Uro-oncology deals with cancers of the kidney(s), the prostate and the urinary bladder.
Kidney Cancer:The kidneys are a matched pair of vital organs, located underneath the liver and stomach, and near the backbone on either side. As the blood flows through the kidneys, urea, salt and other substances are filtered from the blood. In this way, they help remove wastes from the body by making urine. The kidneys also serve as glands that manufacture and secrete a variety of hormones.
When cell division is not orderly, abnormal growth takes place. Masses of tissue called tumours build up. Tumours may be benign or malignant. Benign tumours remain localised and usually do not spread or threaten one’s life. Malignant tumours are cancers. They can invade and destroy nearby tissues and organs, or spread to other parts of the body by way of the bloodstream or the lymphatic system.
Kidney cancer is cancer occurring in the kidneys due to (a) malignant tumour(s).
Prostate Cancer: The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the urinary bladder. Its main function is to produce fluid for semen, which transports sperm.
Prostate cancer is a malignant tumour that begins most often in the outer part of the prostate. It may spread to the inner part of the prostate, and beyond the prostate, to other parts of the body. Prostate cancer is the seventh most common cancer in Singaporean men. Most men who get prostate cancer are 50 years of age or older, and the risk increases with age. It is usually curable when detected early, but can kill if diagnosed late or not treated effectively.
Bladder Cancer: The urinary bladder is part of the urinary tract that transports and stores urine. Urine is the liquid produced by the kidneys as they remove waste and water from the blood. Urine travels from each kidney down a narrow tube, the ureter, and is stored in a balloon-like structure – the urinary bladder.
The inside, or lining, of the urinary bladder is composed of a layer of cells that protect the tissues beneath them from contact with urine. Occasionally, these cells start to multiply uncontrollably and form a growth or tumour. When found and treated in the early stages, cancerous bladder tumours are not likely to be life-threatening. In addition, treatment of most of these tumours does not require the removal of the urinary bladder. Prompt medical attention and regular checkups are necessary to treat bladder tumours and to monitor for new growths.
Bladder cancer is unusual in people under 40 years of age. Men are affected 5 times more often than women, and cigarette smokers have an increased risk of developing bladder cancer. Exposure to certain chemicals in the workplace has also been associated with an increased risk of developing bladder cancer.
Diagnosis & Tests
For Kidney Cancer
The most common symptom of kidney cancer is visible blood in the urine. Blood in the urine can be the sign of a number of disorders other than cancer. But no matter what the cause, the condition should be brought to the attention of a doctor.
Other common symptoms of kidney cancer are the presence of a lump or mass in the abdomen, and pain in the side. Like all cancers, kidney cancer can cause fatigue, loss of appetite, weight loss and anaemia.
Diagnosis begins with a physical examination by your doctor. The tests for kidney cancer are:
- Diagnostic X-Ray: A diagnostic x-ray is always used to confirm a suspected diagnosis of kidney cancer. If the basic x-ray examinations will confirm a diagnosis of kidney cancer, your doctor will want to perform other tests that will tell him whether the cancer has spread.
- Chest X-Rays & Radioisotope Bone Scans: are almost always included among these tests, because the lungs and the long bones are the areas to which kidney cancer cells most often spread.
For Prostate Cancer
In the early stages, when prostate cancer is a small, treatable tumour, there are usually no symptoms. When the growth becomes more advanced, urinary symptoms may develop. These include :
- Frequent urination (especially at night)
- Weak urinary stream
- Inability to urinate
- Interruption of the urinary stream (the urinary stream starts and stops)
- Pain or burning on urination
- Blood in the urine
- Bone pain
The stages of prostate cancer are:
- Stage A The tumour cannot be detected by any routine tests but has been found during surgery for another disorder of the prostate or found by biopsy because of elevated levels of PSA.
- Stage B The tumour can be felt by rectal examination but it has not spread beyond the prostate gland.
- Stage C The cancer has spread beyond the prostate to nearby tissues.
- Stage D The cancer has spread to the pelvic lymph nodes or to distant parts of the body, most commonly to the bones.
The tests and procedures to check for prostate cancer are:
Rectal Examination: Rectal examination is the first step in diagnosing prostate cancer. Using a gloved finger to examine inside the rectum, the doctor may be able to feel a hard lump or growth in the prostate. This examination should be part of a regular checkup for all men over the age of 40.
Test to Detect Elevated Levels of Prostate-Specific Antigen (PSA): Another test that helps to detect prostate cancer is the presence of elevated levels of prostate-specific antigen (PSA) in the blood. PSA is a substance produced by both normal and malignant prostate cells. Some men with Benign Prostate Hypertrophy (BPH) or prostatitis (an inflamed prostate) have increased levels of PSA even without cancer.
Biopsy: If initial clinical evaluation suggests the presence of prostate cancer, a biopsy of the prostate is usually recommended. A biopsy of the prostate causes no more discomfort than a visit to the dentist. If the biopsy is positive, then a bone scan and/or computer scanning may be needed to help determine the extent of the cancer.
For Bladder Cancer: The earliest clue that you may have a bladder tumour is the presence of blood in your urine. You may or may not see the blood. Sometimes it can only be spotted under a microscope. People with kidney stones or urinary tract infections and men with enlarged prostate glands may also have blood in their urine. It is therefore important to find out the underlying cause in each case of having blood in the urine. Blood in the urine is usually not accompanied by pain for those with bladder cancer.
Your doctor will probably refer you to a urologist, a doctor who specialises in diseases of the urinary system and the male reproductive system, who will then perform further tests for you.
All of the tests below may be performed by an urologist without requiring you to stay overnight in a hospital or to have anaesthesia. administered to you (anaesthesia is medication that puts you to sleep). The tests for bladder cancer are:
- An Intravenous Urogram (IVU): An intravenous urogram (IVU) is a test in which a special liquid called a ‘contrast solution’ is injected into a vein and which then passes quickly into the urine. X-rays of the urinary system as the contrast solution is excreted allows the urologist to see images of the kidneys, the ureters, and the urinary bladder.
- Cystoscopy: In cystoscopy, a pencil-thin, telescope-like instrument (cystoscope) with a light source and magnifying lenses is inserted gently into the urethra and passed into the urinary bladder to examine its lining. The cystoscope also permits the urologist to remove a tissue sample for biopsy.
For Kidney Cancer
Your medical history, general health, the type and location of the cancer and many other factors are considered in determining the treatment needed. The treatment must be tailored to your individual needs. The types of treatment for kidney cancer are:
- Surgery: is the treatment for most cases of adult kidney cancers that have not spread to distant areas of the body.
- X-Ray Treatment: may be used for certain types of kidney cancer.
- Anti-Cancer Drugs: If you have widespread kidney cancer, your doctor may recommend anti-cancer drugs.
For Prostate Cancer
For treating prostate cancer, your doctor may use one or more of the following treatment methods – surgery, hormonal treatment, radiation and anti-cancer drugs. Both surgery and radiation provide excellent 10-year survival rates. Your doctor can help advise you about the best treatment for your cancer. The choice depends on the stage of the cancer, your age and your health. The treatments for prostate cancer are:
- Radical Prostatectomy: is used to treat cancer localised in the prostate and involves complete removal of the prostate. Often, the pelvic lymph nodes are removed as well. Surgical treatment of prostate cancer raises many questions about a man’s ability to remain sexually active. For some men, changes including impotence may be temporary, but for others, these problems may be permanent. Urinary incontinence may be present.
- Radiation Therapy: uses high-energy x-rays to kill cancer cells. Radiation may be provided from a machine located outside the body (external radiation therapy), or from a radioactive substance introduced directly into the tumour. Sometimes, a combination of these methods is used. During radiation therapy, patients may notice a number of side effects, which usually disappear when treatment ends. For example, patients may have skin reactions (redness, dryness or wetness) in the area being treated, and they may feel unusually tired. Patients may also have diarrhoea, and frequent and uncomfortable urination. Some patients are impotent after radiation therapy.
- Hormonal Therapy: is used to treat prostate cancer that has spread. The 2 basic techniques involve :Chemotherapy: Occasionally, chemotherapy is used. The side effects of chemotherapy depend on the drugs given and the response of the individual patient. Chemotherapy commonly affects hair cells, blood-forming cells and cells lining the digestive tract. As a result, patients may have side effects such as hair loss, lowered blood counts, nausea or vomiting. Most side effects end after the treatment is over. Watchful Waiting: has also been advocated as a reasonable approach for some men with prostate cancer. Not all men diagnosed with the disease require immediate treatment. Some cancers grow slowly and may take 10 years or more to cause problems or to spread. Immediate treatment may not be necessary for men with an early-stage cancer whose age or general health make it unlikely that they will live for at least 8 to 10 years. After treatment for prostate cancer, you should continue to visit your doctor for regular checkups. At various times after your treatment, your doctor will examine you and perform several different tests to determine whether any further treatment is necessary. The PSA test has proved to be particularly useful in monitoring the response of prostate cancer to treatment.
- Medicinal Treatment: Drugs that prevent the release of male harmones or counter their action are administered.
- Surgical Removal: of the testicles, which make the male hormones. Because male hormones stimulate the growth of prostate cancer, treatments that interfere with the effect of these hormones can slow the cancer’s growth, sometimes dramatically. Occasionally, chemotherapy is used. Surgical treatment of prostate cancer raises many questions about a man’s ability to remain sexually active. For some men, changes including impotence may be temporary, but for others, these problems may be permanent. Urinary incontinence may be present. Hormonal therapy also may cause side effects. Female hormones (estrogen) may cause breast tenderness and enlargement, nausea, vomiting and water retention. High doses of estrogen also increase the risk of heart problems.
For Bladder Cancer
The treatment for bladder cancer depends on how deeply the tumour has grown into the bladder wall. The treatments for bladder cancer are:
- Transurethral Resection: If the growth is superficial, that is, if it is confined to the bladder wall, the tumour is usually removed with an instrument called a resectoscope. Removal of a bladder tumour in this way is referred to as transurethral resection.
- Medical Treatment: If the doctor believes that you are likely to develop new cancer, you may be advised to undergo additional treatments such as having medications instilled into the urinary bladder.
- Cystectomy: Some bladder cancers are invasive, meaning that the cancer has grown through the bladder lining into the bladder wall. In such cases, the urologist may recommend that the urinary bladder be completely removed. This operation is called a cystectomy.
- X-Rays and Drugs: The doctor may also recommend additional treatment with x-rays and drugs.
- Endoscopic Surgery
- Intravesical Immunotherapy: It is a form of treatment where a specific medicine [Bacille Calmette-Guerin (BCG)] is most commonly used] is introduced into the urinary bladder in patients who are diagnosed with cancer of the urinary bladder. The goal is to decrease recurrence of the disease, prevent progression and eradicate residual disease after endoscopic surgery for the cancer. The treatment is usually started 2 weeks after the patient’s initial endoscopic operation. Regular follow-up is required because bladder cancers often recur, especially within the first year or two after discovery of the first cancer. Because tumours can recur, it is important for the urologist to look into your urinary bladder regularly with a cystoscope and to inspect cells from your urine with a microscope.