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URO ONCOLOGY

KIDNEY CANCER

What is 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.

 

Benefits:

  1. Maximum kidney preservation
  2. Lower risk of long-term kidney disease
  3. Excellent cancer control


Approaches:

  • Robotic or laparoscopic (preferred)
  • Open surgery for complex cases.

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

Used for:

  • Large tumors
  • Centrally located tumors
  • Tumors not suitable for partial nephrectomy

Approaches:

  • Robotic
  • Laparoscopic
  • Open

4. Thermal Ablation
For small tumors, especially in high-risk surgical patients.

 

  1. Radiofrequency Ablation (RFA)
  2. Cryoablation

Performed with CT guidance through a needle.

 

5. Systemic Therapy
For advanced or metastatic disease.

Includes:

  • Targeted therapy (TKIs) like sunitinib, pazopanib
  • Immunotherapy (IO) with checkpoint inhibitors
  • Combination therapy (IO-IO or IO-TKI)

Often used after surgical removal or when surgery is not possible.

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

Symptoms (when present) may include urinary difficulty or blood in urine/semen.


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

For low-risk cancers.
Includes:- Periodic PSA- MRI- Repeat biopsy
Avoids over treatment while monitoring for progression.

 

2. Robotic Radical Prostatectomy

Removal of prostate, seminal vesicles along with surrounding lymph nodes using robotic surgery.
While preserving nerves suppling penis for erection as much as possible without compromising oncological outcomes.

 

Benefits:

  1. Better precision
  2. Minimal blood loss
  3. Faster recovery
  4. Early catheter removal
  5. Better continence and potency outcomes

3. Radiation Therapy

Two types:

  • External Beam Radiation Therapy (EBRT)
  • Brachytherapy (seed implantation)Used for patients not opting for surgery or with locally advanced disease.

4. Hormone Therapy (Androgen Deprivation Therapy – ADT)

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

 

Used for:

  • Locally advanced disease
  • Metastatic cancer
  • In combination with radiation

5. Chemotherapy

Used for metastatic or hormone-resistant prostate cancer (CRPC).
Common drugs: Docetaxel, Cabazitaxel.

 

6. Advanced/Modern Therapies

  • PSMA-targeted radionuclide therapy
  • Next-generation hormone therapy – abiraterone, enzalutamide
  • PARP inhibitors for genetic mutation–positive cancer
  • Immunotherapy in selected cases

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)

First and most important step.

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.

Reduces recurrence and progression of bladder cancer.

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

Minimally invasive surgery (Robotics) can be done for minimal blood loss, hospital stay without compromising oncological outcomes.

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.
Other symptoms include heaviness in testicle or dull ache.

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

First and essential step in treatment.

  • 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.

Common symptoms:

  • Non-healing ulcer
  • Persistent growth
  • Foul-smelling discharge
  • Swollen lymph nodes in the groin.

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.