducing responses in 80% of previously untreated patients with prostate cancer but without the prominent cardiovascular side effects of DES, including thrombosis and exacerbation of coronary artery disease.

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  • Adrenal carcinomas are very rare and the real number diagnosed in the United States is not known. It is probably around 300 per year. They are much less common than adrenal adenomas, which are found frequently among middle aged and elderly people. Adrenal tumors (most of which are adenomas) are found in about one in every 10 people who have an imaging test (like a CT or MRI) of the adrenal gland. The average age of patients with adrenal cancer is around 45 to 50, but adrenal cortical cancer can occur in people of any age; even in children....

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  • Robert A Haward MB ChB DPH FFPH is Emeritus Professor of Cancer Studies at Leeds University. He qualified at Bristol University in 1968 and pursued a career in public health medicine in three district authorities before being appointed Regional Director of Public Health for Yorkshire from 1986 to 1994. He was then appointed Professor of Cancer Studies in Leeds until his retirement in 2006. He remains involved in national research activities. His academic career combined extensive national work developing cancer policies, with research interests in cancer services delivery.

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  • There has been a great deal of progress since the original breast guidance was published, so much so that it may seem to some that implementation of that guidance is largely achieved, that modern multidisciplinary breast cancer care is ‘a done deal’. But the challenges of rising numbers of new referrals, the need to respond within tight time-scales, and advances in diagnosis and treatment mean that teams must be very well organised and well supported to succeed. Despite obvious progress, breast teams do not all work optimally.

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  • If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed. You may be uncomfortable for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

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  • In a study of potential bone marrow transplant recipients, patients reported an improved outlook on life, enhanced relationships, and greater satisfaction with religious concerns (Andrykowski et al., 1993). The authors note that cancer should not be viewed as a homo- geneously negative event, but as a “psychosocial transition, i.e. an event with significant negative implications that can nevertheless cause individuals to restructure their attitudes, values, and behaviors, and thus can serve to trigger positive psychosocial change” (p. 274).

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  • The population of disabled elderly in the United States is growing rapidly. The number of Americans who will suffer functional disability due to arthritis, stroke, diabetes, coronary artery disease, cancer, or cognitive impairment is expected to increase at least 300 percent by 2049.1 Although people tend to develop chronic conditions as they age, growing old does not have to mean becoming disabled.

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