Helen Forristal Cancer Nurse Co-Ordinator St.Vincent’s University Hospital
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Transcript of Helen Forristal Cancer Nurse Co-Ordinator St.Vincent’s University Hospital
Helen ForristalCancer Nurse Co-Ordinator
St.Vincent’s University Hospital
Case Presentation
Presentation • John• 35 male, presented to A&E October 2010 • Smoker – Smoking Advice Service• Alcohol – 20 units C2H5OH per week• History of left loin pain & back pain lasting 2
months • CT KUB – Large lobulated retroperitoneal mass
consistent with lymphadenopathy & mild to moderate hydronephrosis secondary to compression of the right renal pelvis
Presentation (cont)• On further questioning John describes first
noticing a right testicular swelling in August 2009 ( did not seek medical advice)
Investigations• Testicular ultrasound showing a primary right
testicular mass lesion with cystic, solid and calcified components. Appearances consistent with a germ cell tumour.
• CTTAP – bulky retroperitoneal adenopathy extending from the renal hilum to the aortic bifurcation raising the possibility of a metastatic germ cell tumour.
• Two tiny peripheral pulmonary nodules in the lower lobe of the right lung
Medications
• Oxycontin 10 mgs BD, Increased to 75mgs BD• Oxynorm 5 mgs PRN - 4 hourly• Paracetamol PRN• Difene 75 mgs BD• Lyrica 25mgs TDS
Pre- OperativeTumour Markers 4/7/2010
• LDH 1074 (240-480)• AFP 480 (0-5.8)• HCG 91 <0.6
Right Radical Orchidectomy 9/7/2010
• Histology p T1• Malignant Germ Cell Tumour, non
seminomatous type (4cms), comprising teratoma.
• Many cysts contain old haemorrhage.• Atypical cartilage• Tumour does not invade the spermatoic cord,
tuna albuginea, epididymis or rete testis.• No lymphovascular invasion identified
1
2
3
M
IGCN
N
C
HH
H
Post operative Tumour Markers 15/07/2010
• LDH 1024 (240-480)• AFP 605.4 (0-5.8)• HCG <0.6 (<0.6)
MDT 22/07/2010• Intertubular Germ Cell Tumour • Need tissue diagnosis• Booked for CT Guided Biopsy of Lymph Node
MDT 12/8/2010• Orchidectomy Specimen – Cystic tumour,
mature teratoma• Malignant non - seminomatous germ cell
tumour • p T1• Retroperitoneal Biopsy 3/8/2010 – no evidence
of carcinomatous changes, similar in appearances to orchidectomy specimen
• p T 1• Referred to Medical Oncology – 3 cycles BEP• Referral for RPLND
Post Chemotherapy• 3 cycles BEP, tumour markers decreased but
did not normalise• Referred for RPLND surgery Dec 2010• Extensive RPLND Jan 2011• Surgically achieved complete remission,
histopathology teratoma, no adjuvant chemotherapy required.
Recovery • Bilateral Lymphoedema• No respiratory embarrassement.• Retrograde ejaculation
• Follow up CTTAP – post operative changes only with some intermediate very small pulmonary nodules which require follow up.
• Follow up Oncology 14/11/2011 – all tumour markers normal.
Pain• Back Pain • Constant knee pain radiating to Hip • Heavy Legs• “ Pins and Needles” & “Burning”• “hips appear to seize on walking”• Referred to Palliative Care locally for
pain control
Lymphoedema
• Physiotherapy – waiting list 7 months• Self referral to Lymphoedema Specialist- daily
visits initially with bandaging on alternate days, gradually decreasing visits over time to weekly, monthly since 2011
• Spent 6,000 plus euro
Retrograde Ejaculation
PersonalHEALTH PROMOTION
HEALTH EDUCATION
FAST – EASY ACCESS
RAPID DIAGNOSIS
TREATMENT
FOLLOW - UPSYMPTOM CONTROL
SUPPORT