Urologic cancers include cancers of the bladder, kidney, prostate and testicles, all relatively common. Prostate cancer, for example, is the most common cancer in American men. One out of every 10 men will develop the disease at some time in his life — most often after age 50.
Bladder cancer is the fourth most common cancer among men and the ninth most common among women in the United States. Each year, more than 50,000 new cases of bladder cancer are diagnosed.
Among American men age 15 to 44, testicular cancer is the most common. Denial and embarrassment contribute to making it one of the least mentioned cancers. The American Cancer Society estimates that about 6,900 cases of testicular cancer are diagnosed each year in the United States and about 300 men die from it annually.
Urologic cancers affect five main areas of the body: the bladder, prostate, testicles, kidneys and adrenal glands. Urologic cancers are among the most common cancers. The American Cancer Society (ACS) estimates that over 240,000 new cases of prostate cancer are diagnosed each year. For bladder cancer, ACS counts more than 69,000 new cases per year, meaning one in 26 men, and one in 86 women, will develop the condition in their lifetime.
Other than skin cancer, prostate cancer is the most commonly diagnosed cancer in men. In fact, it is estimated that more than 230,000 men will be diagnosed with prostate cancer this year alone. According to the Centers for Disease Control and Prevention (CDC), after lung cancer, prostate cancer is the leading cause of cancer death among American men. The good news, however, is that the current survival rate is 97 percent. On average, an American man has a 30 percent risk of having prostate cancer in his lifetime, but only a 3 percent risk of dying of the disease.
The other good news is that among all racial and ethnic groups, prostate cancer death rates are declining. Perhaps the most encouraging prostate cancer statistic is that more men die with prostate cancer than from prostate cancer. The reason could be twofold: prostate cancer typically affects men older than 65 and, it is often a slowly progressing disease.
For many men, a diagnosis of prostate cancer can be frightening not only because of the threat to their life, but because of the threat to their life style, particularly sexual function. The possible consequences of treatment, including bladder control problems and impotence, also known as erectile dysfunction, can be a greater worry for some men than the cancer itself. If prostate cancer is detected early — when it's still confined to the prostate — you have a better chance of successful treatment with minimal or short-term side effects.
Here are other some other significant prostate cancer statistics:
• Prostate cancer represents over 32 percent of all new cancer cases in American men.
• About 70 percent of prostate cancer diagnoses are made in men 65 years or older.
• Only about 25 percent of prostate cancer cases occur in men under 65.
• The average age at diagnosis is 72.
• One in six American men has a risk of developing prostate cancer at some time in his life. If a close relative has prostate cancer, his risk more than doubles.
• African-American men have the highest incidence of prostate cancer. The death rate for prostate cancer is more than double for African American men compared to Caucasian men.
• Asian men have a relatively low rate of prostate cancer compared to other ethnic groups.
Signs and Symptoms
Prostate cancer often doesn't produce any symptoms in the early stages. Symptoms that may indicate prostate cancer, and which should be followed up with a visit to the doctor, include:
• Frequent urination, especially at night
• Urgency in urinating
• Trouble starting your urine stream
• A weak or interrupted urine stream
• Pain or burning during urination
• A feeling that your bladder doesn't empty completely
• Blood in the urine
• A nagging pain in the back, hips or pelvis
Although these symptoms may indicate prostate cancer, they also can be caused by other conditions that are not cancer, such as benign prostatic hyperplasia (BPH). As men age, the prostate often enlarges and can press on and block the urethra and bladder, producing some of the symptoms described above. BPH can be successfully treated with medication or surger
Prostate Cancer Diagnosis
The two most commonly used methods for screening are the digital rectal exam and the prostate-specific antigen (PSA) test.
• Digital Rectal Examination (DRE) — During a digital rectal exam, a doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or abnormally firm areas in the prostate. Some, though not all, prostate cancers can be detected this way. The DRE also can be used to monitor the progress of treatment. • Prostate-Specific Antigen (PSA) Test — Prostate specific antigen (PSA) is a protein in the blood that is produced only by prostate cells. PSA reflects the volume of both benign and malignant prostate tissue. The higher the PSA level, the more likely it is that prostate cancer is present.
PSA test results are reported as nanograms per milliliter (ng/ml). Results less than 4.0 ng/ml usually are considered normal. Values over this are regarded as high. The average PSA level increases with age, so some values below 4.0 ng/ml for men younger than 60 should warrant a more thorough evaluation. Ask your doctor for acceptable values for your age.
The following tests may be used to make a definite diagnosis of prostate cancer:
• Biopsy — A biopsy is performed to obtain samples of prostate tissue, which are then examined by a pathologist, to make a formal diagnosis of prostate cancer. In most cases, a fine needle is inserted into the prostate to withdraw small samples of tissue. Local anesthesia is typically used.
• Bone Scan — This test shows if cancer has spread from the prostate to the bones. Low level radioactive material is injected into the body. If diseased bone cells are present, they will take up the radioactive material. This allows the location of diseased bone to be seen on the total body bone scan image. These areas may suggest that metastatic cancer is present, although arthritis and other bone diseases can create the same pattern.
Usually, a bone scan is ordered only if there are signs of aggressive disease such as a markedly elevated PSA level, a high Gleason score — a prostate cancer grading system — or a large tumor.
• Computed Tomography (CT) Scan — This test uses a rotating X-ray beam to create a series of pictures of the body from many angles that can be put together into a detailed cross-sectional image. This can help reveal abnormally enlarged pelvic lymph nodes, or spread of the cancer to other internal organs. A CT scan usually is ordered if there is a markedly elevated PSA, a high Gleason score — a prostate cancer grading system — or evidence of a large tumor.
• Magnetic Resonance Imaging (MRI) — Similar to a CT scan, this test uses magnetic fields instead of X-rays to create detailed images. These scans are less effective in revealing microscopic-sized cancers, although an MRI using a rectal coil is superior to a routine pelvic MRI. A modification of the MRI that is still considered experimental, called magnetic resonance spectroscopy imaging (MRSI), may provide more precise information on where the cancer is located in the prostate gland and the surrounding area.
• Transrectal Ultrasound (TRUS) Guided Biopsy — This test uses sound waves produced by a small probe placed in the rectum to create an image of the prostate on a video screen. The echoes from the waves are translated by a computer into a picture that can show the location of suspicious or abnormal areas of the prostate. An instrument called a biopsy gun quickly inserts and removes a narrow needle, obtaining small cores of tissue that are sent to the laboratory for examination. The entire prostate should be sampled since cancer may not be seen with the TRUS.
Prostate Cancer Treatment Your team of doctors will help you decide which prostate cancer treatment is the best, most effective option for you. Each treatment has its benefits, risks and impacts on quality of life. Several treatments are very successful in providing a cure or keeping the cancer under control for many years. Most men with prostate cancer are living testimony to this.
Some prostate cancers grow quickly and spread — or metastasize — to other parts of the body. If unchecked, these cancers can be fatal. Most prostate cancers, however, are slow growing and in many cases, immediate treatment isn't necessary. Many men take several months to decide what to do. The decision can be complicated. You should consider the pros and cons of the various treatments, get second opinions and decide what is best for you, all of which may take time.
The right treatment for you may depend on a number of factors including:
• Attitudes about cure and living with cancer
• General health and specific medical conditions
• Life expectancy
• Needs, concerns, values and social relationships
• Stage and grade of the cancer
Determining if your cancer is confined to the prostate is key in choosing a treatment. If the cancer is confined to the prostate, you may consider a localized treatment that attempts a cure. If the cancer has spread — to nearby lymph nodes or more distantly to bones or other organs — then the goal of treatment may be to control the cancer rather than cure it.
No matter which treatment or combination of treatments you and your doctor choose, your PSA should be monitored regularly. Here are some of the treatment options for prostate cancer:
Some prostate cancer patients don't pursue any active treatment and instead use a "watch and wait" approach, also known as active surveillance, which involves extensive monitoring. This may be recommended if the cancer is very small and confined to one area of the prostate; is expected to grow very slowly; or if the patient is elderly, frail or has other serious health problems. Since prostate cancer tends to grow very slowly, older men with the disease may never need treatment. Younger patients, or those with a life expectancy greater than 10 years, may need a more aggressive approach. The best candidates for this regimen are those with small, low grade cancers associated with low and stable PSA levels.
Some men, however, may decide that the side effects of more aggressive treatments outweigh the benefits and they turn to alternative therapies to slow cancer development. In these cases, close monitoring is critical so if the cancer develops into a more serious form, it is immediately detected.
More than 500 patients at the UCSF Prostate Cancer Center have chosen active surveillance. About one in five on active surveillance receive treatment two to three years after diagnosis, after a change is detected such as a rapidly rising PSA level or increased tumor size.
At UCSF, men on active surveillance have PSA levels checked every three to fourth months, prostate ultrasounds every six to nine months and prostate biopsies after one year of active surveillance, then again every one to two years.
Chemotherapy drugs are commonly used to treat many different cancers. They kill cancer cells directly, usually by disrupting the reproductive cycle of those cells. Chemotherapy usually is used with patients whose prostate cancer has metastasized outside the prostate and for whom hormone therapy has failed.
In the past, chemotherapy has shown only limited effectiveness in treating advanced prostate cancer. More recently, new developments in this approach — such as giving two or more drugs together, using newly developed chemotherapy agents, and combining chemotherapy with hormone therapy — have significantly improved treatment outcomes.
Cryosurgery, used to treat localized prostate cancer, kills the cancer cells in the prostate by freezing them. Probes containing liquid nitrogen are inserted into the prostate and maneuvered using ultrasound to destroy prostate tissue. This method has shown good results in treating cancer confined to the prostate, but is only offered at a limited number of medical centers around the country.
Some doctors believe that the entire prostate must be frozen, which impacts the nerve bundles on the sides of the gland. Impotence almost always results from cryosurgery when the entire gland is treated. Urinary incontinence also may occur. Some doctors are performing "nerve-sparing" cryotherapy, where only the cancerous area of the prostate is treated. This is often used for men who have failed other therapies, such as radiation therapy.
Prostate cancer cells usually require testosterone — the main male hormone or androgen — to grow. Lowering androgen levels with hormone therapy can stop or slow cancer growth. Hormone therapy may control the cancer, often for a number of years, but it is not a cure. Usually, the cancer will change over time into a form that no longer needs testosterone to grow, called androgen independent, at which point other treatments are considered.
Most prostate cancers are very responsive to hormone therapy when first diagnosed and it is usually recommended as the initial treatment for advanced cancers, including prostate cancers that have metastasized or spread. Hormone therapy does have significant side effects, such as a decrease in sexual desire and some level of erectile dysfunction. The decision to undergo this therapy should be considered carefully.
Intermittent Hormone Therapy
In this approach, also called intermittent androgen blockade, a patient is placed on hormone therapy for a period of some months to a year or more. After the patient's PSA level has dropped close to zero and remains at this level, the hormone therapy is stopped. When the PSA rises to a certain level following the return of testosterone production, the hormone therapy is resumed.
The length of time that a man can stay off treatment may range from several months to well over a year. The intermittent approach may reduce some of the side effects of hormone therapy, improve quality of life and allow some men to regain their sexual interest and potency during the off period.
This method is regarded as experimental. Studies are being conducted to compare its effectiveness with continuous hormone therapy and to determine if it delays androgen independence.
Radiation therapy uses high-energy rays and particles to kill cancer cells. The two main types are external beam radiation therapy (EBRT) and brachytherapy.
External Beam Radiation Therapy
Radiation, usually in the form of X-rays, is focused from a source outside the body onto the area affected by cancer. After imaging studies are done to locate the cancer, treatment is designed to guide where the radiation beams will be directed. Marks are placed on the patient's skin to help position the patient for treatment. Patients are treated five days per week over a period of seven to eight weeks, with each treatment lasting only a few minutes. Patients return home after each treatment and no hospital stay is required.
• 3-D Conformal Radiation Therapy — This is a state-of-the-art form of external beam radiation therapy that uses a sophisticated computer program to map the prostate gland more precisely and pinpoint radiation beams from up to six or seven different directions. An external mold cast keeps the patient still.
• This more accurate aiming from multiple sources reduces the radiation received by nearby tissues while concentrating the dose at the cancer site. A more advanced form of this therapy — intensity modulated radiation therapy (IMRT) — can vary the intensity of the radiation beams. Another improvement on this treatment involves placing gold seeds into the prostate to help increase the accuracy of the external beams.
• Intensity Modulated Radiation Therapy (IMRT) — This is the most advanced form of 3-D conformal radiation therapy, which adjusts the radiation beam to the contours of a tumor, allowing for higher, more effective doses of radiation while minimizing exposure to surrounding healthy tissue.
• Proton Beam Radiation Therapy — Presently available at only a few medical centers in the country, this advanced approach uses protons rather than X-rays. Studies have shown that proton beam therapy is effective in treating localized prostate cancer. However, the data are inconclusive as to whether proton therapy yields better outcomes than X-ray therapy.
• CyberKnife — One of the most advanced forms of radiosurgery, this is a painless, non-invasive therapy that delivers high doses of precisely targeted radiation to destroy tumors or lesions within the body. Radiosurgery minimizes radiation exposure to healthy tissue surrounding the tumor.
The CyberKnife uses a robotic arm to deliver highly focused beams of radiation. The flexibility of the robotic arm makes it possible to treat areas of the body, such as the spine and spinal cord, that can't be treated by other radiosurgery techniques. We are one of the few medical centers in California that offers this treatment. Brachytherapy
There are two forms of this treatment — permanent and temporary.
• Permanent Seed Implant (SI) — In this treatment, small radioactive pellets, often called "seeds," each about the size of a grain of rice, are implanted into the prostate. These seeds contain radioactive isotopes such as iodine 125 or palladium 103.
Seeds are permanently placed in the prostate and give off radiation for periods of weeks or months. This is done as an outpatient procedure. Imaging tests such as a transrectal ultrasound or an MRI are used to accurately guide the placement of the seeds into the prostate. The seeds are placed inside thin needles inserted through the skin of the perineum, the area between the scrotum and anus. • Temporary Seed Implant (SI) — In this approach, also called high-dose rate brachytherapy (HDR), the radioactive material, such as iridium, is placed in the inserted needles for relatively short periods of time and then withdrawn from the prostate. Two to three treatments administered over one to two days in a hospital is usually required.
A radical prostatectomy removes the entire prostate gland and some surrounding tissue. Usually, it is performed when the cancer has not spread far outside the gland. The surgery is done under general anesthesia, generally takes two to four hours and requires a hospital stay of one to two days. Prostatectomies have been performed successfully for many years. In the past, these procedures were regarded as the "gold standard" although other techniques have yielded similarly good results.
There is still no guarantee, however, that the cancer will not return. Some cancers are found to be more extensive or aggressive than believed before surgery, indicating a higher risk for cancer recurrence. The value of the procedure is that the primary tumor is removed and more accurate staging of the cancer can be done.
Here are the main types of radical prostatectomy:
• Laparoscopic — In this procedure, the prostate is removed through five very small (less than 1 centimeter) incisions using lighted, magnified scopes and cameras. The prostate is removed in a small bag through one of the incisions, which is expanded to 2 to 3 centimeters. Potential benefits of this procedure are less pain and earlier return to normal activities.
This procedure can be used as a nerve-sparing approach that can lower, but not completely eliminate the risk of impotence after surgery. In a nerve-sparing approach, the surgeon tries to preserve one or both of the small nerve bundles needed for unassisted erections. If cancer has spread to the nerves, nerve sparing may not be advised. Lymph nodes also can be removed for examination with laparoscopic surgery.
• Perineal — In this procedure, the prostate is removed through an incision in the skin between the scrotum and anus. The lymph nodes cannot be removed through this incision. If the lymph nodes need to be examined, they are removed through a small abdominal incision or by a laparoscopic procedure. Nerve sparing also can be performed perineally.
• Retropubic — In this procedure, an incision is made in the lower abdomen to remove the prostate as well as lymph nodes for examination. This procedure also can be used as a nerve-sparing approach.
• Robotic Radical Prostatectomy — This advanced laparoscopic procedure uses a robotic system, called the daVinci Surgical System that provides a magnified, 3-dimensional view during the operation and maintains surgeon dexterity through its robotic arms. At UCSF, the robotic system is used to perform radical prostatectomy.
New Treatments and Clinical Trials
Research has increased our overall understanding of prostate cancer and new treatments are being tested in patients. Clinical trials primarily involve patients who have rising PSAs after treatment or who have more advanced, metastatic cancers. A number of new agents may eventually provide more treatment options for new and recurring cancers. But at this time, none of them are regarded as cures, or even as replacements for surgery, radiation or hormone therapy.
Generally, patients being treated with these new approaches have experienced fewer side effects than patients receiving more traditional treatments.
Alternative and Complementary Therapies
Alternative and complementary therapies are treatments that fall outside conventional medicine in this country. Their effectiveness for treating cancer is, as yet, unproven. The field of alternative and complementary medicine is very broad and encompasses changes in diet and lifestyle, stress reduction, acupuncture, homeopathy and other approaches.
Tell your doctor if you are using any complementary or alternative therapies. Many of these therapies may benefit patients by helping them lead more healthy and active lives, reducing emotional stress associated with prostate cancer and its treatment, and reducing pain and discomfort. The main treatments include:
• Diet, Nutrition and Supplements — There is a broad consensus that diets high in fat, especially animal fat, increase the likelihood of developing prostate cancer. Some people believe that reducing the fat in your diet may slow cancer growth, but there is no agreement as to how much fat reduction is needed.
• Exercise — Being physically active is not only good for the body, it also relieves depression and promotes a sense of well-being. Exercise does not have to be aerobic or intense. Taking a walk for up to an hour three times a week can provide benefit.
• Stress Reduction — A wide array of activities can help reduce stress and anxiety. These include meditation, breathing exercises, visualization, relaxation exercises and massage. Classes and groups are available to teach these techniques. The Cancer Resource Center at the UCSF Helen Diller Family Comprehensive Cancer Center can provide information and resources.
• Asian Medicine — There is a growing interest in the treatment and meditative practices developed over hundreds of years in Asian countries, particularly China. Acupuncture has been shown effective in reducing pain and discomfort associated with medical conditions. Stylized movements and exercises such as tai chi, qigong and yoga can help people feel more balanced and at ease.
Traditional Chinese medicine uses herbal preparations to treat many disorders, including prostate cancer. Some of these treatments are being studied in the United States.
The prostate is a walnut-shaped gland found beneath the male bladder. Its job is to create a fluid that is a major component of semen. Cancer that begins in the prostate is the most common type of cancer in men. While prostate cancer is very treatable, it remains the second deadliest cancer in men. It must be detected and treated early for a good prognosis.
In the early stages, most types of prostate cancer grow slowly and tend to stay within the prostate. However, as the cancer develops, it can easily spread to the bones, lymph nodes, or other areas of the body. Rarer, more aggressive forms of prostate cancer are much quicker to grow and spread to new areas of the body. Early detection is vital: the most successful treatments for prostate cancer are begun before the cancer has spread.
Prostate cancer is strongly linked to older age, and is rarely found in men under 40. African-American men, who can develop prostate cancer at any age, are an exception. Other people at high risk for prostate cancer include:
Men over 60
Men with a father or brother with prostate cancer
Men who abuse alcohol
Men with a high-fat diet
Early forms of prostate cancer often do not cause symptoms, underscoring the importance of screening with digital rectal exams and PSA tests in those with risk factors. Late-stage symptoms may include:
Bloody urine or semen
Dribbling or leaking urine
Urination that is slow to start
Straining to urinate
Inability to pass all of the urine within the bladder
Lower back or pelvic bone pain (often a sign that prostate cancer has spread)
Prostate cancer is found in the prostate gland, which is a walnut-shaped gland that produces prostate fluid (which is a part of semen). It is one of the most common types of cancer in men, and it is usually quite treatable. There are screenings for prostate cancer, but not all doctors recommend those screenings for all men.
Prostate Cancer Genetics
The majority of cases of prostate cancer are sporadic, which means that one person in the family developed prostate cancer by chance at a typical age of onset. In these cases, other male relatives have little to no increased risk of developing prostate cancer.
Signs and symptoms of prostate cancer
Not all people with prostate cancer will have symptoms, at least not symptoms that are noticeable. However, as the cancer grows, it may cause signs and symptoms, such as:
• Trouble with urination (difficulty starting to urinate or difficulty holding urine back)
• Weak urine stream or interruption of stream
• Pelvic discomfort
• Bone pain
• Erectile dysfunction (ED)
• Painful urination or ejaculation
• Blood in the urine
• Blood in the semen
Diagnosing prostate cancer
Prostate cancer screening is a controversial issue, so recommendations vary among doctors. Ask your doctor if prostate cancer screening is right for you, and if it is, when you should start screening. Screening tests include digital rectal exam (DRE) and prostate-specific antigen (PSA) test. A digital rectal exam involves your doctor inserting a finger into your rectum to feel for abnormal texture, size and shape of your prostate gland. The PSA test is a blood test that looks for higher-than-normal prostate-specific antigen in your blood, which may indicate cancer. An elevated PSA can also be a sign of non-cancerous conditions, like infection, inflammation or enlargement of the prostate.
If you have an abnormal DRE or PSA test, your doctor will likely recommend additional testing. Other diagnostic tests for prostate cancer include:
Transrectal ultrasound (an ultrasound of your prostate)
Prostate biopsy (removing and analyzing a sample of cells from your prostate)
If your prostate biopsy indicates cancer, the lab will test your prostate tissue samples to see if they act like cancer cells. If you are diagnosed with prostate cancer, your doctor may order additional tests to find out how advanced your cancer is. This is called staging. Some of the tests that may be involved in staging are:
Computerized tomography scan (CT scan)
Magnetic resonance imaging (MRI)
Positron emission tomography scan (PET scan)
About 50,000 people in the United States are diagnosed with kidney cancer every year. The kidneys are a pair of kidney bean-shaped organs, located above the waist on either side of the spine, that filter and clean blood and produce urine.
The most common adult kidney cancer is renal cell carcinoma, which forms in the lining of small tubes in the kidney. Children usually develop a different form of kidney cancer called Wilms' tumor.
Kidney Cancer Signs and Symptoms
In its early stages, kidney cancer usually causes no obvious signs or troublesome symptoms. As a kidney tumor grows, symptoms may occur. These may include:
Blood in the urine. In some cases, blood is visible. In other instances, traces of blood are detected in a urinalysis, a lab test often performed as part of a regular medical checkup.
A lump or mass in the kidney area.
Other less common symptoms may include:
• Loss of appetite
• Weight loss
• Recurrent fevers
• Pain in the side that doesn't go away
• General feeling of poor health
• High blood pressure or a lower than normal number of red cells in the blood (anemia) may also signal a kidney tumor. These symptoms occur less often.
Kidney Cancer Diagnosis
To find the cause of symptoms, your doctor may ask about your medical history and perform a physical exam. In addition to checking for general signs of health, your doctor may perform blood and urine tests. Your doctor also may carefully feel the abdomen for lumps or irregular masses.
Other tests that produce pictures of the kidneys and nearby organs are often recommended. These pictures can often show changes in the kidney and surrounding tissue. For example, an intravenous pyelogram (IVP) is a series of X-rays of the kidneys, ureters, and bladder after the injection of a dye into the veins. The pictures produced can show changes in the shape of these organs.
Another test, arteriography, is a series of X-rays of the blood vessels. Dye is injected into a large blood vessel through a catheter. X-rays show the dye as it moves through the network of smaller blood vessels in and around the kidney.
Kidney cancer, however, is most commonly detected with either computed tomography (CT) scan, ultrasound or magnetic resonance imaging (MRI).
• Abdominal Ultrasound — Sound waves, called ultrasound, that cannot be heard by humans, are sent into the abdomen. The waves bounce off the kidneys and a computer uses the echoes to create a picture called a sonogram.
• Computed Tomography (CT) Scan — A series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an X-ray machine. This also is called computerized tomography and computerized axial tomography (CAT) scan.
• Magnetic Resonance Imaging (MRI) — A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body.
Kidney Cancer Treatment
Treatment for kidney cancer depends on the stage of the disease, the patient's general health and age, and other factors. Our doctors develop a treatment plan to fit each patient's needs.
At UCSF Medical Center, patients with kidney cancer often are treated by a team of specialists, including urologists, oncologists and radiation oncologists. Kidney cancer usually is treated with surgery or biological therapy, also called immunotherapy. Doctors may decide to use one treatment method or a combination of methods.
Surgery is the most common treatment for kidney cancer. An operation to remove the kidney is called a nephrectomy. Most often, the surgeon removes the whole kidney along with the adrenal gland and the tissue around the kidney. Some lymph nodes in the area also may be removed. This procedure is called a radical nephrectomy. Very often, the surgeon is able to remove just the part of the kidney that contains the tumor. This procedure, called a partial nephrectomy, is best suited for patients with small tumors or tumors on the edge of the kidney.
Radiation therapy, also called radiotherapy, uses high-energy rays to kill cancer cells. Doctors sometimes use radiation therapy to relieve pain (palliative therapy) when kidney cancer has spread to the bone.
Radiation therapy for kidney cancer involves external radiation, which comes from radioactive material outside the body. A machine aims the rays at a specific area of the body. Most often, treatment is given on an outpatient basis in a hospital or clinic five days a week for several weeks. This schedule helps protect normal tissue by spreading out the total dose of radiation. You don't need to stay in the hospital for radiation therapy, and you're not radioactive during or after treatment.
Biological therapy, also called immunotherapy, is a form of treatment that uses the body's natural ability or immune system, to fight cancer. Interleukin-2 and interferon are types of biological therapy used to treat advanced kidney cancer.
Clinical trials continue to examine better ways to use biological therapy while reducing the side effects patients may experience. Many people receiving biological therapy stay in the hospital during treatment so that these side effects can be monitored.
Chemotherapy is the use of drugs to kill cancer cells. Although useful in the treatment of many other cancers, chemotherapy has shown only limited effectiveness against kidney cancer. Researchers continue to study new drugs and new drug combinations that may prove to be more useful.
Hormone therapy is used in a small number of patients with advanced kidney cancer. Some kidney cancers may be treated with hormones to try to control the growth of cancer cells. More often, it is used as palliative therapy or therapy to relieve pain.
The most common form of kidney cancer in adults is called renal cell carcinoma. This is a type of cancer that forms in the lining of the tiny tubes within the kidneys. Other types of kidney cancers include:
Transitional cell carcinoma
Wilms' tumors (a pediatric form of kidney cancer)
About 50,000 new cases of kidney cancer are diagnosed each year in the United States. It is most likely to appear in men between the ages of 50 to 70.
It is not clear what causes kidney cancer, but physicians know that certain risk factors can increase the likelihood of developing kidney cancer, including:
High blood pressure
Undergoing dialysis treatment
Von Hippel-Lindau disease
Polycystic kidney disease
Family history of kidney cancer
Having a horseshoe-shaped kidney
The most common symptoms of kidney cancer are:
Blood in the urine
Back and side pain
Unexplained weight loss
Swelling and pain in the abdomen
Swelling of the testicular veins
Kidney cancer is cancer of the kidneys. Renal cell carcinoma is the most common type of kidney cancer in adults.
Symptoms of kidney cancer
Signs and symptoms of kidney cancer can be similar to symptoms of kidney infection, but the following symptoms and signs should always be checked out:
• Blood in the urine (discolored urine that is pink, red or brown-ish may be a sign of blood)
• Continuous back pain just below the ribs
• Weight loss
• Fever (which may come and go)
Diagnosing kidney cancer
Tests to diagnose kidney cancer are similar to tests used to diagnose other urological cancers. The most common tests used to diagnose kidney cancer are:
Imaging tests, such as
--- Computerized tomography scan (CT scan)
--- Magnetic resonance imaging (MRI)
Biopsy of kidney tissue
The wall of the bladder is lined with cells called transitional cells and squamous cells. More than 90 percent of bladder cancers begin in the transitional cells. This type of bladder cancer is called transitional cell carcinoma. About 8 percent of bladder cancer patients have squamous cell carcinomas.
Cancer only in cells in the lining of the bladder is called superficial bladder cancer. This type of bladder cancer often comes back after treatment, but it does not tend to progress. If the tumor recurs, the disease often recurs as another superficial cancer in the bladder. Cancer that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder. This is known as invasive cancer. Invasive cancer may extend through the bladder wall. It may grow into a nearby organ such as the uterus or vagina in women or the prostate gland in men. It also may spread to other parts of the body.
When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, cancer cells may have spread to other lymph nodes or other organs, such as the lungs, liver or bones.
When cancer spreads or metastasizes from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if bladder cancer spreads to the lungs, the cancer cells in the lungs are actually bladder cancer cells. The disease is metastatic bladder cancer, not lung cancer. It is treated as bladder cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.
Fortunately, the majority of bladder cancers do not grow rapidly and can be treated without major surgery. Thus, most patients with bladder cancer are not at risk of developing a cancer that will spread and become life threatening. Early detection is vital; it allows the prompt treatment that gives patients the best chance for a favorable outlook.
Signs and Symptoms
Common symptoms of bladder cancer include:
• Blood in the urine, making the urine slightly rusty to deep red
• Pain during urination
• Frequent urination, or feeling the need to urinate without result
These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones or other problems also can cause these symptoms.
Bladder Cancer Diagnosis
If a patient has symptoms that suggest bladder cancer, the doctor may check general signs of health and may order lab tests. The person may have one or more of the following procedures:
• Physical exam — The doctor feels the abdomen and pelvis for tumors. The physical exam may include a rectal or vaginal exam.
• Urine tests — The laboratory checks the urine for blood, cancer cells and other signs of disease.
• Intravenous Pyelogram — The doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder show up on X-rays.
• Cystoscopy — The doctor uses a thin, lighted tube, called a cystoscope, to look directly into the bladder. The doctor inserts the cystoscope into the bladder through the urethra to examine the lining of the bladder. The patient usually does not need anesthesia for this procedure.
Bladder Cancer Treatment
People with bladder cancer have many treatment options, including surgery, radiation therapy, chemotherapy or biological therapy. Some patients may receive a combination of therapies.
Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and grade of the tumor. Your doctor can explain each type of surgery and discuss which is most suitable for you.
• Transurethral resection — The doctor may treat early or superficial bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and burn away any remaining cancer cells with an electric current, called fulguration. You may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy. (See below.)
• Radical cystectomy — For invasive bladder cancer, the most common type of surgery is radical cystectomy. Your doctor also may choose this type of surgery when superficial cancer involves a large part of the bladder.
Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes and part of the vagina are removed.
• Segmental cystectomy — In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a low-grade cancer that has invaded the bladder wall in just one area.
Radiation therapy, also called radiotherapy, uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area. A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.
Doctors use external radiation therapy to treat bladder cancer. A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated five days a week for five to seven weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation.
Chemotherapy uses drugs to kill cancer cells. Your doctor may use one drug or a combination of drugs.
If you have superficial bladder cancer, your doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. A tube or catheter is inserted through the urethra and puts liquid drugs in the bladder. The drugs remain in the bladder for several hours. They mainly affect cells in the bladder. Usually, patients have this treatment once a week for several weeks. Sometimes, treatments continue once or several times a month for up to a year.
If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, your doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period.
You may have chemotherapy alone or combined with surgery, radiation therapy or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic or at your doctor's office. Depending on which drugs are given and your general health, you may need a short hospital stay.
Biological therapy, also called immunotherapy, uses the body's natural ability or immune system to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. Drugs are delivered directly into the bladder using a catheter. This helps prevent the cancer from coming back.
Most bladder cancers progress very slowly and are unlikely to spread to other areas of the body. Regardless, early detection remains critical as bladder cancer has the potential, though rare, to become life-threatening.
More than 90% of bladder cancer cases in the United States are referred to as transitional cell carcinomas. Transitional cell carcinomas begin in the transitional cells of the bladder wall. These cells are on the innermost layer of the wall.
Most cases of transitional cell carcinoma are superficial in nature. Superficial bladder cancer only affects the cellular lining of the bladder. This type of cancer does not tend to progress to a life-threatening form. Still, it often returns quickly after treatment. It usually reoccurs as a second case of superficial cancer, though it has been observed growing past the lining and into the muscles of the bladder.
Much rarer, squamous cell carcinoma is a type of bladder cancer that begins in the squamous cells, which appear in a healthy bladder in response to inflammation and infection. Also rare, adenocarcinoma is a bladder cancer that begins in the cells within the bladder’s mucus-secreting glands.
Cancer that grows past the bladder lining is called invasive bladder cancer. Most cases of squamous cell carcinoma and adenocarcinoma are invasive. They are particularly dangerous because they can spread to other parts of the body, including the prostate in men and the uterus in women. If invasive bladder cancer reaches the lymph nodes, it can spread to the liver or lungs.
All forms of bladder cancer have distinguishing signs and symptoms, such as:
Frequent need to urinate
Inability to urinate despite feeling the need to
Bladder cancer is cancer that affects the bladder. It most often occurs in older adults, but anyone can get bladder cancer. The most common place for bladder cancer to develop is in the cells that line the bladder. Fortunately, most bladder cancer is found early because it tends to cause blood in the urine. When it is found early, it is highly treatable.
Bladder cancer occurs when there are abnormal, cancerous cells growing in the bladder. According to the American Cancer Society (ACS), about 74,000 cases of bladder will be diagnosed in the US in 2015.
Bladder cancer affects men four times more often than women, and it occurs in Caucasians twice as often as in African-Americans. The risk of bladder cancer increases with age - over 70 percent of people who are diagnosed with it are older than 65.
The bladder is a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.
There are several types of bladder cancers, including the following:
Transitional cell (urothelial) carcinoma
Transitional cell carcinoma is cancer that begins in the cells lining the bladder. Transitional cells also line the other parts of the urinary tract including the kidneys, ureters, and urethra. Transitional cell carcinoma is the most common kind of bladder cancer, occurring in about 90 percent of cases.
Squamous cell carcinoma
Squamous cell carcinoma is cancer that begins in squamous cells - thin, flat cells found in the tissue that form the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. About 4 percent of bladder cancers are squamous cell carcinomas.
Adenocarcinoma is cancer that begins in the cells of glandular structures lining certain organs in the body and then spreads to the bladder. Common primary sites for adenocarcinomas include the lung, pancreas, breast, prostate, stomach, liver, and colon. Adenocarcinomas account for only about 2 percent of bladder cancers.
Symptoms of bladder cancer
• Blood in the urine - Bladder cancer can often be detected early, as it tends to cause blood in the urine (known as hematuria). That blood can cause the urine to change color.
• Changes in urination habits - Having pain or burning during urination, urinating more often than usual and having a strong urge to urinate even when your bladder isn't full can all be signs of bladder cancer. (These are also signs of other conditions, including urinary tract infections. If you have changes in urination habits, contact your doctor.)
• Inability to urinate
• Lower back pain, especially on one side
• Loss of appetite
• Weight loss
• Swelling in the feet (edema)
• Bone pain
Diagnosing bladder cancer
If your doctor suspects you have bladder cancer, he or she may recommend tests to confirm or rule out cancer. Those tests may include:
Physical exam of the bladder, which can be done through the rectum or vagina
Urinalysis to check for blood in the urine
Lab tests, such as Urine cytology, Urine culture, Urine tumor marker test
Biopsy of the bladder
Imaging tests: Ultrasound, Bone scan, Computerized tomography scan (CT scan), Magnetic resonance imaging (MRI)
Intravenous pyelogram (IVP) or intravenous urogram (IVU)
When detected early, testicular cancer is highly treatable and usually curable, which is why early diagnosis and treatment are so important for men of all ages. Adolescent boys and young men should be particularly aware of the signs and symptoms of the disease and perform regular testicular self-exams.
Testicular cancer is a disease in which cells become malignant, meaning cancerous, in one or both of the testicles. Testicular cancer can be broadly classified into two types: seminoma and nonseminoma. Seminomas make up about 40 percent of all testicular cancers. Nonseminomas are a group of cancers that include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. A testicular cancer may have a combination of both types.
Signs and Symptoms
Most men can detect their own testicular cancers. Doctors generally examine the testicles during routine physical exams. Between regular checkups, if you notice anything unusual about your testicles, you should talk with your doctor.
Common symptoms include:
• A painless lump or swelling in either testicle • Any enlargement of a testicle or change in the way it feels • A feeling of heaviness in the scrotum • A dull ache in the lower abdomen or the groin • A sudden collection of fluid in the scrotum • Pain or discomfort in a testicle or in the scrotum
Testicular Cancer Diagnosis
To help find the cause of symptoms, the doctor will evaluate your general health. Your doctor will perform a physical exam and may order laboratory and diagnostic tests. If a tumor is suspected, your doctor will probably recommend an ultrasound. If a tumor is detected, the testicle is removed.
• Blood tests — Measures the levels of tumor markers. Tumor markers are substances often found in higher-than-normal amounts when cancer is present. Tumor markers for testicular cancer involve beta human chorionic gonadotropin hormone (B-hCG); alpha-fetoprotein, a blood protein that's present in adults with some forms of cancer; and lactate dehydrogenase (LDH), a protein that can be elevated by cancer.
• Ultrasound — A diagnostic test in which high-frequency sound waves are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. Ultrasound of the scrotum can show the presence and size of a mass in the testicle. It is also helpful in ruling out other conditions, such as swelling due to infection.
• Biopsy — If a testicular tumor is suspected based on physical examination, blood tests and ultrasound, the testicle is removed. In nearly all cases of suspected cancer, the entire affected testicle is removed through an incision in the groin. This procedure is called inguinal orchiectomy.
In rare cases, for example, when a man has only one testicle, the surgeon performs an inguinal biopsy, removing a sample of tissue from the testicle through an incision in the groin and proceeding with orchiectomy only if the pathologist finds cancer cells. (The surgeon does not cut through the scrotum to remove tissue, because if the problem is cancer, this procedure could cause the disease to spread.)
Testicular Cancer Treatment
Four treatments commonly used for testicular cancer are surgery, radiation therapy, chemotherapy and bone marrow transplant.
Surgery is a common treatment for most stages of cancer of the testicle. A doctor may take out the cancer by removing one or both testicles through an incision (cut) in the groin. This is called a radical inguinal orchiectomy. Some of the lymph nodes in the abdomen may also be removed in a procedure called a lymph node dissection.
Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation usually is emitted by a machine and is called external-beam radiation, rather than radiation emitted by a substance consumed by the patient.
Chemotherapy uses drugs to kill cancer cells. It may be taken by pill, or injected into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body and can kill cancer cells outside the testicle.
Bone Marrow Transplantation
Bone marrow transplantation is a newer type of treatment. In an autologous bone marrow transplant, bone marrow is taken from the patient and treated with drugs to kill cancer cells. The marrow is then frozen. The patient is given high-dose chemotherapy — with or without radiation therapy — to destroy the remaining marrow. The marrow removed from the patient is then thawed and returned to the patient by injection in a vein to replace the marrow that was destroyed.
The testes are the male reproductive glands located below the penis inside the scrotum. The testes produce sperm. Testicular cancer begins in the testes (most often in just one) and can spread to other areas of the body. It is the most common form of cancer in men ages 15 to 35, though in rare cases is can occur in young boys or older men. Caucasian men are more likely to develop testicular cancer than African-American men.
The two main forms of testicular cancer occur in the "germ cells," or the cells that produce the sperm. Seminomas are slow-growing germ cell cancers found in men in their 30s and 40s. Seminomas usually do not spread beyond the testes and are very responsive to radiation therapy.
Nonseminonas are the more common type of testicular germ cell cancer. These tumors grow quickly and are composed of many different types of cells.
It is not understood exactly why testicular cancer occurs, but several factors are known to increase the risk of developing the condition, including:
Family history of testicular cancer
Abnormal development of the testicles
History of an undescended testicle
Testicular cancer may or may not present any symptoms. When it does, symptoms may include:
Pain in the back or lower abdomen
Heavy feeling in the scrotum
Pain or discomfort in the testicles
Enlarged, lumpy or swollen testicles
Development of excessive male breast tissue
Testicular cancer is cancer that develops in one or both testicles. Most often, it is confined to one testicle. This type of cancer is more common in younger men, but it can occur at any age. Testicular cancer is a highly treatable cancer that can usually be cured. Men are encouraged to perform testicular self-exams every month to check for lumps or changes in the testicles.
There are nearly 140,000 survivors of testicular cancer in the United States.
When testicular cancer spreads, the cancer cells are carried by blood or by lymph, an almost colorless fluid produced by tissues all over the body. The fluid passes through lymph nodes, which filter out bacteria and other abnormal substances such as cancer cells. The exact cause of testicular cancer is not known. However, there are a number of factors that increase the risk for the disease.
The exact cause of this disease is unknown. However, research does show that some men are more likely than others to develop testicular cancer. Possible risk factors include the following:
age - testicular cancer is the most common form of cancer in young men between the ages of 20 and 54
cryptorchidism - undescended testicle(s) is the main risk factor for this cancer
Klinefelter's syndrome - a sex chromosome disorder
personal history of cancer in the other testicle
race and ethnicity - the rate of testicular cancer is higher in Caucasians than in other populations
men whose mother took a hormone called DES (diethylstilbestrol) during pregnancy to prevent miscarriage
Signs and symptoms of testicular cancer
Most of the time, testicular cancer only affects one testicle. The signs and symptoms may include:
• A lump in the testicle
• An enlarged testicle
• A heavy feeling in the scrotum
• Pain in a testicle or the scrotum
• An achy feeling in the groin or lower abdomen
Diagnosing testicular cancer
Testicular cancer is often found during a routine self-exam of the testicles or through unintentional finding of a lump in a testicle. If you or your doctor find a lump in one of your testicles, you will likely need to have additional tests to determine whether you have cancer. Those tests may include:
Ultrasound of the scrotum and testicles
Blood tests for tumor markers
If the test results reveal that you may have cancer, your doctor may recommend that you have surgery to remove the affected testicle. This is called a radical inguinal orchiectomy. Once the testicle is removed, it will be analyzed in a lab to find out whether the growth is cancer, and if it is cancer, how advanced it is.
If you do have cancer, additional tests will be required to find out whether the cancer has spread. Those tests will likely include:
Computerized tomography scan (CT scan)
Additional blood tests for tumor markers
Penile cancer is found on the skin or within the tissues of the penis. Most penile cancers are squamous cell cancers that are found on the foreskin or the glans (head) of the penis. When penile is found early, it is usually curable.
Penile cancer, otherwise known as cancer of the penis, is cancer that affects the skin and tissue of the penis. In the United States, penile cancer is very rare. Less than one man in 100,000 will get penile cancer. According to the American Cancer Society, each year in the U.S., about 1640 men will be diagnosed with penile cancer and 320 men will die from it. Prostate cancer, which is the most common cancer in men, will be diagnosed in 233,000 men each year, and 29,480 will die from it.
There are five main types of penile cancer. The types are:
• Squamous cell carcinoma is the most common type of penile cancer. About 95 percent of all cancers of the penis develop from squamous cells, which are flat skin cells. Cancer that develops from squamous cells is called squamous cell carcinoma. Squamous cell cancers tend to grow slowly, and they can usually be cured if they are found early.
Carcinoma in situ, or CIS, is the earliest stage of squamous cell penile cancer. With CIS, cancer is only found in the top layers of the skin on the penis.
• Melanoma is a type of skin cancer that can sometimes affect the skin on the penis. It can grow and spread quickly, which makes it especially dangerous. Melanoma is an uncommon type of cancer of the penis, making up less than 2 percent of all penile cancer.
• Basal cell cancer of the penis is rare, making up less than 2 percent of all cases of penile cancer. It affects the basal cells, which are found in the deepest layers of the skin.
• Adenocarcinoma, otherwise known as Paget disease of the penis, is a very rare form of penile cancer that can develop from sweat glands in the penis. Adenocarcinoma can look very much like carcinoma in situ of the penis, so it may be difficult to diagnose.
• Sarcoma is another rare type of penile cancer that develops from the blood vessels, smooth muscle or connective tissue cells of the penis. It is considered a soft tissue cancer. Sarcomas tend to grow more quickly than other types of cancer.
What causes penile cancer?
The exact cause of penile cancer is not known, however, many risk factors for getting penile cancer are known. A risk factor is something that increases a person’s chance of getting a disease. Some risk factors for penile cancer are:
• HPV infection (human papilloma virus infection) – HPV is a virus. There are many strains of HPV. Some strains cause genital warts and others can cause cancer, including penile cancer. HPV is considered a sexually transmitted virus, as most people contract it through contact with infected sex organs.
• Not being circumcised – Uncircumcised men have a higher risk of getting penile cancer. To reduce the risk, make sure you clean underneath the foreskin to reduce the risk of infection, smegma and phimosis.
• Phimosis – Phimosis is a condition that makes it difficult to retract the foreskin of the penis. When the foreskin cannot be easily retracted, it’s difficult to clean properly underneath it, which can lead to problems. Phimosis may be preventable by retracting the foreskin and cleaning underneath it regularly.
• Smegma – This is a foul-smelling, thick substance that can develop when oily secretions, dead skin cells and bacteria build up under the foreskin of the penis. Retracting the foreskin and cleaning thoroughly underneath it can help reduce the risk of smegma, which may also reduce the risk of penile cancer.
• Smoking –Smoking can put people at risk for many types of cancer, not just lung cancer. Smokers or former smokers who are also infected with HPV have an even higher risk of getting penile cancer than someone who has either risk factor individually.
• AIDS – Men who have AIDS are at higher risk of penile cancer, most likely due to their decreased immune response.
• UV light treatment for psoriasis – A skin disease called psoriasis is sometimes treated with PUVA therapy, which involves taking the drug psoralens and following up with exposure to ultraviolet A (UVA) light. To reduce the risk of penile cancer, men who undergo this type of therapy should cover their genitals during treatment.
• Age – More than half of the men who develop penile cancer are over the age of 68.
Signs and symptoms of penile cancer
• Change in the skin on the penis, such as color change, change in thickness, a sore or lump, and new tissue build up
• A rash or flat growths that can bed reddish, velvety, crusty or blueish-brown
• Discharge or drainage from the penis that may be accompanied by a foul smell
• Swelling near the tip of the penis
• Swollen lymph nodes in the groin
Diagnosing penile cancer
If your doctor suspects you have penile cancer, he or she will recommend tests to determine whether you do have cancer. Those tests may include:
• Physical exam, focusing on the penis
Incisional biopsy, which removes only part of the growth or lesion
Excisional biopsy, which removes all of the growth or lesion
CT-guided fine needle biopsies
Lymph node biopsy, which is most often done if cancer has invaded deep into the penis; it can be done by fine needle aspiration of the lymph nodes or by surgically removing an entire lymph node or nodes
• Imaging tests
Computerized tomography scan (CT scan)
Magnetic resonance imaging (MRI)
The adrenal glands sit atop both kidneys. They secrete hormones to assist kidney function and control the body's response to stress. Cancer of the adrenal glands is relatively rare, with about 300 to 500 cases occurring in the United States each year. When it does occur, adrenal cancer is most likely to be found in women over the age of 45.
The body has two adrenal glands, one above each kidney. Each adrenal gland is made of two parts: the cortex and the medulla. Tumors can develop in either area.
Cortical tumors begin in the cortex and exist in two forms: benign adenomas and adrenal cortical carcinomas.
Benign adenomas are the most common type of cortical tumor. They are small noncancerous tumors usually less than two inches across. They usually occur in a single adrenal gland, though they can occur in both. Benign adenomas generally do not cause any symptoms, but if they cause excess hormones to be produced, symptoms may be similar to those caused by adrenal cortical carcinoma — the cancerous form of a cortical tumor.
Adrenal cortical carcinomas are larger than benign adenomas. The can grow so large that they press on nearby organs, causing an array of symptoms. When adrenal cortical cancer interrupts hormone production, the symptoms may include:
Excess body or facial hair in women
Buildup of fluids
The other part of the adrenal gland is called the medulla. Two main types of tumors arise here: neuroblastomas, an aggressive form of pediatric cancer, and pheochromocytomas, typically benign growths that increase the adrenal gland's hormonal output.
The risk factors for developing adrenal cancer are:
Certain genetic conditions, including:
Multiple endocrine neoplasia
Familial adenomatous polyposis
Wilms' tumor is a type of childhood cancer that occurs in the kidneys. The kidneys are a pair of kidney bean-shaped organs, located above the waist on either side of the spine, that filter and clean blood and produce urine.
Wilms' tumor also is called nephroblastoma, for nephro, meaning kidney, blast, meaning primitive cell and oma, meaning tumor. It is the fifth most common childhood cancer and one of the most common tumors of the abdomen in children. About 400 children in the United States are diagnosed with Wilms' tumor each year. The disease, which affects boys and girls equally, can occur at any age between infancy and 15 years, although it's usually diagnosed by age 3.
Typically it occurs in one kidney but occasionally involves both. If the cancer spreads, it usually spreads to the lungs and liver. With treatment, many children can have a good prognosis for recovery.
Generally, the condition causes a painless swelling in the abdomen and is discovered while bathing, dressing or changing the diapers of your child. Some children may have bloody urine, abdominal pain, loss of appetite, fatigue or weight loss.
If a tumor is suspected in your child's abdomen, don't apply pressure to this area. Careful bathing and handling of your child is important before and during any tumor evaluation. If the tumor ruptures, cancer cells could spread to other tissues of the body.
Signs and Symptoms
Children with Wilms' tumor may experience many different symptoms. The following, however, are the most common:
• Mass or lump, which causes no tenderness, in the abdomen
• Pain in the abdomen from pressure on other organs near the tumor
• Swelling of the abdomen
• Veins that appear distended or large across the abdomen
• Blood in the urine
• Decreased appetite
• High blood pressure
• Weakness or tiredness
Wilms' Tumor Diagnosis
Your child's doctor will conduct a complete medical history and physical examination. Diagnostic procedures may include:
• Abdominal Computed Tomography (CT or CAT) Scan — This is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images, both horizontally and vertically, of the body. These images, often called slices, are more detailed than X-rays. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs.
• Abdominal Ultrasound — This is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. It can provide an outline of the kidneys and tumor as well as identify problems in the renal or other major veins in the abdomen. It also can determine if there are any lesions or tumors in a kidney.
• Blood and Urine Tests — These tests are used to evaluate kidney and liver function.
• Chest X-ray — This diagnostic test uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film. A chest X-ray can determine if there are metastases or cancer that has spread in the lungs.
• Magnetic Resonance Imaging (MRI) — This diagnostic procedure uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. MRI can determine if there are metastases or cancer that has spread, any tumor cells in the lymph nodes and if any other organs are involved. Wilm's tumors can compress other organs in the area, affecting their function.
• Surgery — Surgical removal of the tumor and kidney may be necessary for a definitive diagnosis and to determine the extent of the disease.
Categories of Wilms' Tumor
In the diagnosis of Wilms' tumor, the appearance of cancer cells under a microscope is very important. Wilms' tumors generally are categorized by five stages as well as recurrent disease. The categories are as follows:
• Stage I — Cancer is found only in the kidney and can be completely removed by surgery.
• Stage II — Cancer has spread to areas near the kidney, such as to fat or soft tissue, to blood vessels or to the renal sinus, a large part of the kidney through which blood and fluid enter and exit the kidney. The cancer can be completely removed by surgery.
• Stage III — Cancer has spread to areas near the kidney and cannot be completely removed by surgery. The cancer may have spread to important blood vessels or organs near the kidney. It also may have spread throughout the abdomen, making it difficult to remove all cancer. Cancer may have spread to lymph nodes — the small bean-shaped structures found throughout the body that produce and store infection-fighting cells — near the kidney.
• Stage IV — Cancer has spread to organs further away from the kidney, such as the lungs, liver, bone and brain.
• Stage V — Cancer cells are found in both kidneys.
• Recurrent — Recurrent disease means that the cancer has come back or recurred after it has been treated. It may come back where it started or in another part of the body.
Wilms' Tumor Treatment
Surgery, chemotherapy and radiation therapy are common treatments for Wilms' Tumor, depending on the stage of the cancer and the condition of your child.
Surgery is a common treatment for Wilms' tumor. Your child's doctor may take out the cancer using one of the following:
• Partial Nephrectomy — This procedure removes the cancer and part of the kidney around the cancer. It typically is used only in special cases, such as when the other kidney is damaged or has already been removed.
• Simple Nephrectomy — This procedure removes an entire kidney. The other kidney can take over filtering blood.
• Radical Nephrectomy — Radical nephrectomy is performed to remove an entire kidney as well as tissues around it. Some lymph nodes also may be removed.
Chemotherapy is the use of drugs to kill cancer cells. It may be taken by pill or may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because drugs enter the bloodstream, travel through the body and can kill cancer cells throughout the body. Chemotherapy given after an operation, when there are no known remaining cancer cells, is called adjuvant therapy.
When very high doses of chemotherapy are used to kill cancer cells, these high doses can destroy the bone marrow, the blood-forming tissue in the bones. If very high doses of chemotherapy are needed to treat the cancer, bone marrow may be taken from the bones before therapy and frozen until it is needed. Following chemotherapy, the bone marrow is returned through a needle in a vein. This is called autologous bone marrow reinfusion.
Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for Wilms' tumor usually comes from a machine outside the body, also called external radiation therapy. Radiation may be used before or after surgery and chemotherapy.
After several years, some patients develop a second, different form of cancer as a result of treatment with chemotherapy and radiation. Clinical trials are underway to determine if lower doses of chemotherapy and radiation can be used.
Treatment by Stage
Treatment depends on the stage of the disease, cell type or histology and your child's age and general health. Treatment may be standard, based on its effectiveness in a number of patients in past studies, or experimental. Your doctor may propose that your child participate in a clinical trial, a research project involving experimental treatments. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new, better treatments.
If the tumor has a "favorable" cell type or if your child has anaplastic Wilms' tumor, your child's treatment will probably involve surgery to remove the cancer followed by chemotherapy. If your child has either clear cell sarcoma of the kidney or rhabdoid tumor, treatment will probably involve surgery followed by radiation therapy and chemotherapy.
If the tumor has a "favorable" cell type, your child's treatment will probably involve surgery to remove the cancer followed by chemotherapy. If your child has an "unfavorable" cell type such as anaplasia, clear cell sarcoma or rhabdoid tumor of the kidney, treatment may involve surgery followed by radiation therapy and chemotherapy.
Treatment will probably involve surgery, followed by radiation therapy and chemotherapy. Sometimes, the cancer cannot be removed by surgery because it is too close to important organs or blood vessels or because it is too large. In these cases, the doctor may perform a biopsy only and then suggest chemotherapy with or without radiation. Once the cancer is reduced by treatment, surgery may be performed, followed by additional chemotherapy and radiation therapy.
Treatment will probably involve surgery, followed by radiation therapy and chemotherapy. If the cancer has metastasized or spread to the lungs, your child will receive additional chemotherapy.
In this stage, both kidneys contain cancer. Usually, it isn't possible to remove both kidneys. Your child's doctor may remove a piece of the cancer from both kidneys and remove some of the surrounding lymph nodes to see if they contain cancer. Following surgery, chemotherapy is given to shrink the cancer. After the cancer is reduced, a second operation is performed to remove as much of the cancer as possible, while leaving as much of the kidneys as possible. Surgery may be followed by more chemotherapy and radiation therapy.
If your child's cancer recurs, treatment will depend on the treatment he or she received before, how much time has passed since the treatment, the cancer cell type and where the cancer emerges. Depending on these factors, treatment may involve surgery, radiation therapy and chemotherapy.
Clinical trials — research projects involving patients — help to evaluate new treatments, such as chemotherapy drugs, new combinations of treatments and bone marrow reinfusion.
Treatment for urological cancer depends on a number of factors, including:
• Type of cancer
• Stage of cancer (how far the cancer has spread)
• Your age
• Your overall health
• Your personal preferences
There are many treatment options available for different types of urological cancers . Some types of treatment are similar for all urological cancers, like chemotherapy and radiation therapy, although the types of chemotherapy drugs used and the length of treatment can vary widely.
Some treatments are specific to the type of cancer, like prostatectomy for prostate cancer and segmental cystectomy for bladder cancer.
General cancer treatments
Chemotherapy treats cancer by killing rapidly growing cells, which includes cancer cells. There are many types of chemotherapy drugs. Sometimes they are used alone, and sometimes they are used in conjunction with other chemotherapy drugs. Typically, they are injected into a vein through an IV, and they travel throughout the body to attack cancer cells. Chemotherapy drugs can be very effective at finding and killing cancer cells that have spread to other areas of the body. Low-dose chemotherapy is often used together with radiation therapy.
Radiation therapy uses energy beams to destroy cancer cells. It can be used by itself or in conjunction with other treatments, such as surgery or chemotherapy. There are two basic types of radiation therapy - external beam radiation that is given externally and internal radiation that is injected directly into the areas affected by cancer (such as brachytherapy for prostate cancer treatment).
• Mohs surgery , also known as microscopically controlled surgery, is used to remove cancer cells while preserving as much of the surrounding healthy tissue as possible. During Mohs surgery, a surgeon removes layers of the affected tissue a little at a time, checking to see if there is any evidence of cancer in that layer. If there is, he or she removes the next layer and repeats the process until they find a cancer-free layer. Surgeons must be trained to perform Mohs surgery because it is a highly specialized technique that requires specific training. It can be used to treat some cancers that have not spread to deep tissue, such as early-stage penile cancer.
• Laparoscopic surgery (laparoscopy) involves using a camera and thin surgical instruments that are inserted through small incisions to perform surgery. Laparoscopy is a minimally invasive technique that can have benefits, such as less pain, quicker recovery, less scarring and shorter hospital stays.
• Robotic surgery is a minimally invasive surgery that uses a robot to assist the surgeon with the procedure. Robotic surgeries are becoming more common as more surgeons are being trained to use the surgical robots. Robotic surgery can reduce swelling, bleeding, scarring and recovery time.
• Biologic therapy , otherwise known as biotherapy and immunotherapy, works by encouraging the body's immune system to help fight cancer cells. Using the immune system to fight cancer can be done in two ways: by stimulating your immune system to work harder and/or smarter to attack specific cancer cells and by giving your immune system a boost, which in turn can help your body fight off cancer.
• Cryoablation , otherwise known as cryosurgery, freezes tissue in order to kill cancer cells. It can be used for a number of urological cancers, including cervical cancer, kidney cancer and prostate cancer.
• Radiofrequency ablation (RFA) involves inserting an X-ray guided needle into the cancer cells and using electricity to heat and burn cancer cells. It is a new treatment that isn't widely done, but it may be an option for people who cannot safely have surgery. RFA may be used to treat kidney cancer, among other types of cancer.
Targeted therapy is done to block abnormal signals present in cancer cells that allow them to spread. There are a number of different types of targeted therapy. The FDA has approved certain types of therapy for kidney, prostate and cervical cancer. Targeted therapies include signal transduction inhibitors, gene expression modulator, angiogenesis inhibitor, apoptosis inducer, immunotherapies, hormone therapies and toxin delivery molecules. Learn more about targeted therapies from the National Cancer Institute .
Brachytherapy is a type of radiation treatment for prostate cancer that involves putting tiny radiation seeds directly into the prostate tissue to deliver low doses of radiation over time. The goal is to kill cancer cells while preserving as much healthy tissue as possible.
Prostatectomy is a surgery to remove the prostate gland. There are four basic techniques used.
• Robotic prostatectomy is a minimally invasive surgery in which a surgeon uses a robot to assist with removing the prostate gland. This type of surgery can be more precise, and it can reduce scarring, bleeding and healing time.
• Retropubic surgery involves making an incision in the abdomen to remove the prostate. One of the benefits of this surgery is that is reduces the risk of nerve damage. Nerve damage can lead to bladder control problems and erectile dysfunction, so this type of surgery is preferable to some men.
• Perineal surgery involves removing the prostate through an incision made between the scrotum and anus. The recovery time is usually reduced with this type of surgery, but it can make lymph node removal difficult, and it can increase the risk of nerve damage.
Hormone therapy is one prostate cancer treatment option. When men have early-stage cancer, hormone therapy is sometimes used to shrink tumors prior to radiation therapy. In men who have later-stage prostate cancer, it is sometimes used to both shrink the cancer cells and slow tumor growth. Hormone therapy may also be used after surgery or radiation. There are a few options for hormone therapy for prostate cancer.
• Luteinizing hormone-releasing hormone (LH-RH) agonists block messages telling the testicles to make testosterone.
• Anti-androgens keep testosterone from reaching cancer cells. They are often used along with LH-RH agonists.
• Removing the testicles through a surgery called orchiectomy lowers testosterone levels.
Radical inguinal orchiectomy involves removing one testicle. It is used to treat testicular cancer. In most cases of testicular cancer, only one testicle is involved. When two are removed, it is called an orchiectomy. The surgeon makes an incision in the groin and removes the entire testicle. Some men choose to have a prosthetic testicle inserted at the time of surgery, but that is not necessary.
Penectomy (partial or total) is a treatment for some stages of penile cancer. It is usually reserved for cancer that has spread deep into the penis. A partial penectomy involves removing the end of the penis, and a total penectomy involves removing the entire penis.
Nephrectomy involves removing a kidney, some surrounding tissue and the lymph nodes that are closest to the affected kidney in order to treat kidney cancer (renal cancer). This surgery can be done traditionally with open surgery or by using minimally invasive laparoscopy.
Nephron-sparing surgery , otherwise known as partial nephrectomy, is a surgery to treat kidney cancer. The goal is to save some healthy kidney tissue. During nephron-sparing surgery, surgeons remove the tumor and some healthy tissue surrounding the tumor (the margin), leaving some kidney behind. It is most common when people have small tumors or only have one kidney left. It is preferred over nephrectomy whenever possible.
Intravesical immunotherapy , such as Bacillus Calmette-Guerin (BCG) for treating early-stage bladder cancer, involves injecting a liquid drug into the area affected by cancer.
Transurethral resection (TUR) is a surgery done to remove bladder cancer that is in the inner layers of the bladder and hasn't spread. A loop-shaped wire burns away cancer cells with an electric current. Sometimes TUR is done using a laser rather than electricity.
Radical cystectomy is a surgery performed to remove the bladder and the surrounding lymph nodes when cancer has invaded the bladder wall and possibly surrounding lymph nodes and organs. When men have this surgery, surgeons often remove the prostate gland and the seminal vesicles, while women typically have their uterus and ovaries removed along with the bladder. If the bladder is removed, the surgeon will have to create a way to pass urine from the body. There are a few different surgical techniques used to achieve this goal.
Segmental cystectomy , otherwise known as a partial cystectomy, is a surgical procedure done to remove the part of the bladder that contains cancer cells.
The above is a partial list of cancer treatments. Other treatments may be available to you.