THE ORCHIECTOMY

If your doctor tells you that you need an orchiectomy, dont freak out. It may cause you some issues, but in most physical instances, the orchiectomy should not affect you in any way other than minor post operative recovery. One testicle is all that is needed to do all the things that you have always done. You will be able to return to your normal sex life soon after recovery from the orchiectomy - a minor surgery. Yes it is minor, infact an orchiectomy is almost always done in an outpatient facility, which means you wouldnt even need to stay in a hospital for a night. Most men can even father children after an orchiectomy with only one testicle - ask your doctor about possibly banking sperm, prior to the orchiectomy just as a precaution. Bi-Lateral Orchiectomy, which means they remove BOTH testicles due to cancer or fear of cancer, is also nothing that will change your normal routine of life. Natrually, you will not be able to father children with no testicles - so you will definately want to bank sperm if you are planning on ever having children of your own. Medical advances has made it easy to "replace" testosterone levels in your body and maintain a normal, happy sex life! Talk to your Doctor about different hormone replacement options. Currently there are daily gel applications and shots available. To learn more about "Sex and Testicular Cancer", Click Here.

Before the Orchiectomy...

The doctor should have some blood tests done. They need to check your blood for the presence of certain tumor markers and their levels while the tumor is still in your body. These tumor markers can later be used to determine if the cancer has spread outside of the testicle, but it is very important that they begin testing and establish some baselines before the surgery. Similarly, we strongly encourage newly diagnosed men to ask their doctors to check their serum testosterone level before the orchiectomy. There is no therapeutic reason to do this, but we have found that it may be useful to know this number at some point in the future. The doctors may also give you the option of an epidural or general anesthesia for the orchiectomy. General anesthesia is clearly the more traditional choice. However, an epidural (lower back) block may be beneficial if you do not react well to general anesthetics. With the epidural anesthetic it is possible (though maybe not desirable!) to remain awake and talkative during the whole operation! Both anesthetics have possible problems and side effects, carefully discuss your options with your doctor.

AFTER..The Orchiectomy...
The actual removal is done by making about a 4 inch incision along the "bikini line" through the lower abdomen on the side in question--they will NOT cut through the scrotal sack whatsoever during an orchiectomy. Once the incision has been made, the surgeon pushes the testicle up through the pelvic region and out it comes. A snip here, a stitch there, and you're done before you know it. Average time on the table is about 45 minutes to an hour, but you should probably expect to stay in the hospital at least overnight following the orchiectomy. Unlike the RPLND, this operation is very simple and should not require any special expertise on the part of the surgeon. After the orchiectomy - surgery, they will probably wake you up pretty soon after and encourage you to get up and try to walk. It will hurt, but it will also get your insides working faster and get you out of the hospital sooner. You'll probably have a reasonable amount of

pain at the incision, and you might want to consider wearing sweatpants for a week or two. There may also be numbness of the skin around the incision, but that should eventually go away. Different people will react differently to the operation. Some will be up and about the next day; others will lay around in bed for a while. We recommend that you try to get up and do something because otherwise you may just end up sitting around feeling sorry for yourself. Your attitude will make a huge difference in your recovery time; the better it is the better you will do. We suggest you learn about the cancer, so that you know what to expect from the pathology report and from the doctor and the future ahead -- but don't let it overwhelm you. The doctor probably wont let you drive or do any heavy lifting for a couple of weeks, so be prepared to ask for help getting around. What is recommended postsurgery?

After the surgery - now what do I do?? This is the biggest question as all patients with testicular cancer are just ready for this all to be over and ready to move on with their lives. These are some of the "RECOMMENDED" treatment options for testicular cancer. Please note that these are recommendations, and you should follow what your Physician advises you do. If you are unsure or not comfortable with what your Physician is recommending, then Lymph node metastases, CT scan we would suggest that you get a A CT scan of the middle abdomen showing a large tumor mass due to metastasis (spreading cancer) in abdominal lymph nodes. second opinion. Clinical Stage I Nonseminoma - Treated with Surveillance only Note: "Clinical" refers to the diagnosis being based on clinical data (pathology, markers, xrays) Year 1: Tumor Markers and Chest X-ray done every month Abdominal CT scan doneevery 2 months Year 2: Tumor Markers and Chest X-ray done every 2 months Abdominal CT scan done every 4 months Years 3-5: Tumor Markers and Chest X-ray done every 6 months Abdominal CT scan done every 6 months After Year 5: Tumor Markers and Chest X-ray done once a year

Pathological Stage I Nonseminoma - Treated with RPLND only Note: "Pathological" refers to the diagnosis being based on physical evidence Year 1: Tumor Markers and Chest X-ray done every month Year 2: Tumor Markers and Chest X-ray done every 2 months Years 3-5: Tumor Markers and Chest X-ray done every 6 months After Year 5: Tumor Markers and Chest X-ray done once a year

Pathological Stage II Nonseminoma - Treated with RPLND only Year 1: Tumor Markers and Chest X-ray done every month Year 2: Tumor Markers and Chest X-ray done every 2 months Years 3-5: Tumor Markers and Chest X-ray done every 6 months

After Year 5: Tumor Markers and Chest X-ray done once a year

Pathological Stage II Nonseminoma - Treated with RPLND and 2xBEP Year 1: Tumor Markers and Chest X-ray done every 2 months Year 2: Tumor Markers and Chest X-ray done every 4 months Years 3-5: Tumor Markers and Chest X-ray done once or twice a year After Year 5: Tumor Markers and Chest X-ray done once a year

Stage IIc or Stage III nonseminoma - Treated with Chemotherapy, cancer in remission: For Good Risk cancer (seminoma; nonseminoma with AFP < 1000 ng/ml, hCG < 5000 mIu/ml, or LDH < 1.5 times the upper limit of normal; no liver, bone, or brain metastases; gonadal or retroperitoneal primary tumor) Year 1: Tumor Markers and Chest X-ray done every 2 months Year 2: Tumor Markers and Chest X-ray done every 4 months Years 3-5: Tumor Markers and Chest X-ray done every 6 months After Year 5: Tumor Markers and Chest X-ray done once a year

UNIVERSITY OF BAGUIO
SCHOOL OF NURSING

JOURNAL

In Partial Fulfillment of the Requirements for the Subject NURSING PRACTICE

SUMITTED TO: MAAM EMOCK,RN,MAN

Submitted by: CATHRINE TANGWARA BSN IV NPG 1