Urologic Cancers

Bladder Cancer | Kidney Cancer | Penile Cancer | Prostate Cancer | Testicular Cancer

Bladder Cancer

Diagnosis

Although most bladder cancers are slow-growing, once they have spread to the bladder's muscle tissue, they often metastasize to sites such as the lungs, liver, bone, or lymph nodes.

Symptoms

The early stages of bladder cancer may not produce any noticeable signs or symptoms. The most common sign of bladder cancer is hematuria (bloody urine; urine that appears bright red or rusty). Hematuria is usually painless and may only appear occasionally over a period of months. Over 80% of all bladder cancer patients eventually do experience either gross (visible to the naked eye) or occult (visible only by microscope) hematuria.

When bladder cancer causes noticeable symptoms, they are usually the result of irritation brought about by tumor growth. "Irritative" voiding symptoms can include urination that is frequent, urgent, painful or difficult. This is referred to as dysuria. Irritative symptoms are more common among patients with "carcinoma in situ" (CIS or TIS, cancer that is "in place" and has not spread) type of bladder cancer than in patients with papillary, wart-like tumors. In fact, irritative voiding may be the only noticeable symptom of CIS. Since irritative voiding symptoms are also caused by bacterial infections and kidney stones, it is essential to see a physician to rule out these more common and less dangerous conditions. Any signs or symptoms that lasts longer than 2 weeks should be evaluated by a health-care practitioner.

If a bladder tumor blocks a ureter (one of two tubes that carries urine out of the kidneys and into the bladder), a patient may experience pain in the flank. The flank is the side of the body between the ribs and the top of the hip. In some cases, tumor growth may constrict the urethra (the tube that passes urine from the bladder out of the body) and slow the flow of the urine stream. Bladder cancers that have become necrotic (having areas of dead tissue) may shed pieces of dead tissue into the urine. Fragments of papillary tissue and calcareous (chalky) deposits are other forms of tumor-related matter that may be passed out with the urine.

If the tumor has spread outside of the bladder to surrounding tissues, the patient may experience pelvic pain. In addition, metastases from a bladder cancer may cause secondary symptoms, such as bone pain at the site of the new cancer or leg edema (swelling) due to involvement of the lymphatic system. Bladder cancer that has progressed to the point of organ invasion and metastasis eventually may cause the patient to lose weight and strength. Anemia (low red blood cell count), uremia (high blood levels of urea) and blood elevations of other metabolic by-products can also be caused by urinary tract obstruction and may accompany late-stage bladder cancer.

Treatment Options:

Transurethral Resection (TUR)
Removal of a bladder tumor using cystoscope. During your evaluation, your doctor uses cystoscopy to look inside your bladder. If the cancer is in an early state and growing slowly, it may be removed using cystoscopy. Removal of a tumor during cystoscopy is known as transurethral resection (TUR). Most of the time, tissue removed during TUR can be studied to see if more treatment is needed.

Intravesical Therapy
Placement of liquid medication directly into the bladder to help destroy cancer cells or keep them from returning. Certain types of bladder tumors are hard to remove using surgical procedures like TUR. These include tumors that are high grade, occur in more than one area, are flat against the bladder wall, or come back after treatment. In these cases, the special medications that destroy cancer cells may be placed into the bladder. This treatment is called intravesical therapy. Intravesical therapy may be an option if you have a hard-to-remove tumor such as CIS. It may also be done after TUR to help keep the cancer from coming back.

Chemotherapy
Use of intravenous (IV) medications to destroy cancer cells. Chemotherapy is a way to treat cancer using medications. These medications destroy cancer cells. They are injected directly into the patient’s veins. Chemotherapy may be used alone, or with radiation or surgery. It may help cure or control cancer. It may also help relieve cancer symptoms, such as pain.

Radiation
Radiation therapy is another way of treating cancer. Radiation therapy uses beams of energy to destroy cancer cells. With each dose, the tumor gets smaller. The cancer cells die and healthy cells take their place. Radiation therapy may be used alone or with chemotherapy, and may be done before or after surgery. Radiation can take place outside or inside your body.

Cystectomy
Cystectomy is the surgical removal of the entire bladder. This surgery may be suggested in certain cases of bladder cancer, especially high-grade, high-stage cancer. Your doctor can discuss the risks and benefits of cystectomy with you. If you decide to have surgery, the surgeon can explain the procedure and answer your questions.

Kidney Cancer

Diagnosis

Several types of cancer can develop in the kidneys. Renal cell carcinoma (RCC), the most common form, accounts for approximately 85% of all cases. In RCC, cancerous (malignant) cells develop in the lining of the kidney's tubules and grow into a mass called a tumor. In most cases, a single tumor develops, although more than one tumor can develop within one or both kidneys. Early diagnosis of kidney cancer is important. As with most types of cancer, the earlier the tumor is discovered, the better a patient's chances for survival. Tumors discovered at an early stage often respond well to treatment. Survival rates in such cases are high. Tumors that have grown large or spread (metastasized) through the bloodstream or lymphatic system to other parts of the body are more difficult to treat and present an increased risk for mortality.

The primary symptoms of RCC include the following:

  • Abdominal mass or lump
  • Blood in the urine (hematuria)
  • Fever
  • High blood pressure (hypertension)
  • Pain in the side (flank) or lower back not associated with injury
  • Persistent fatigue
  • Rapid, unexplained weight loss
  • Swelling (edema) in the legs and ankles

Treatment Options

  • Surgery (to remove cancerous tissue) - Laparoscopic Surgery
  • Chemotherapy (using drugs to destroy cancer cells)
  • Radiation therapy (using high-energy radiation to destroy cancer cells and shrink tumors)
  • Biological or Immunotherapy (using compounds produced by the body's immune system, or laboratory-produced copies of them, to destroy cancer cells)

Procedures

Laparoscopic Radical Nephrectomy
Patients with kidney cancer can be treated by either laparoscopic radical or partial nephrectomy. The word radical in this case means that the entire kidney, its surrounding fat, part of the ureter, and possibly the adjacent adrenal gland are removed. Currently, laparoscopic radical nephrectomy can be used for tumors up to about 10 cm.

This procedure is performed through three to five small holes in the abdomen and takes between two to three hours. Inside the body, the blood vessels leading to the kidney are identified, clipped and divided. The surrounding structures are dissected away and the kidney is placed inside a "sack." The neck of the sack is pulled out one of the incisions and the kidney is divided into small portions to remove it. This enables the entire surgery to be performed without any incisions larger than 2 cm. Since the sack is resistant to cells and fluid, it is safe to remove a cancer in this manner. Once the kidney is removed, all the instruments, drapes, gowns, and gloves are changed to further protect the patient from cancer spread.

Success rates for this procedure are equivalent to open radical nephrectomy and, the significant benefits to the patient are shorter hospital stays (one to two days), less pain, and earlier return to work (10-14 days).

Laparoscopic Partial Nephrectomy
In a partial nephrectomy, a tumor or portion of the kidney is removed rather than the entire organ. This procedure can be performed laparoscopically for the appropriate patient, usually when the tumor is less than 4 cm.

The procedure involves three to five small incisions in the abdomen and takes between two to three hours. The kidney is dissected away from surrounding structures, identifying the renal artery and vein. These vessels are clamped and the diseased portion of the kidney is removed. The remaining kidney is then sewn closed with suture.

Post-operative pain and recovery are similar to that for the laparoscopic radical nephrectomy.

Radical Nephrectomy
Your surgeon will make a cut about 8 to 12 inches long. This cut will be on the front of your belly, just below your ribs. It may also be done through your side. Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed. Your surgeon will also take out the adrenal gland and some lymph nodes. The cut is then closed with stitches or staples.

Penile Cancer

Diagnosis

Penile cancer is the rare growth of malignant cells on the external skin and in the tissues of the penis. Different types of penile cancer can develop in different cells of the penis, which determines the seriousness of the cancer and the type of treatment needed.

The majority of penile cancers develop from flat, scale-like skin cells called squamous cells. Like most other forms of nonmelanoma skin cancer, these tumors tend to grow slowly and are usually preceded by precancerous changes that may last for several years. When detected in the early stages, these tumors can usually be cured.

The most common symptom of penile cancer is a tender spot or an open sore at the tip of the penis.


Treatment

Penile cancer is usually treated with a combination of surgery and radiation therapy.

Prostate Cancer

Risk Factors & Prevention

Being aware of your risk factors can help you, and your doctor, determine when and how often to schedule prostate screenings.

Risk factors can include:

  • Age- Prostate cancer is rare in men younger than 45, but your risk sharply increases with age.  In the U.S., 75 percent of all prostate cancers are found in men over the age of 65.
  • Race- African-American men have the highest risk, followed by Caucasian, Hispanic and Native American men. Asian- American men have the lowest rate of prostate cancer.
  • Family History- Your risk is two to three times higher if your father or brother had the disease.
  • Weight and Diet-Men who are overweight or obese are more likely to develop prostate cancer, and studies suggest that your risk increases if you eat a diet high in animal fat or meat.

Can Prostate Cancer Be Prevented? Prostate cancer can't be prevented, but you can make choices to decrease your risk:

  • Lose weight if you are overweight
  • Schedule routine exams with your doctor
  • Eat a healthy diet
  • Exercise- 30 min a day at least 5 times a week.

 

Detection & Screening

The purpose of screening for cancer is to detect the cancer at its earliest stages, before any symptoms have developed.

Some men, however, will experience symptoms that might indicate the presence of prostate cancer. Because these symptoms can also indicate the presence of other diseases or disorders, these men will undergo a more thorough work-up. Typically, men whose prostate cancer is detected through screening are found to have very early-stage disease that can be treated most effectively.

Screening for prostate cancer can be performed using the following tests:

  • Prostate-specific antigen (PSA) blood test measures a substance made by the prostate called prostate-specific antigen –-the higher the level, the more likely cancer is present.
  • Digital rectal exam (DRE) exam involves inserting a rubber-gloved, lubricated finger into the rectum to feel for lumps on or enlargement of the prostate.
  • Transrectal ultrasound – your doctor inserts a sound wave probe into your rectum to check for any prostate irregularities.
  • Urine test – a urine sample can be used to help detect prostate abnormalities.

Dependig on which test results are returned abdnormal in your case Dr. Ryan will recommend a biopsy to determine whether cancer is present. Note: While these tests can be used to detect a prostate problem, they cannot determine the presence of cancer.

Symptoms

Understanding the Symptoms of Prostate Cancer
In its early stages, most men will not notice any symptoms of their prostate cancer. If the cancer advances and spreads just beyond the prostate, some men experience difficulty urinating or impotence - which can also be symptoms of diseases other than prostate cancer.

What are the symptoms of prostate cancer?
Possible symptoms include:

  • trouble urinating
  • frequent urge to urinate, especially at night
  • weak or interrupted urine stream
  • pain or burning while urinating
  • blood in the urine or semen
  • painful ejaculation
  • difficulty having an erection
  • nagging pain in your back, hips or pelvis
  • persistent bone pain
  • loss of appetite and weight

Talk to your doctor if you have any of these symptoms. Note: These symptoms could indicate other prostate conditions, such as enlarged prostate.

The Stages of Prostate Cancer
After diagnosing your cancer, your doctor will determine if and where the cancerous cells have spread before recommending treatment.

  • Stage I - Cancer is found in the prostate only. It cannot be felt during a digital rectal exam and is not visible with imaging.
  • Stage II -Cancer is more advanced, but hasn't spread outside the prostate.
  • Stage III -Cancer has spread outside the prostate to nearby tissues, and possibly to the seminal vesicles.
  • Stage IV -Cancer has spread to lymph nodes, and possibly to other parts of the body, including the pelvic bone and bladder.

Treatment

Once you have been diagnosed with prostate cancer, your healthcare team will recommend a plan of treatment that meets your individual needs. Doctors consider several key factors when choosing the treatment that is right for you:

  • Your age and overall health
  • If your prostate cancer has just been discovered or if it was previously diagnosed and has now recurred
  • The stage of your cancer – based on how much cancer you have and whether it exists only in the prostate, or if it exists beyond the prostate as well.

Radiation Therapy
Can take place outside or inside your body:

  • Externally – IMRT: uses high-energy x-ray beams to kill cancer cells
  • Internally – Brachytherapy: small radioactive implants are inserted into your prostate to kill cancer cells

Hormone Therapy
Is used to help prevent cancer cells from growing. Testosterone, a male sex hormone, can stimulate the growth of cancer cells.  The goal of hormone therapy is to either stop your body from producing testosterone or to block testosterone form getting into cancer cells.

Robotic Assisted Surgery
For qualified candidates, robotically assisted prostate surgery offers numerous potential benefits over the traditional open prostatectomy, including shorter hospital stay, less pain, less risk of infection, less blood loss and transfusions, less scarring, faster recovery, and quicker return to normal activities.

Radical Prostatectomy
Removal of the prostate gland, lymph nodes, and surrounding tissue.

Cryosurgery
Freezes prostate tissue in order to destroy cancer cells

Watchful Waiting
May be an option if your cancer isn't growing quickly or harming your health. If you choose this option, you'll work with your doctor to monitor any changes to your prostate.

Testicular Cancer

Diagnosis

Testicular cancer develops in the testicles (testes), the male reproductive glands. The testicles are located in the membranous pouch (scrotum) below the penis and are suspended from the body by the spermatic cord. They produce male reproductive cells (sperm) and testosterone. Testicular cancer is treated successfully in more than 95% of cases.

Most (95%) testicular cancer originates in undeveloped cells (germ cells) that produce sperm. These tumors, called germ cell tumors (GCTs), are most common in men between the ages of 20 and 40 and are curable in more than 95% of cases. There are two main types: seminomas and nonseminomas. A third type, called stromal tumors, develops in the supporting tissues of the testicle.

Treatment Options

Surgery-  Radical inguinal orchiectomy is the surgical removal of the testicle and the spermatic cord through an incision in the groin. Surgery is performed under general or regional anesthesia and takes approximately 1 hour. Most patients remain in the hospital overnight.

Radiation- Radiation uses high energy x-rays to destroy cancer cells. In testicular seminoma, external beam radiation (from a machine outside of the body) is primarily used after orchiectomy (called adjuvant therapy) to destroy cancer cells that have spread (metastasized) to lymph nodes.

Chemotherapy- Chemotherapy is a systemic (i.e., circulates throughout the body via the bloodstream) cancer treatment that uses toxic drugs to destroy cancer cells. In testicular cancer cases, it is used to destroy cancer cells that remain after surgery. Chemotherapy may be administered intravenously (IV), taken in pill form, or injected into muscle.

 

© 2011 Guadalupe Urology ~ Robert T. Ryan, III, M.D. ~ Seguin | Gonzales | Cuero | Yoakum