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URO ONCOLOGY

KIDNEY CANCER

Kidney cancer develops from abnormal cells in the kidney tissue. Most cases are discovered incidentally during ultrasounds or CT scans done for other reasons. Some tumors grow silently,
while others may cause:
• Blood in urine

• Pain in the flank
• Unexplained weight loss
• Fatigue
• A lump on the side of the abdomen
Risk factors include smoking, obesity, high blood pressure, family history, and certain genetic conditions.

TREATMENT OPTIONS FOR KIDNEY CANCER

1. Active Surveillance (for small tumors)
For tumors <3 cm in elderly or medically unfit patients, regular monitoring with imaging may be recommended.

 

2. Partial Nephrectomy (Kidney-Sparing Surgery)
This is the gold standard when possible. Only the tumor is removed, and the remaining kidney is preserved.

 

3. Radical Nephrectomy
Complete removal of the kidney, adrenal gland (if needed), and surrounding fat.

 

4. Thermal Ablation
Especially in high-risk surgical patients.

  1. Radiofrequency Ablation (RFA)
  2. Cryoablation

5. Systemic Therapy
Includes:

  • Targeted therapy 
  • Immunotherapy 
  • Combination therapy

PROSTATE CANCER

Cancer arising from the prostate gland, common in men over 50. Often silent in early stages, detected by:

  • PSA blood test
  • Digital rectal exam
  • MRI prostate

Risk Factors

  • Age
  • Family history
  • BRCA1/BRCA2 gene mutations
  • African ancestry

Diagnosis

  • MRI-guided biopsy
  • Transperineal biopsy (safer, lower infection risk)
  • PSA levels, Gleason score, staging scans

TREATMENT OPTIONS FOR PROSTATE CANCER

1. Active Surveillance

Avoids over treatment while monitoring for progression.

 

2. Robotic Radical Prostatectomy

Removal of prostate, seminal vesicles along with surrounding lymph nodes using robotic surgery.

 

3. Radiation Therapy

Two types:

  • External Beam Radiation Therapy (EBRT)
  • Brachytherapy (seed implantation)

4. Hormone Therapy (Androgen Deprivation Therapy – ADT)

Prostate cancer depends on male hormones (androgens).
ADT reduces testosterone production and slows cancer growth.

 

5. Chemotherapy

Used for metastatic or hormone-resistant prostate cancer (CRPC).

 

6. Advanced/Modern Therapies

  • PSMA-targeted radionuclide therapy
  • Next-generation hormone therapy 
  • PARP inhibitors for genetic mutation
  • Immunotherapy

BLADDER CANCER

Cancer arising from the inner lining of the bladder, often presenting with:
• Painless blood in urine
• Frequent urination
• Burning urination
Strongly associated with smoking and chemical exposure.

Types
• Non–muscle invasive bladder cancer (NMIBC)
• Muscle invasive bladder cancer (MIBC)
• Advanced/metastatic bladder cancer

TREATMENT OPTIONS FOR BLADDER CANCER

1. TURBT (Transurethral Resection of Bladder Tumor)

 

The tumor is shaved off internally using a telescope through urine passage. Used for both diagnosis and initial treatment.

2. Intravesical Therapy (BCG/chemotherapy into the bladder)

For non–muscle invasive cancer.

  • BCG Immunotherapy – strengthens the bladder’s immune response.
  • Mitomycin/ Gemcitabine + Docetaxel Intravesical chemotherapy.

3. Radical Cystectomy

Complete removal of bladder with urinary diversion.

Indications: 

  • Muscle-invasive cancer
  • Recurrent high-risk tumors

Urinary diversion options:

  • Ileal conduit
  • Neobladder (internal pouch)
  • Continent reservoir

4. Chemotherapy

Used for:

  • Locally advanced disease.
  • Pre-operative (neo-adjuvant) to shrink tumor.
  • Post-operative (adjuvant).

5. Immunotherapy / Targeted Therapy

 

Checkpoint inhibitors:

  • Pembrolizumab
  • Atezolizumab
  • Enfortumab vedotin

Used for advanced/metastatic disease or BCG-refractory cases

TESTICULAR CANCER

A highly curable cancer affecting young men (20–40 years). Usually presents as a painless swelling or lump in scrotum or abdomen.
Types

1. Seminoma
2. Non-seminomatous germ cell tumors (NSGCT)

Diagnosis

• Scrotal ultrasound
• Tumor markers: AFP, β-HCG, LDH
• CT scan for staging

TREATMENT OPTIONS FOR TESTICULAR CANCER

1. Radical Inguinal Orchidectomy

  • The testis is removed through the groin—not the scrotum—to avoid spread.

2. Chemotherapy

  • Highly effective, especially for NSGCT.
  • BEP regimen: Bleomycin, Etoposide, Cisplatin.

3. Radiotherapy

  • Used mainly for seminoma.

4. RPLND (Retroperitoneal Lymph Node Dissection)

  • Used in selected NSGCT cases. Particularly in patients with post.
  • Chemotherapy residue in nodal areas.
  • Can be done laparoscopically or robotically.

5. Fertility Preservation

  • Sperm banking recommended before chemotherapy / RPLND in selected patients.

PENILE CANCER

Rare cancer, but early recognition is critical.

Risk factors:

  • Poor hygiene
  • HPV infection
  • Chronic inflammation
  • Phimosis

TREATMENT OPTIONS FOR PENILE CANCER

1. Topical Treatments (early cases)

  • 5-FU or imiquimod creams for very early lesions.

2. Local Excision / Glans Surgery

  • Removal of only the affected part of the penis with reconstruction.

3. Partial or Total Penectomy

  • For larger or more advanced tumors removal of part or entire penis for cancer control.
  • Reconstructive options available for cosmetic and functional restoration.

4. Inguinal Lymph Node Dissection

  • If cancer has spread to groin nodes need to combine removal of nodes along with penectomy sentinel node biopsy must be used for early staging.

5. Radiotherapy/Chemotherapy

  • Used in advanced or unresectable cases.