Professional Documents
Culture Documents
6.0 INTRODUCTION
Enclosed
6.1 NEED FOR THE STUDY
Enclosed
6.1.1 STATEMENT OF THE PROBLEM
Enclosed
6.2 REVIEW OF RELATED LITERATURE
Enclosed
6.3 OBJECTIVES OF THE STUDY
Enclosed
6.3.1 OPERATIONAL DEFINITIONS
Enclosed
6.3.2 ASSUMPTIONS
Enclosed
6.3.3 HYPOTHESIS
Enclosed
6.3.4 SAMPLING CRITERIA
Enclosed
(Inclusion and Exclusion criteria)
6.0 INTRODUCTION
“When I was sick, I didn't want to die. When I race I don't want to lose. Dying and losing, it's
Cancer is potentially the most preventable and major chronic life threatening disease. According to
a report released on December 2008 by the World Health Organization's Cancer Research Agency,
twenty-seven million new cancer cases are expected by 2030. That compares to 12 million new
cases in 2007, the report found. The group forecast a 1 percent increase globally each year, with
emerging economies such as China, Russia and India being hit the hardest.1 Cancer is always
considered as intimidating and terrifying disease for all human beings over the last few decades.
When a person comes across cancer it’s really tough to overcome the stress and fear of this painful
ailment. However, in this innovative and dynamic world it is possible to cure cancer if it is detected
Testicular cancer is the most common malignancy in men aged between 15 to 35 years and has an
annual incidence of 7 per 100,000 population. If diagnosed early, the cure rate of this cancer is
nearly 99 percent. Unfortunately, researchers don't know exactly what causes testicular cancer.
They have however identified several risk factors for testicular cancer.2 Recent advances in
medicine have changed this disease into one of the most treatable of all cancers. In general, the
As many of you know, Lance Armstrong recently won the Tour de France (cycling marathon).
Arguably this is one of the hardest athletic events and the athletes that compete in this are toughest
in the world. Lance’s victory was indeed impressive, but when you consider his recent battle with
advanced testicular cancer, the best description is, "miraculous".3 The prime reason behind his
success is nothing but he has diagnosed testicular cancer in its early stage and done proper
treatment in time.
A lump on the testicle is often the first sign of testicular cancer. A major risk factor for the
considered as another risk. According to the Testicular Cancer Resource Center, men should
perform monthly self-exams of the testicles as early as age 15. It is well known that the monthly
breast self-exam is an effective part of early breast cancer detection for women. However, most
men do not realize that following a similar self-exam routine for testicles is just as important.
Testicular self-examination (TSE) is the best way to accomplish early recognition of Testicular
Cancer. Most testicular cancers are discovered by the man himself when he notices a painless
The death rate associated with various cancer’s are high not because it is hard to discover or
diagnose, but due to the cancer’s being routinely discovered late in its development. Often it is
only discovered when the cancer has metastasized to another location. Prognosis at this stage of
discovery is significantly worse than when it is caught in localized regions. Hence, it is significant
to educate youths in our country regarding testicular cancer and its preventive aspects in order to
Numerous publications and studies have shown an increase in the incidence of testis cancer in
the last 40 years with substantial differences among countries. Misconception and lack of
knowledge among youngsters regarding testicular lump and testicular cancer leads to
metastasis of cancer and subsequently results in death. Some of the studies done among
World wide new cases of testicular cancer are diagnosed in approximately 7 men per 100,000
per year. Even though it represents only 1.6% of all cancers in men, testicular cancer is the
most common cancer among 15 – 35 year old. In India the rate is up to 7.9 per 100,000 in
various regions. Looking at all cases of testicular cancer, the peak age range is also found in
18– 30 year olds. Statistical data accessed from internet suggest that incidents of testicular
A study conducted in All India Institute of Medical Sciences (AIIMS), Delhi, India states that
the prognosis of patients with germ cell tumors of the testis has improved over the past two
decades following chemotherapy if diagnosed in early stage. Currently staging and risk
assessment of the disease is crucial in order to provide curative therapy for patients with poor
risk features. This study has reviewed the case records of 101 men diagnosed to have germ
cell tumors between January 2002 and October 2008. Their clinical characteristics, staging,
treatment outcome and prognostic factors for response and survival were analyzed. Result of
these study shows that the median age of the patients was 25 years (range: 3-55 years); 69%
were in the second and third decades. 84 patients (86%) had a primary testicular tumor while
in 15 (14%) the tumor was extragonadal. Histopathologically, 76 patients (75%) had non-
seminomatous germ cell tumors and 22 (21%) had a seminoma. Sixty three patients (62%)
seminomatous germ cell tumor patients could be divided into good, intermediate and poor
prognostic groups comprising 41%, 17% and 40% of patients, respectively. All patients with
a seminoma were in the good prognostic subgroup. Fifty-eight patients were evaluable for
response. Overall, 91% of patients responded. The outcome for germ cell tumors in men with
good risk is excellent if detected early. The study suggest that testicular self examination
must be practiced among adults in order to find out this malignancy in its early stage.6
A study was conducted to find out the world wide incidence of testicular cancer shows an
alarming rate of increase in the incidence. This study states that testicular cancer (TC) is the
most common malignancy in 18 to 34-years-old men. Result of this study observed a clear
trend toward an increased testicular cancer incidence in the last 30 years in the majority of
industrialized countries in North America, Europe and North East Asia and in Indian sub
among regions of the same country (2.8 to 7.9/100,000 according to various regional Indian
registers). In addition, substantial differences in the testicular cancer incidence and trends
were observed among ethnic groups. Conclusion of this study states that such a recent
increase in the testicular cancer rate in most industrialized and developing countries should
enhance the attention of medical professionals to give more significance to testicular cancer
symptoms in adolescents and young adults. In a public health perspective further research
using cases collected through national and regional population based registers and case-
control studies must be strongly encouraged if we wish to be able to assess future trends in
for early detection of testicular cancer. The main objective of the study was to assess the
knowledge and attitudes toward testicular cancer and the prevalence of testicular self-
examination among senior high school male students in Sweden. Another aim was to describe
to what extent the students had received information about testicular cancer and testicular self
examination prior to this study. Seven hundred twenty-seven (70.7%) male students (M = 17
information, knowledge and attitudes toward, testicular cancer and prevalence of testicular
self examination practice. The results showed that most students had never heard of testicular
cancer or testicular self examination, had limited knowledge of common symptoms, and had
hardly ever practiced testicular self examination. Most of the students considered testicular
cancer to be a serious disease and were afraid of getting it. Thus, there is a need for imparting
health education with respect to this subject, information that could preferably be included
when promoting health in school settings and during enlistment to the military services. This
investigation is the first part of an intervention study aiming to describe the effect of different
educational materials on male students' knowledge of testicular cancer and their practice of
testicular self examination. Therefore, this study point out the importance of educating the
Another cross sectional study was conducted among boys scouts of America shown a similar
result. The study was regarding testicular cancer awareness and self-examination among
Testicular cancer is the most common neoplasm affecting males between 15 and 35 years,
and testicular self-examination has been recommended for early detection. Studies have
found that young adult men have poor awareness of testicular cancer and low rates of
performing testicular self examination, but little research has examined adolescents. Result
shows that nearly 73% of scouts had heard of testicular cancer , but only 10.3% performed
testicular self examination at levels consistent with current recommendations (10 or more
times per year). Testicular self examination is underutilized as an early cancer detection tool.
Efforts are needed to increase testicular cancer knowledge among adolescents and to integrate
organizations.9
Unlike most other cancers testicular cancer affects young males before the prime of their life
when they are completing their education, starting a family, and contributing to society. In
fact, it not only has an impact on the patient but also on his family and society. Hence,
increased public awareness and professional education regarding testicular cancer and
testicular self examination is needed to alert the youth of our society to educate about this
dreadful disease.
Moreover, investigator has a personal influence which strongly persuades him to do this
study. Investigators colleague who is his neighbor and intimate friend has debilitated and
instigated by this terrible disease. Now he is in the final stage of his life and the prime reason
of this is the late diagnosis of his malignancy. This incident has moved the investigator a lot
and he felt the need for such a study to improvise his effort for challenging this malignancy.
It enhances the depth of the knowledge and inspires a clear insight into the crux of the
problem. Literature review throws light on the studies and their findings reported about the
The review of literature is a broad, comprehensive, in depth, systemic and critical review of
scholarly publications, unpublished scholarly print materials, audio visual materials and
personal communications. Reviewing and evaluating the literature is central to the research
A study conducted in Mumbai, Maharashtra state in India regarding Trends and predictions
of cancer incidence cases by site and sex has suggested that testis cancer in male is the cancer
with highest incidence and prevalence rate in India. This study had done to estimate the
resources needed for the diagnosis, treatment, follow-up and rehabilitation services needed
for cancer patients, it is important to know the magnitude of common cancers at present and
in future. Keeping this view in mind an attempt has been made to predict cancer incidence
cases for most common cancers for Greater Mumbai up to the year 2002. The trend analysis
is carried out for major 30 cancer sites for both the sexes using age incidence data of Greater
Mumbai. Present trend analysis showed that cancers of the tongue, mouth, oropharynx,
oesophagus, stomach and larynx in both sexes and cervix for females have registered a
decline in incidence over a period of observation. While, during the same period, cancers of
the liver, pancreas, bladder, brain and thyroid in both the sexes, breast, endometrium and
ovary in females, and testis cancer in males showed increasing trends in incidence. 10It is
believed that the results of the present study will provide a sound basis for planning the
cancer control, prevention, diagnostics, treatment and rehabilitation in Mumbai for the years
to come. This study proves that the incident of testicular cancer is alarmingly high in India.
A study done by global statistical cancer association states that the testicular cancer is
alarmingly increasing, with 66,000 new cases annually, accounting for 1.3% of cancers in
men. The highest rates are observed in Europe (Western and Northern), temperate South
America, North America, and Australia/New Zealand. The highest incidence rates occur in
men aged 15to 34 years, and testicular cancer is the most common cancer among men in this
age range in developed Countries (18.5% of new cases). Testicular cancer is a common cause
of cancer mortality among adults aged between 15-34 years (22,000 deaths per year),
although the good prognosis depends on early detection through Testicular self examination
and the availability of expensive chemotherapy (cisplatin). The ratio of mortality to incidence
is more favorable in developed countries, it is much less optimistic in the developing world
because of the increase in incident rate. This study also explain the hike of testis cancer
An Indian study have suggested that the incidence of genitourinary abnormalities in human
males has increased during the past 50 years, including congenital abnormalities such as
cryptorchidism and hypospadia, which seem to be occurring more commonly. Also, the
incidence of testicular cancer has increased 3- to 4-fold since 1940s. This increase seems to
be worldwide including countries with a very high frequency of testicular cancer as well as
those in which this cancer is rather uncommon. The remarkable increase in frequency of
testicular abnormalities over a relatively short period of time may be due to environmental
rather than genetic factors. There is an epidemiological link between the occurrences of
with adverse effects on the fetal male gonad might be suspected. However, postnatal
influences may also have a deleterious effect on male fertility. From the reproductive point of
Testicular tumors account for 1.6 % of all cancers in men and it occurs in 1 in 400 men.
Total number of cases till the year 2002 in identical twins is 42, in brothers 164 and father-
son both affected in 62 pairs. We report a case of two brothers presenting simultaneously
examination of one revealed embryonal cell carcinoma and other mature teratoma of the
testis. Patient with embryonal carcinoma was given adjuvant chemotherapy based on
Bleomycin, Etoposide and cisplatinum (BEP) and one with mature teratoma was put on a
follow up.
This study suggests that testicular cancer is most common malignancy in youngsters and need
All the studies mentioned above suggest that there is a significant increase in testicular cancer
questionnaire, this study: (a) surveyed men's knowledge of testicular cancer and testicular
self-exam, and (b) measured the effect of written information on men's behavioral intentions
to do testicular self-exam. The majority of men did not know the signs, symptoms, and risk
factors associated with testicular cancer. Most men had never heard of testicular self-exam
but the majority indicated they were interested in learning about it. The results suggests that
men should be encouraged to perform testicular self examination in a regular interval .14
Another study determines baseline levels of testicular cancer and genetics knowledge among
sectional study of familial testicular cancer. Researcher evaluated 258 male and female
participants including testicular cancer (TC) survivors, blood relatives and spouses to assess
factors associated with a Genetic Knowledge Scale (GKS) and Testicular Cancer Knowledge
Scale (TCKS). Result of study suggests that knowledge levels were generally low, with
genetic knowledge lower than testicular cancer knowledge (p < 0.01). Men with a personal
testicular cancer history scored highest on testicular cancer knowledge, while gender, age and
tailoring familial testicular cancer genetic education to the different informational needs of
testicular cancer survivors, their spouses and relatives, in preparation for the day when
A study was done to determine the college student’s knowledge of risk and screening
recommendations for breast, cervix and testicular cancer. According to the study there is a
gap in the literature regarding the knowledge of college students about breast, cervical, and
testicular cancers. Researcher surveyed 3362 college students about their knowledge of risk
factors and screening recommendations for these 3 cancers during the 2002-2003 school year
at a large public university in the Northeast. Results explain that Students knew
approximately 50% of the information about risk factors and screening recommendations for
these 3 cancers. The study concluded that based on these results, college students appear to
have limited knowledge about breast, cervical, and testicular cancers and need education
about them.16
The objective of this study was to compare testicular self-examination (TSE) practice in 13
European countries over a 10-year period. Testicular cancer predominantly affects young
men. It is rare but on the increase and is most common in Caucasian ethnic groups living in
industrialized nations, particularly northern Europe. Stage and prognosis are related to early
diagnosis and testicular self examination has been advocated to help achieve this. Over the
last 15 years there have been efforts to increase disease awareness and self-examination
practice.
Results: Although, testicular self examination practice rates are low, there have been
significant increases over this 10-year period .Increased testicular self examination may
reflect greater awareness of testicular cancer and could contribute to timelier help-seeking.17
is the most common malignancy in men 20 to 35 years of age and has an annual incidence of
four per 100,000. If diagnosed early, the cure rate is nearly 99 percent.
Risk factors for testicular cancer include cryptorchidism (i.e., undescended testicles), family
Routine self-examination and physician screening have not been shown to improve outcomes,
and the U.S. Preventive Services Task Force and American Cancer Society do not
recommend them in asymptomatic men. Patients presenting with a painless testicular mass,
scrotal heaviness, a dull ache, or acute pain should receive a thorough Testicular self
ultrasonography shows an intratesticular mass, the patient should be referred to a urologist for
tomography and chest radiography. The family physician's role after diagnosis of testicular
cancer includes encouraging the patient to bank sperm because of possible infertility and
examination. The objective of this study was to examine the effectiveness of a simple
experience with testicular self examination and intention to perform testicular self
examination within a 3-week period. Participants in the intervention group were instructed to
formulate specific plans for when and where they would perform testicular self examination.
self examination during the study period and future intention to perform testicular self
examination. One hundred and fifty-nine male undergraduates aged between 18 and 35 were
assigned, at random, to an intervention or non-intervention group. Men over 35 were
excluded so that the sample reflected the highest risk age group for testicular cancer. Just
fewer than half of the original participants (76/159) completed the study. We measured
performance of testicular self examination and future intention to perform testicular self
examination. Responders and non-responders did not differ on any of the measures assessed.
compared with 12 (40%) in the control condition, and chi-square analyses revealed that the
difference was significant.19 This study implicate the seriousness of encouraging testicular
self examination.
All these review suggests that testicular cancer is most common cancer among youngsters
and only negligible efforts are taken to retaliate against this very dangerous scourge which is
affecting the youths in our society and also suggest the significance of providing knowledge
2. To find out the association between knowledge on testicular cancer and selected demographic
variables.
Testicular cancer: Refers to the most common malignancy among adults which results from
Students: Male adult individuals those who are in age group of 18-22 years.
Selected colleges: Professional colleges like Christ College, Baldwin’s boys college. etc in
Bangalore.
Information Booklet: Refers to organized written materials which contain various aspects of
testicular cancer like signs, causes, symptoms, steps in testicular self examination and
treatment.
6.3.2 ASSUMPTION
1. Young male adults may have lack of knowledge regarding testicular cancer.
6.3.3 HYPOTHESIS
There will be a significant association between knowledge regarding testicular cancer and
i) Inclusion Criteria
1. Students who are available in colleges at the time of data collection.
7.1 Sources of data: Data will be collected from students aged between 18-22 years, at
iv. Population : All male students in the age group of 18-22 years
vi. Sample : 60 male students in the age group of 18-22 years who
• The data will be analyzed by using descriptive and inferential statistics tests.
Chi-square
7.3 Does the study require any investigation or intervention to be conducted on the patient or
YES.
YES
8. LIST OF REFERENCES
1. Miriam Falco. WHO: Cancer to surpass heart disease as world's leading killer
URL: http://www.cnn.com/2008/HEALTH/12/09/cancer.leading.killer/index.html
URL: http://www.cancernetwork.com/cancer-management-11
exam.php/
5. Robert J Morgan. Testicular cancer. The Journal of the Royal Society for the
www.sagepub.com/cgi/reprint/124/5/217.pdf (2004)
http://linkinghub.elsevier.com/retrieve/pii/S0022534705634234
9. Ward KD, Vander Weg MW, Read MC, Sell MA, Beech BM. Testicular cancer
10. Yeole BB. Trends and predictions of cancer incidence cases by site and sex for
www.ncbi.nlm.nih.gov/pubmed/10921221(1999 Jun-Dec)
http://epirev.oxfordjournals.org/cgi/pdf_extract/17/2/433
13. Gupta MK, Seam RK, Gurung DS, Kanika S. Familial testicular tumour in two
www.linkinghub.elsevier.com/retrieve/pii/0738399187900036
15. June A. Peters. Ellen B. Beckjord. Deliya R. Banda Ryan. Testicular cancer
Available from:
URL:http://www.britannica.com/bps/additionalcontent/18/25621661/College-
http://linkinghub.elsevier.com/retrieve/pii/S1571891306001609
18. Joel Shaw. Diagnosis and Treatment of Testicular Cancer. MD consultant. Com.
www.mdconsult.com/das/article/body/174571069
11.2 Signature
11.4 Signature
12.2 Signature