Tumors of the testis

It is theimaging examination reference because it is rapid, inexpensive, and has high sensitivity. It is typically used as a diagnostic confirmation following the objective examination and is also used to evaluate the contralateral testis.

Scrotal ultrasound is performed at the Division of Radiation Diagnostics.

These are alpha-fetoprotein (AFP), human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH). In non-seminomatous neoplasms, AFP and b-HCG are often elevated. The latter can also be elevated, but less frequently, in cases of seminoma. Generally, the seminoma does not express AFP.

In contrast, LDH represents an index of tumor volume. These markers should be performed at both the diagnosis and follow-up stages in order to monitor the outcome of the therapies performed and diagnose any recurrence early.

Staging of the disease can be performed after surgery, with histological confirmation of malignancy, or, if there is a strong diagnostic suspicion, even before surgery.

The staging process is generally based on performing a CT (computed tomography) scan of the chest and abdomen. This examination uses ionizing radiation (X-rays) to obtain very detailed three-dimensional images of the internal structures of the body. To improve image quality, contrast medium is administered. CT scanning is performed at the Division of Radiodiagnostics.

The examination allows for the detection of metastases, which can spread through lymph nodes, especially retroperitoneal ones, or through the blood, reaching organs such as the lungs.

Based on staging test results, the disease is classified into:

• Stage I: tumor confined to the testis;

• Stage II: tumor that has spread to abdominal lymph nodes;

• Stage III: tumor with distant spread, involving organs such as lungs and liver

Histologic examination is an analysis performed on a tissue sample taken from the tumor, usually during or after surgery. This specimen is examined under a microscope by the anatomo-pathologist, who studies the cellular characteristics to identify the precise type of neoplasm present.

In the case of testicular tumors, histologic examination makes it possible to distinguish between germinal ne oplasms (about 95% of cases) and non-germinal neoplasms, and to further classify germinal neoplasms into seminomas or non-seminomas. This distinction is critical because each type has different characteristics interms of aggressiveness, prognosis, and treatment. Histological examination is therefore essential to define the exact diagnosis and guide treatment choices.

In the presence of a suspected malignant testicular tumor, surgical exploration, which is performed through an inguinal incision, is always recommended. The surgery, called orchifunicolectomy, involves the removal of the testis, epididymis and spermatic funiculus along with related blood vessels.

After surgery, if the patient wishes, a silicone testicular prosthesis may be inserted inside the scrotum to preserve its cosmetic appearance. This surgery has a dual function: on the one hand, it allows the removal of the tumor mass (therapeutic); on the other hand, it allows the tissue needed for definitive histological analysis (diagnostic) to be obtained.

Once the diagnosis has been confirmed through histologic examination, and the results of staging tests and tumor markers have been evaluated, the multidisciplinary team of specialists meets to define an individualized course of treatment. This planning takes into account the patient’s age, general health condition, and specific tumor characteristics.

At the end of the discussion, the doctor presents the patient with the therapy deemed most suitable for his or her case, explaining its benefits and, if there are multiple possible treatment options, also explaining their advantages and disadvantages for a shared decision.

If the tumor is discovered at an early stage, whether it is a seminoma or a non-seminomatous tumor (stage I without risk factors), orchifunicolectomy may be sufficient as the only treatment.

Thereafter, the patient will undergo active surveillance, including regularly scheduled checkups, including blood tests, ultrasounds, and X-rays, to monitor for possible disease recurrence.

Chemotherapy hinders the growth and reproduction of cells and causes the death of cells that multiply faster than normal, a typical feature of cancer cells. It very importantly improves the survival of patients with testicular tumors, both seminomatous and non-seminomatous.

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

The type and number of chemotherapy cycles depend on tumor characteristics and clinical stage. It may be administered in order to reduce the risk of recurrence or for therapeutic purposes if there is evidence of distant extension of the disease.

The most commonly used drugs are carboplatin or the PEB scheme (cisplatin, etoposide, bleomycin).

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

The purpose of radiation therapy is to treat retroperitoneal lymph nodes.

This is a complex surgical procedure aimed at removing retroperitoneal lymph node chains (para-aortic, paracaval, interaorto-caval, and iliac).

It can be offered to low-risk patients who are unwilling (or unable) to follow surveillance protocols, as well as high-risk patients who do not accept chemotherapy.

It also finds indication in so-called “residual masses” after chemotherapy.

All cancer therapies can cause side effects that variably affect the patient’s quality of life. At the Candiolo Institute, before starting treatment, the patient is always informed about the possible side effects associated with each treatment option and the solutions available to manage them.

The multidisciplinary team, consisting of physicians and nurses, is on hand to offer ongoing support and help the patient cope with difficulties that may arise during the course of care.

In addition, prior to initiating treatment for testicular cancer, cryopreservation of semen is generally recommended, given the possible impairment of fertility caused by both surgery and chemotherapy.

The impact of cancer in a person’s life also affects the psychological sphere: getting cancer is in fact always a traumatic event that affects all dimensions of a person and can generate anxiety, fear, anger, and depression.

At the Candiolo Institute, alongside cutting-edge therapies, the treatment and care pathway always includes qualified psycho-oncological support that helps patients cope positively not only with treatment but also with the delicate phase of physical and psychological recovery.

You can also participate in psychological support groups to compare yourself with others who have gone through or are going through the same experience.

To ensure timely and direct support and receive timely answers to concerns and questions, a dedicated support service is in place at the Candiolo Institute for all patients.

From Monday to Friday, from 8 a.m. to 5 p.m., you can contact the secretariat of the oncology day hospital at 011.993.3775, reporting the need for urgent consultation.

The patient will be quickly put in touch with his or her medical specialist, to receive clear answers and immediate support.

The cancer patient is a person with complex needs that requires multidisciplinary support not only for the cancer disease, but also for all related issues.

At the Candiolo Institute, patients who need or require it have access to specialists in different areas to receive nutritional support, physical therapy, pain therapy and management of other associated conditions.

The Social Service Department of the Candiolo Institute conducts information and orientation interviews to patients and their families on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).

The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059).

At the end of the treatment course, the follow-up period begins, during which the patient undergoes examinations and a series of tests to monitor both the side effects of the treatment received and the effectiveness of the treatment, while assessing his or her recovery.

These checks are critical for early detection of any recurrence, allowing rapid intervention with appropriate therapies. They also provide a valuable opportunity to maintain an ongoing dialogue with the specialist.

It is the attending physician who schedules follow-up visits, during which the patient’s general condition is assessed and the results of the tests performed are analyzed.

The follow-up protocol for testicular cancer includes the assay of tumor markers in the blood, testicular ultrasound, and, when necessary, radiological examinations such as CT scans and X-rays.

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.