Submitted by,

Mr. Jeo Thomas,1st year M.Sc Nursing,Medical Surgical Nursing,2009-2011,Sarvodaya College of Nursing,Bangalore – 560 079.

1. NAME OF THE CANDIDATE AND ADDRESS Mr. JEO THOMAS,

I ST YEAR M.Sc. NURSING, SARVODAYA COLLEGE OF NURSING,11/2, MAGADI ROAD,AGRAHARA- DASARAHALLI,BANAGLORE – 560 079.

2. NAME OF THE INSTITUTION Sarvodaya College of Nursing,Bangalore – 560 079.

3. COURSE OF THE STUDY AND SUBJECT I st year M.Sc. Nursing.[Medical Surgical Nursing]

4. DATE OF ADMISSION TO COURSE 15.06.20095. TITLE OF THE STUDY “A Study To Assess The

Knowledge Regarding Testicular Cancer Among Students At Selected Colleges Of Bangalore With A View To Develop An Information Booklet”

6. BRIEF RESUME OF THE INTENDED WORK

6.0 INTRODUCTION6.1 NEED FOR THE STUDY6.1.1 STATEMENT OF THE PROBLEM 6.2 REVIEW OF RELATED LITERATURE6.3 OBJECTIVES OF THE STUDY6.3.1 OPERATIONAL DEFINITIONS6.3.2 ASSUMPTIONS6.3.3 HYPOTHESIS6.3.4 SAMPLING CRITERIA (Inclusion and Exclusion criteria)

EnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosed

7. MATERIALS AND METHODS

7.1 Source of data-Data will be collected from students in selected colleges at

Bangalore.

7.2 Method of data collection: Questionnaire Method.

7.3 Does the study require investigation or interventions to be conducted on

the patients or other human being or animals ? YES.

7.4 Has ethical clearance been obtained from your institution? YES

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATIONRAJIVGANDHI UNIVERSITY OF HEALTHSCIENCES, KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. NAME OF THE CANIDATE AND ADDRESS Mr. JEO THOMAS,I ST YEAR M.Sc.NURSING, SARVODAYA COLLEGE OF NURSING,11/2, MAGADI ROAD,AGRAHARA-DASARAHALLI,BANAGLORE – 560 079.

2. NAME OF THE INSTITUTION Sarvodaya College of Nursing,Banaglore – 560079.

3. COURSE OF THE STUDY AND SUBJECT I st year M.Sc. Nursing. [Medical Surgical Nursing]

4. DATE OF ADMISSION 15.06.2009.

5. TITLE OF THE STUDY “A Study To Assess The Knowledge Regarding Testicular Cancer Among Students At Selected Colleges Of Bangalore With A View To Develop An Information Booklet”

6.

BRIEF RESUME OF THE INTENDED WORK

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

the same thing.”- Lance Armstrong

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

in the early stage.

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

earlier it is found the more that can be done.

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

development of testis cancer is cryptorchidism. Having a familial history of testis cancer is

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

swelling (58%), lump (27%), or pain (33%) in a testicle.4

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

detect this cancer in its early stage itself.

6.1 NEED FOR THE STUDY

“My cancer scare changed my life. I'm grateful for every new, healthy day I have. It has

helped me prioritize my life.” - Olivia Newton-john

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

young adults are given below.

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

cancer among youngsters are alarmingly high in Indian subcontinent.5

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%)

had evidence of metastatic disease at the time of diagnosis. On prognostication, non-

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

continent. Nevertheless, surprising differences in incidence rates were seen between

neighboring countries (Finland 2.5/100,000 cases versus Denmark 9.2/100,000) as well as

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

testicular cancer incidence rates and also identify risk factors.7

A study conducted among Swedish male shows the significance of testicular self examination

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

years) completed a 60-item questionnaire, encompassing background characteristics,

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

youths regarding testicular self examination and Testicular cancer.8

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

adolescent males in a community-based youth organization. According to this study

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

testicular self examination education with promotion of healthy behaviors in community

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.

6.1.1 STATEMENT OF THE PROBLEM

“A Study To Assess The Knowledge Regarding Testicular Cancer Among Students At

Selected Colleges Of Bangalore With A View To Develop An Information Booklet”

6.2 REVIEW OF LITERATURE

Review of related literature is an integral component of any study or research project.

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

problem under study.

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

process. Mainly three types of reviews are included in this study.

1) Reviews related to incidence and prevalence of testicular cancer.

2) Reviews related to knowledge of students regarding testicular cancer.

3) Reviews related to testicular cancer and its preventive measures.

1) Reviews related to incidence and prevalence of testicular cancer.

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

across the world.11

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

different testicular abnormalities. Therefore, common parentally acting etiological factors

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

view, an increased impact on the human male gonad is of concern.12

A study conducted in Kashmir regarding incidence of testicular cancer

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

with testicular tumors. Both were subjected to retrograde orchidectomy. Histopathologic

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

to be screened and educate them properly.13

All the studies mentioned above suggest that there is a significant increase in testicular cancer

among adults aged between 15 to 35 years.

2) Reviews related to knowledge of students regarding testicular cancer

A study done on Men's Knowledge About Testicular Cancer and Testicular Self-Exam

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

members of families with Familial Testicular Cancer (FTC).  This is a sub-study of an

ongoing National Cancer Institute (NCI) multidisciplinary, etiologically-focused, cross-

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

education differentially influenced knowledge levels, particularly among unaffected relatives.

Prior to identifying familial testicular cancer susceptibility genes, researcher recommend

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

clinical susceptibility testing may be available.15

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

3) Reviews related to testicular cancer and its preventive measures

A study conducted to compare testicular cancer self examination in different countries

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

A study done regarding significance of early diagnosis of testicular cancer.Testicular cancer

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

history, infertility, tobacco use, and white race.

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

examination (TSE). Testicular masses should be examined with scrotal ultrasonography. If

ultrasonography shows an intratesticular mass, the patient should be referred to a urologist for

definitive diagnosis, orchiectomy, and further evaluation with abdominal computed

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

evaluating for recurrence and future complications, especially cardiovascular disease.18

A study conducted in UK about encouraging young males to perform testicular self-

examination. The objective of this study was to examine the effectiveness of a simple

psychological intervention known as 'implementation intentions' to promote performance of

testicular self-examination (TSE) in a sample of young males.

A prospective, randomized controlled design measured knowledge of testicular cancer, prior

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.

Three weeks later, a second questionnaire assessed self-reported performance of testicular

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.

65% participants in the intervention reported performing testicular self examination

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

about testicular cancer among youngsters.

6.3 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding testicular cancer among students.

2. To find out the association between knowledge on testicular cancer and selected

demographic variables.

3. To develop an information booklet on Testicular cancer.

6.3.1 OPERATIONAL DEFINITIONS

Knowledge: refers to the information possessed by the students regarding testicular cancer as

assessed by the responses to the structured questionnaire.

Testicular cancer: Refers to the most common malignancy among adults which results from

abnormal proliferation of germ cells and non germ cells in testicles.

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.

2. Information booklet on testicular cancer may enhance the knowledge of students.

6.3.3 HYPOTHESIS

There will be a significant association between knowledge regarding testicular cancer and

selected demographic variables.

6.3.4 SAMPLING CRITERIA.

i) Inclusion Criteria

1. Students who are available in colleges at the time of data collection.

2. Students who are willing to participate in the study.

ii) Exclusion Criteria.

1. Students who are diagnosed with testicular cancer.

2. Who cannot read English or Kannada.

7. MATERIALS AND METHODS

7.1 Sources of data: Data will be collected from students aged between 18-22 years, at

selected colleges of Bangalore.

7.2 Methods of data collection

i. Research design : Descriptive.

ii. Research approach : survey

iii. Setting : Selected colleges, Bangalore. (Christ College,

Baldwins Boys College)

iv. Population : All male students in the age group of 18-22 years

v. Sample size : 60.

vi. Sample : 60 male students in the age group of 18-22 years who

fulfills the inclusion criteria.

vii. Sampling technique : Convenient sampling technique.

viii. Method of data collection : Self administered questionnaire

ix. Tool for data collection : Structured questionnaire,

x. Method of data analysis and interpretation:-

The investigator will use appropriate statistical technique for data analysis and

present in the form of tables, graphs and diagrams.

The data will be analyzed by using descriptive and inferential statistics tests.

Level of knowledge will be analyzed by using mean and standard deviation.

Association between knowledge and selected variables will be analyzed by

Chi-square

xi. Duration of the Study : 4 Weeks.

xii. Research Variables : Knowledge on Testicular cancer

xiii. Demographic Variables : Age, Education, Type of family, previous source of

information regarding Testicular cancer.

xiv. Projected outcome : The study will be successful in improving the

knowledge of students regarding various

aspects of testicular cancer and will enhance the

testicular self examination practice among them.

7.3 Does the study require any investigation or intervention to be conducted on the patient or

other human beings or animals?

YES.

7.4 Has ethical clearance been obtained from your institution?

YES

8. LIST OF REFERENCES

1. Miriam Falco. WHO: Cancer to surpass heart disease as world's leading killer

CNN health.com. 9 December 2009 Available from:

URL: http://www.cnn.com/2008/HEALTH/12/09/cancer.leading.killer/index.html

2. Patrick J. Loehrer. Testicular cancer. In: Thomas E. Ahlering, Mark K.

Buyyounouski, Douglas Skarecky. Cancer Management: A Multidisciplinary

Approach, 11th Edition.Cancer network.com. 2008. Available from:

URL: http://www.cancernetwork.com/cancer-management-11

3. Sports medweb.Testicular cancer.Rice.edu. 11 December 1999. Available from:

URL: www.rice.edu/~jenky/sports/testicular_cancer.html(11 December 1999)

4. Leviston .P.A.Self-Exam for Testicular Cancer. Pedihc.com. 25 November

2009.Availablefrom: URL: http://www.pedihc.com/health-resources/testicular-

exam.php/

5. Robert J Morgan. Testicular cancer. The Journal of the Royal Society for the

Promotion of Health,Vol. 124, No. 5, 217-218 .2004. Available from: URL:

www.sagepub.com/cgi/reprint/124/5/217.pdf (2004)

6. Sharma.B.D. Indian perspective of cancer research.Newdelhi.2001

7. E. Hugyghe, T. Matsuda, P. Thonneau. Increasing Incidence of Testicular Cancer

Worldwide.The Journal of Urology, Volume 170, Issue 1, Pages 5-11.

Available from: URL:

http://linkinghub.elsevier.com/retrieve/pii/S0022534705634234

8. Rudberg L, Nilsson S, Wikblad K, Carlsson M. Pubmed.gov . Testicular cancer and

testicular self- examination: knowledge and attitudes of adolescent Swedish men.

men.28 July 2005 . Available from: URL:

http://www.ncbi.nlm.nih.gov/pubmed/16046886(28 July 2005)

9. Ward KD, Vander Weg MW, Read MC, Sell MA, Beech BM. Testicular cancer

awareness and self-examination among adolescent males in a community-based

youth organization.Pubmed.gov. August 2005. Available from: URL:

www.ncbi.nlm.nih.gov/pubmed/15917035 (August 2005)

10. Yeole BB. Trends and predictions of cancer incidence cases by site and sex for

Mumbai.Pubmed.gov. 1999 Jun-Dec.

www.ncbi.nlm.nih.gov/pubmed/10921221(1999 Jun-Dec)

11. Stephan. A. Beutow. Epidemiology of testicular cancer. Oxford journals.

http://epirev.oxfordjournals.org/cgi/pdf_extract/17/2/433

12. A Giwercman, E Carlsen, N Keiding, and N E Skakkebaek. Evidence for increasing

incidence of abnormalities of the human testis.pubmed.gov. January 2004.

Available from: URL: www.ncbi.nlm.nih.gov/pmc/articles/PMC1519947/

13. Gupta MK, Seam RK, Gurung DS, Kanika S. Familial testicular tumour in two

brothers.Bioline international.org. Indian journal of cancer.5 Nov 2005.

Available from: URL: www.bioline.org.br/request?cn05038(5 November 2005)

14. Lawrence H. Ganong a, and John Markovitz. Science direct.com. 25 March

2004.Available from: URL:

www.linkinghub.elsevier.com/retrieve/pii/0738399187900036

15. June A. Peters. Ellen B. Beckjord. Deliya R. Banda Ryan. Testicular cancer

Knowledge – Genetic counseling. Springerlink. May 15 2008.Available from:

URL:www.springerlink.com/content/2w77281067h5q730/.(15 may 2008)

16. Christine Makosky Daley. College Students' Knowledge of Risk and Screening

Recommendations for Breast, Cervical, and Testicular Cancers.6 September 2007.

Available from:

URL:http://www.britannica.com/bps/additionalcontent/18/25621661/College-

Students. (6 September 2007)

17. R. Evans, A. Steptoe, J. Wardle. Testicular self-examination: change in rates of

practice in European university students. The Journal of Men's Health &

Gender, Volume 3, Issue 4, Pages 368-372. Available from: URL:

http://linkinghub.elsevier.com/retrieve/pii/S1571891306001609

18. Joel Shaw. Diagnosis and Treatment of Testicular Cancer. MD consultant. Com.

4 February2008. Available from: URL:

www.mdconsult.com/das/article/body/174571069

19. Steadman L, Quine L. Encouraging young males to perform testicular self

examination.Pubmed.gov. 2004 Nov 9. Available from: URL:

http://www.ncbi.nlm.nih.gov/pubmed/15509356 (2004 November 9)

9. Signature of the candidate

10. Remark of the Guide

11.

Name and Designation

11.1 Guide

11.2 Signature

11.3 Head the Department

11.4 Signature

12 12.1 Remarks of the chairman & principal

12.2 Signature