Urology Cancer Surgeries

Urologic Oncology Overview

Thousands of men and women are diagnosed each year with cancer of the prostate, bladder or kidney, as well as testicular cancer. New breakthroughs in cancer care, experimental treatment options, and ongoing research into the causes and potential cures of urologic malignancies spell new hope for patients from all walks of life.

Types of Urology Cancer

Prostate cancer

Prostate cancer is the second most common cancer in men after skin cancer. It is the second leading cause of cancer death in men after lung cancer. The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.

Cancer only in cells in the lining of the bladder is called superficial bladder cancer. This type of bladder cancer often comes back after treatment, but it does not tend to progress. If the tumor recurs, the disease often recurs as another superficial cancer in the bladder. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina in women or the prostate gland in men. It also may spread to other parts of the body.

Signs and Symptoms

Prostate cancer often doesn't produce any symptoms in the early stages. Symptoms that may indicate prostate cancer, and which should be followed up with a visit to the doctor, include:

• Frequent urination, especially at night
• Urgency in urinating
• Trouble starting your urine stream
• A weak or interrupted urine stream
• Pain or burning during urination
• A feeling that your bladder doesn't empty completely
• Blood in the urine
• A nagging pain in the back, hips or pelvis

Although these symptoms may indicate prostate cancer, they also can be caused by other conditions that are not cancer, such as benign prostatic hyperplasia (BPH). As men age, the prostate often enlarges and can press on and block the urethra and bladder, producing some of the symptoms described above. BPH can be successfully treated with medication or surgery.

Bladder Cancer

The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.

Cancer only in cells in the lining of the bladder is called superficial bladder cancer. This type of bladder cancer often comes back after treatment, but it does not tend to progress. If the tumor recurs, the disease often recurs as another superficial cancer in the bladder. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina in women or the prostate gland in men. It also may spread to other parts of the body.

Symptoms

Common symptoms of bladder cancer include:

• Blood in the urine, making the urine slightly rusty to deep red
• Pain during urination
• Frequent urination, or feeling the need to urinate without result

These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones or other problems also can cause these symptoms.

Treatment

People with bladder cancer have many treatment options, including surgery, radiation therapy, chemotherapy or biological therapy. Some patients may receive a combination of therapies.

Surgery

Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. Your doctor can explain each type of surgery and discuss which is most suitable for you.

• Transurethral resection — The doctor may treat early or superficial bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and burn away any remaining cancer cells with an electric current, called fulguration. You may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy.
• Radical cystectomy — For invasive bladder cancer, the most common type of surgery is radical cystectomy. Your doctor also may choose this type of surgery when superficial cancer involves a large part of the bladder.
  Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed.
• Segmental cystectomy — In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.

Kidney Cancer

The most common adult kidney cancer is renal cell carcinoma, which forms in the lining of small tubes in the kidney. Children usually develop a different form of kidney cancer called Wilms' tumor.

Signs and Symptoms

In its early stages, kidney cancer usually causes no obvious signs or troublesome symptoms. As a kidney tumor grows, symptoms may occur. These may include:

• Blood in the urine. In some cases, blood is visible. In other instances, traces of blood are detected in a urinalysis, a lab test often performed as part of a regular medical checkup.
• A lump or mass in the kidney area.

Other less common symptoms may include:

• Fatigue
• Loss of appetite
• Weight loss
• Recurrent fevers
• Pain in the side that doesn't go away
• General feeling of poor health

High blood pressure or a lower than normal number of red cells in the blood (anemia) may also signal a kidney tumor. These symptoms occur less often.

Kidney Cancer Treatment

Treatment for kidney cancer depends on the stage of the disease, the patient's general health and age, and other factors. Our doctors develop a treatment plan to fit each patient's needs.

At UCSF Medical Center, patients with kidney cancer often are treated by a team of specialists, including urologists, oncologists and radiation oncologists. Kidney cancer usually is treated with surgery or biological therapy, also called immunotherapy. Doctors may decide to use one treatment method or a combination of methods.

Surgery
Surgery is the most common treatment for kidney cancer. An operation to remove the kidney is called a nephrectomy. Most often, the surgeon removes the whole kidney along with the adrenal gland and the tissue around the kidney. Some lymph nodes in the area also may be removed. This procedure is called a radical nephrectomy. Very often, the surgeon is able to remove just the part of the kidney that contains the tumor. This procedure, called a partial nephrectomy, is best suited for patients with small tumors or tumors on the edge of the kidney.

Radiation Therapy
Radiation therapy, also called radiotherapy, uses high-energy rays to kill cancer cells. Doctors sometimes use radiation therapy to relieve pain (palliative therapy) when kidney cancer has spread to the bone.

Radiation therapy for kidney cancer involves external radiation, which comes from radioactive material outside the body. A machine aims the rays at a specific area of the body. Most often, treatment is given on an outpatient basis in a hospital or clinic five days a week for several weeks. This schedule helps protect normal tissue by spreading out the total dose of radiation. You don't need to stay in the hospital for radiation therapy, and you're not radioactive during or after treatment.

Biological Therapy
Biological therapy, also called immunotherapy, is a form of treatment that uses the body's natural ability or immune system, to fight cancer. Interleukin-2 and interferon are types of biological therapy used to treat advanced kidney cancer.
Clinical trials continue to examine better ways to use biological therapy while reducing the side effects patients may experience. Many people receiving biological therapy stay in the hospital during treatment so that these side effects can be monitored.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Although useful in the treatment of many other cancers, chemotherapy has shown only limited effectiveness against kidney cancer. Researchers continue to study new drugs and new drug combinations that may prove to be more useful.

Hormone Therapy
Hormone therapy is used in a small number of patients with advanced kidney cancer. Some kidney cancers may be treated with hormones to try to control the growth of cancer cells. More often, it is used as palliative therapy or therapy to relieve pain.

Testicular Cancer

When detected early, testicular cancer is highly treatable and usually curable, which is why early diagnosis and treatment are so important for men of all ages. Adolescent boys and young men should be particularly aware of the signs and symptoms of the disease and perform regular testicular self-exams.
Testicular cancer is a disease in which cells become malignant, meaning cancerous, in one or both of the testicles. Testicular cancer can be broadly classified into two types: seminoma and nonseminoma. Seminomas make up about 40 percent of all testicular cancers. Nonseminomas are a group of cancers that include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. A testicular cancer may have a combination of both types.

Most men can detect their own testicular cancers. Doctors generally examine the testicles during routine physical exams. Between regular checkups, if you notice anything unusual about your testicles, you should talk with your doctor.

symptoms

Common symptoms include:

• A painless lump or swelling in either testicle
• Any enlargement of a testicle or change in the way it feels
• A feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or the groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or in the scrotum

Testicular Cancer Treatment

Four treatments commonly used for testicular cancer are surgery, radiation therapy, chemotherapy and bone marrow transplant.

Surgery

Surgery is a common treatment for most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed in a procedure called a lymph node dissection.

Radiation Therapy
Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation usually is emitted by a machine and is called external-beam radiation, rather than radiation emitted by a substance consumed by the patient.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be taken by pill, or injected into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body and can kill cancer cells outside the testicle.

Bone Marrow Transplantation
Bone marrow transplantation is a newer type of treatment. In an autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill cancer cells. The marrow is then frozen. The patient is given high-dose chemotherapy — with or without radiation therapy — to destroy the remaining marrow. The marrow removed from the patient is then thawed and returned to the patient by injection in a vein to replace the marrow that was destroyed.