Tumors of the Testis

Scrotal ultrasound is the primary imaging test used in the evaluation of suspected testicular cancer. It is a rapid, non-invasive, and cost-effective examination with a high degree of sensitivity for detecting testicular abnormalities.

This test is typically performed to confirm findings identified during the physical examination and to characterize any suspicious masses. It is also used to assess the contralateral testis (the unaffected testicle) for the presence of additional abnormalities.

Scrotal ultrasound is performed within the Division of 

Clinical staging is used to determine the extent of testicular cancer and guide treatment planning. It may be performed after surgery, once malignancy has been confirmed through histological examination, or, when there is a strong suspicion of cancer, even before surgery.

Staging is typically based on computed tomography (CT) scans of the chest, abdomen, and, when indicated, the pelvis. CT imaging uses X-rays to generate detailed cross-sectional and three-dimensional images of the body’s internal structures. An intravenous contrast agent is usually administered to enhance image quality and improve the detection of abnormal findings. CT examinations are performed within the Division of Diagnostic Radiology.

The purpose of staging is to identify whether the cancer has spread beyond the testicle. Testicular cancer most commonly spreads through the lymphatic system, particularly to the retroperitoneal lymph nodes, or through the bloodstream to distant organs, most frequently the lungs and, less commonly, the liver and other sites.

Based on the results of staging investigations, testicular cancer is classified into the following stages:

• Stage I: The tumor is confined to the testis, with no evidence of spread beyond the primary site.
• Stage II: The cancer has spread to the regional lymph nodes in the abdomen, particularly the retroperitoneal lymph nodes.
• Stage III: The cancer has spread to distant organs or tissues, most commonly the lungs, and may also involve the liver or other sites.

Accurate staging is essential for determining prognosis and selecting the most appropriate treatment strategy.

A histological examination is performed on a tissue sample obtained from the tumor, typically during or after surgery. The specimen is analyzed under a microscope by a pathologist, who evaluates the cellular and tissue characteristics to determine the exact type of cancer present.

In testicular cancer, histological analysis is essential for establishing a definitive diagnosis. It allows tumors to be classified as germ cell tumors, which account for approximately 95% of cases, or non-germ cell tumors, which are much less common. Germ cell tumors can be further categorized into seminomas and non-seminomas.

This distinction is particularly important because the different tumor types vary in their biological behavior, aggressiveness, prognosis, and response to treatment. Histological examination also provides additional information about specific pathological features that may influence staging and therapeutic decisions.

As a result, histological assessment plays a central role in confirming the diagnosis, determining prognosis, and guiding the most appropriate treatment strategy for each patient.

When a malignant testicular tumor is suspected, surgical exploration through an inguinal incision is the standard approach. The procedure, known as radical inguinal orchiectomy, involves the removal of the affected testis, epididymis, and spermatic cord, together with the associated blood vessels.

Following surgery, patients who wish to maintain the appearance of the scrotum may choose to have a testicular prosthesis inserted. Typically made of silicone, the prosthesis can be placed within the scrotum either during the initial procedure or at a later stage.

Radical inguinal orchiectomy serves both a therapeutic and a diagnostic purpose. It removes the primary tumor while also providing the tissue required for definitive histological examination, which is essential for establishing an accurate diagnosis.

Once the diagnosis has been confirmed and the results of histological analysis, tumor marker assessment, and staging investigations have been reviewed, the case is discussed by a multidisciplinary team of specialists. This team may include urologists, medical oncologists, radiation oncologists, radiologists, pathologists, and other healthcare professionals involved in the patient’s care.

Based on a comprehensive evaluation of the patient’s age, overall health, disease stage, and tumor characteristics, the multidisciplinary team develops an individualized treatment plan. The recommended treatment is then discussed with the patient, including its expected benefits, potential risks, and possible alternatives. When more than one treatment option is appropriate, the advantages and disadvantages of each approach are carefully explained to support shared decision-making and ensure that the chosen strategy aligns with the patient’s preferences and clinical needs.

If the tumor is detected at an early stage, whether it is a seminoma or a non-seminomatous tumor (Stage I without risk factors), radical inguinal orchiectomy may be sufficient as the sole treatment.

After surgery, the patient will undergo active surveillance, consisting of regularly scheduled follow-up visits and examinations, including blood tests, ultrasound scans, and X-rays, to monitor for any possible recurrence of the disease.

Chemotherapy works by interfering with the growth and division of cells, leading to the destruction of cells that multiply more rapidly than normal, a characteristic feature of cancer cells. It has significantly improved survival outcomes for patients with both seminomatous and non-seminomatous testicular tumors.

Chemotherapy is administered intravenously in cycles, usually on a day-hospital basis.

The type of treatment and the number of cycles depend on the tumor characteristics and the clinical stage of the disease. Chemotherapy may be used to reduce the risk of recurrence or as a therapeutic treatment when there is evidence of disease spread beyond the testis.

The most commonly used regimens include carboplatin and the PEB regimen, which consists of cisplatin, etoposide, and bleomycin.

Radiation therapy is a treatment that uses high-energy radiation (X-rays) to destroy cancer cells. It is used almost exclusively for seminomas, which are highly sensitive to radiation, unlike non-seminomatous tumors.

The aim of radiation therapy is to treat the retroperitoneal lymph nodes.

Retroperitoneal lymph node dissection (RPLND) is a complex surgical procedure performed to remove lymph nodes located in the retroperitoneum, including the para-aortic, paracaval, interaortocaval, and iliac lymph node chains.

This procedure may be offered to low-risk patients who are unwilling or unable to adhere to surveillance protocols, as well as to high-risk patients who do not accept chemotherapy.

RPLND may also be indicated for the treatment of residual masses that remain after chemotherapy.

All cancer treatments can cause side effects that may affect a patient’s quality of life to varying degrees. Before treatment begins, patients are informed about the potential side effects associated with each therapeutic option and the measures available to prevent or manage them.

The multidisciplinary team, including physicians and nurses, provides ongoing support throughout the treatment journey and helps patients address any difficulties that may arise during care.

In addition, before starting treatment for testicular cancer, semen cryopreservation is generally recommended because both surgery and chemotherapy may have an impact on fertility.

The impact of cancer extends beyond physical health and can profoundly affect a person’s emotional and psychological well-being. A cancer diagnosis is often a traumatic life event that may give rise to feelings of anxiety, fear, anger, and depression.

Alongside advanced medical treatments, the care pathway includes specialized psycho-oncological support, helping patients cope with the emotional challenges of the disease, navigate treatment, and manage the delicate process of physical and psychological recovery.

Patients may also participate in psychological support groups, which provide an opportunity to share experiences, receive mutual support, and connect with others who are facing or have faced similar challenges.

To ensure timely support and quick answers to patients’ concerns, a dedicated assistance service is available at the Candiolo Cancer Institute.

From Monday to Friday, between 8:00 a.m. and 5:00 p.m., patients can contact the secretariat of the oncology day hospital at +39 011.993.3775 to request an urgent consultation.

The patient will then be promptly put in contact with their treating specialist in order to receive clear information and immediate support.

A person with cancer often has complex needs that require multidisciplinary support, not only for the tumor itself but also for other related health issues.

At the Candiolo Cancer Institute, patients who need it have access to different specialists who provide comprehensive supportive care, including nutritional support, physiotherapy, pain management, and treatment of other associated conditions.

The Social Service Department of the Candiolo Cancer Institute provides information and guidance to patients and their families on how to access local services and obtain legally provided welfare and social security benefits, such as disability support, assistance for aids and prostheses, and work leave arrangements, among others.

The service is available on Wednesdays and Fridays, from 9:00 a.m. to 1:00 p.m., and can be contacted at +39 011 9933059.

At the end of treatment, patients enter the follow-up phase, during which they undergo regular medical evaluations and diagnostic tests to monitor both the side effects of treatment and the effectiveness of therapy, while assessing their overall recovery.

These follow-up visits are essential for the early detection of recurrence, allowing prompt intervention with appropriate treatment if necessary. They also provide an important opportunity for patients to maintain an ongoing dialogue with their specialist.

The treating physician schedules the follow-up appointments, during which the patient’s general health status is evaluated and the results of any tests performed are reviewed.

The follow-up protocol for testicular cancer typically includes the measurement of serum tumor markers, testicular ultrasound, and, when indicated, radiological examinations such as CT scans and X-rays.

Thanks to the large number of cancer cases treated each year, the Candiolo Cancer Institute is a national reference center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a personalized approach, tailored to the clinical and individual profile of each patient.

Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.

Advanced laboratory tests, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.

When indicated, surgery is performed using minimally invasive techniques (laparoscopic or thoracoscopic), which reduce surgical trauma, promote faster recovery, and improve postoperative quality of life. Every treatment decision is defined within the Multidisciplinary Team (GIC), ensuring a coordinated and integrated approach to patient management.

As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), the Candiolo Cancer Institute combines clinical care with a strong focus on scientific research. Patients can be considered for participation in active clinical trials, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.

The Interdisciplinary Care Group  (GIC or MDT) supports the patient at every stage: from diagnosis, through treatment, to follow-up. Special attention is paid to nutritional support, psychological health and reintegration into daily life. The organization of checkups, examinations, and treatment is designed to ensure continuity, serenity, and a humane, caring approach to each patient’s needs.