Overview
Urologic Oncology is the field of medicine concerned with the research and treatment of cancers of the urinary system for both genders, as well as those affecting the male sexual organs. Most often, these include cancers of the kidneys and bladder, as well as the prostate and testes. Women’s cancers or cancers of the female reproductive systems are seen by gynecologic oncologists.
Symptoms
Blood in the urine, painful or burning sensation during urination and needing to urinate frequently, particularly during the night, are all symptoms common to bladder, kidney and prostate cancers. Kidney cancer may also result in symptoms of fever, unexplained weight loss, fatigue and a pain in the side that does not subside. Prostate cancer will affect the flow of urine; patients may experience difficulty starting or stopping urination; as well as difficulty in achieving an erection. Testicular cancer often presents as an enlargement or swelling of the testicle, pain in the scrotum and/or pain in the groin, back or lower abdomen.
Causes
Smoking, certain bacterial infections and occupational chemical exposure are among the risk factors for bladder cancer. For kidney cancer, the risk factors include smoking, obesity, high blood pressure and heavy metal exposure. The odds of developing prostate cancer are raised by age and family history, while testicular cancer risk factors include family history and congenital abnormalities or birth defects of the testes, kidneys and penis.
Diagnosis
Prostate Cancer This is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing, however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men. Prostate cancer is most common in the developed world with increasing rates in the developing world. However, many men with prostate cancer never have symptoms, undergo no therapy and eventually die of other unrelated causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.The presence of prostate cancer may be indicated by symptoms, physical examination, Prostate-Specific Antigen (PSA) or biopsy. Prostate-specific antigen testing increases cancer detection but does not decrease mortality.Management strategies for prostate cancer should be guided by the severity of the disease. Many low-risk tumours can be safely followed with active surveillance. Curative treatment generally involves surgery, various forms of radiation therapy or less commonly, cryosurgery; hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (although hormonal therapy may be given with radiation in some cases).The age and underlying health of the man, the extent of metastasis, appearance under the microscope and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localised prostate cancer (a tumour that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life. Kidney Cancer It is a type of cancer that starts in the cells in the kidney.The two most common types of kidney cancer are Renal Cell Carcinoma (RCC) and Urothelial Cell Carcinoma (UCC) of the renal pelvis. These names reflect the type of cell from which the cancer developed.The different types of kidney cancer (such as RCC and UCC) develop in different ways, meaning that the diseases have different outlooks (or prognosis), and need to be staged and treated in different ways. RCC is responsible for approximately 80% of primary renal cancers, and UCC accounts the majority of the remainder. Bladder Cancer This includes any of the several types of malignancy arising from the epithelial lining (i.e. the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma, but these are not ordinarily included in the colloquial term ‘bladder cancer’. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine and is located in the pelvis. The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma.
Treatment
There are three main categories of urologic cancer treatments: surgery, radiation and chemotherapy. A fourth option sometimes applied in the treatment of prostate cancer is termed active surveillance or watchful waiting. In this case, a prostate tumour that is determined to be of very small size and slow growth is not actively treated until such a time that it is determined to be of greater risk to the patient.