Uro Oncology

Definition

Kidney cancer is a disease in which cancer cells grow in the kidneys. The kidneys are two bean-shaped organs. They are located just above the waist, on each side of the spine. Their main function is to filter the blood and produce urine.

There are two main types of kidney cancer: Wilms' tumor, which occurs mainly in children, and renal cell carcinoma in adults. The cells that line the ureter may also give rise to transitional cell cancer, and the connective tissues of the kidney may produce sarcomas, which are rare.

Risk

Factors that increase your risk for kidney cancer include:

• Smoking
• Family history of certain hereditary forms of kidney cancer
• Age: 50 years or older
• Balkan nephritis
• Chronic renal stones
• Tuberous sclerosis
• Dialysis treatment
• Von Hippel Lindau syndrome

Symptoms

Symptoms may include:

• Blood in the urine
• Lower back pain or new pain elsewhere
• A lump in the abdomen
• Unplanned, significant weight loss
• Fever
• Swelling of ankles, legs, and/or abdomen
• Some time diagnosed during routine check-up

Diagnosis

Your bodily fluids and tissues may be tested. This can be done with:

• Blood tests
• Urine tests

Your bodily structures may need to be viewed. This can be done with:

• Bone scan
• Chest x-rays
• CT scan
• MRI scan
• Renal ultrasound

Treatment

Options include:

• Surgery
  • Radical nephrectomy
  • Partial nephrectomy
• Radiation Therapy (or Radiotherapy)
• Chemotherapy
• Immunotherapy
• Targeted Therapy

Prevention

Measures to prevent kidney cancer are limited:

• Avoid using tobacco products.
• Avoid occupational exposures.

Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis.

Definition

Penile cancer is a disease in which malignant (cancer) cells form in the tissues of the penis. It contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):

• Corpora cavernosa: The two columns of erectile tissue that form most of the penis.
• Corpus spongiosum: The single column of erectile tissue that forms a small portion of the penis. The corpus spongiosum surrounds the urethra (the tube through which urine and sperm pass from the body).

The erectile tissue is wrapped in connective tissue and covered with skin. The glans (head of the penis) is covered with loose skin called the foreskin.

Causes

Human papillomavirus infection may increase the risk of developing penile cancer.

Risk

Risk factors for penile cancer include the following:

• Men who were not circumcised at birth
• Being age 60 or older
• Having phimosis (a condition in which the foreskin of the penis cannot be pulled back over the glans)
• Having poor personal hygiene
• Having many sexual partners
• Using tobacco products

Symptoms

Possible symptoms include:

• Redness, irritation, or a sore on the penis
• Sores, discharge, and bleeding
• A lump on the penis

Diagnosis

The following tests and procedures may be used:

• Physical and examination history
• Biopsy
• Fine-needle aspiration (FNA) biopsy
• Incisional biopsy
• Excisional biopsy

Treatment

Three types of standard treatment are used:

• Surgery
  • Mohs microsurgery
  • Laser surgery
  • Cryosurgery
  • Circumcision
  • Wide local excision
  • Amputation of the penis
• Radiation therapy
• Chemotherapy
• Biologic therapy
• Radiosensitizers
• Sentinel lymph node biopsy followed by surgery

Definition

The prostate is a walnut-sized gland in men. It surrounds the urethra. The prostate makes a fluid that is part of semen. Prostate cancer is a disease in which cancer cells grow in the prostate gland.

Risk

Factors that may increase the risk of prostate cancer include:

• Age: 55 or older
• Race: Black
• Family history of prostate cancer, especially father or brother
• Family history of prostate cancer diagnosed at a young age
• A high-fat diet

Symptoms

Symptoms may include:

• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Not able to urinate
• Weak or interrupted urine flow
• Painful or burning urination
• Difficulty having an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Diagnosis

Your doctor may order tests, such as:

• Digital rectal exam
• Urine test
• Blood tests
• Other tests, such as:
  • Transrectal ultrasonography
  • Intravenous pyelogram
  • Cystoscopy
  • Prostate biopsy

Treatment

Treatment options include:

• Watchful Waiting if you:
  • Have early stage prostate cancer that is growing slowly
  • Are of an advanced age
  • Have serious health problems (risks of treatment outweigh the benefits)
• Surgery
  • Pelvic lymphadenectomy
  • Radical retropubic prostatectomy
  • Radical perineal prostatectomy
  • Transurethral resection of the prostate (TURP)
  • Laproscopic Radical Prostatectomy
  • Robotic Assisted Radical Prostatectomy
• Radiation Therapy
  • Conformal radiation therapy
  • Intensity-modulated radiation therapy (IMRT)
  • Radium-223 treatment
• Hormone Therapy
  • Luteinizing hormone-releasing hormone (LHRH) analogs (such as goserelin, histrelin, leuprolide, triptorelin)
  • Luteinizing hormone-releasing hormone (LHRH) antagonists (such as degarelix)
  • Anti-androgens (such as bicalutamide, flutamide, nilutamide)
  • Other types of hormone therapy, such as:
    • Estrogen therapy—rarely used now unless other treatments are not working
    • Ketoconazole—affects the production of androgens
    • Abiraterone—may be used in cases where prostate cancer does not respond to other treatments
    • Orteronel (experimental drug)—affects the production of androgens
    • Enzalutamide—affects the production of androgens
• Other Treatment Options
  • Cryosurgery
  • Chemotherapy
    • Docetaxel (this is usually the first chemotherapy drug that is tried)
    • Cabazitaxel
    • Mitoxantrone
    • Estramustine
    • Doxorubicin
  • Immunotherapy
  • Targeted therapies
    • Selective endothelin A receptor antagonist (SERA)
    • Anti-angiogenic drugs
    • Tyrosine kinase inhibitors (such as Imatinib)
  • High-intensity focused ultrasound

BPH, Prevention

To reduce your risk of prostate cancer, take the following steps:

• Eat a healthy diet. Your diet should be high in fruits, vegetables, and fish, and low in red meat.
• Ask your doctor about taking certain medicines. For example, daily aspirin therapy and 5-alpha reductase inhibitors may reduce your risk of prostate cancer.

Definition

Testicular cancer is a disease in which cancer cells grow in one or both testicles. The testicles are a pair of male sex glands that make and store sperm. The testicles also make male hormones. They are located under the penis in a sac-like pouch called the scrotum. There are three main types of testicular cancer:

• Seminomas
• Nonseminomas (yolk sac, embryonal cell carcinoma, teratomas, and choriocarcinoma)
• Stromal cell tumors

Causes

The causes of testicular cancer are unknown. However, research shows that certain risk factors are associated with the disease.

Risk

These factors increases your chance of developing testicular cancer:

• Personal or family history of testicular cancer
• Race: White
• Age: 25-35
• Abnormal testicular development, such as that seen in Klinefelter syndrome
• Undescended testicle that did not move down into the scrotum before birth

Symptoms

Possible symptoms include:

• A painless lump or swelling in either testicle
• Enlargement or swelling of a testicle or change in the way it feels
• Feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or groin
• Fluid in the scrotum that appears suddenly
• Pain or discomfort in a testicle or in the scrotum
• Lower back pain (in later stages of the cancer)
• Enlarged breasts

Diagnosis

Tests may include:

• Blood tests
• Ultrasound
• Excisional biopsy

Once testicular cancer is found, tests may be done to find out if the cancer has spread and, if so, to what extent. These imaging tests of the body may include:

• Computed tomography (CT) scan
• Positron emission tomography (PET)
• Magnetic resonance imaging (MRI)

Treatment

Options include:

• Surgery
• Radiation Therapy
• Chemotherapy

Prevention

If you were born with undescended testicles, having surgery to correct this condition may reduce your risk of getting testicular cancer.

The United States Preventive Services Task Force (USPSTF) does not recommend regular screening by a doctor or self-screening in men who do not have any symptoms. However, the American Cancer Society recommends that your doctor at your routine cancer-related check-ups should do a testicular exam. No studies have been done that look at the benefit or harm of screening for testicular cancer. Discuss screening with your doctor, especially if you are at high risk for testicular cancer.

In general, the uro oncology is a specialized branch requiring special care and refurbishing of latest knowledge regarding these cancer managements . These are readily fulfilled by the FKI team and provides holistic approach towards these diseases. None the less its needless to emphasise that timely management is the key in curing these cancers.