Urologic Oncology Overview
Thousands of men and women are diagnosed each year with cancer of the prostate, bladder or kidney, as well as testicular cancer. New breakthroughs in cancer care, experimental treatment options, and ongoing research into the causes and potential cures of urologic malignancies spell new hope for patients from all walks of life.
Urologic oncologists are trained to treat urinary tract malignancies using a variety of tools and technologies designed to treat the disease while sparing healthy tissue.
A urologic oncologist will work closely with your care team to tailor treatments to your specific cancer, help reduce side effects and address issues of sexual function.
Surgery often is the primary treatment for many urologic cancers. The type of surgery may depend on the type of cancer and its stage. If a urologic cancer has metastasized, treatment may also include chemotherapy, radiation therapy targeted therapy or immunotherapy.
Surgeries that may be performed to treat and diagnose prostate cancer include:
Prostatectomy: This procedure removes the entire prostate. In most cases, the procedure is performed using the da Vinci Surgical System. This robotic surgical system is designed to require smaller incisions and make more precise cuts. The robotic surgical tool also is designed to navigate around and spare nerves that are essential for sexual function.
Biopsy: Prostate cancer is definitively diagnosed with a biopsy, a minor surgical procedure in which a sample of suspected cancer cells are removed for examination and testing by a pathologist. Biopsies may be performed endoscopically, while others are performed under image guidance, such as with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) technology.
Surgeries that may be performed to treat bladder cancer include:
Transurethral resection: This procedure, also called “transurethral resection of the bladder tumor,” is common for early-stage bladder cancers, or those confined to the superficial layer of the bladder wall. This bladder cancer surgery is performed by passing an instrument through the urethra, to avoid cutting through the abdomen. The surgical instrument used for this operation is called a resectoscope. A wire loop at one end of the resectoscope is used to remove abnormal tissues or tumors.
Cystectomy: This bladder cancer surgical procedure may be used to remove either the entire bladder or portions of it. Sometimes, the bladder may be accessed through an incision in the abdomen. It may also be possible to do laparoscopic surgery. With this approach, several small incisions are made using long, thin instruments, one with a video camera on the end that enables the surgeon to see inside the pelvis. Cystectomies are performed in two ways:
Partial cystectomy: If cancer has invaded the muscle layer of the bladder wall but is not large and is confined to one region of the bladder, it may be possible to treat the cancer by removing only part of the bladder. With this procedure, the portion of the bladder affected by cancer is removed, and the hole in the bladder wall is then closed.
Radical cystectomy: If cancer is aggressive and highly invasive, the entire bladder may need to be removed. With a radical cystectomy, nearby lymph nodes may also be removed, along with the prostate (for men), and, for women, the ovaries, fallopian tubes, uterus and a small part of the vagina. This type of bladder cancer surgery is an extensive procedure but may help remove cancer cells from the body and reduce the likelihood of the disease recurring.
Reconstructive surgery: One type of reconstructive surgery may be performed when bladder cancer is in an advanced stage and cannot be removed by surgery. With this approach, urine is diverted away from the bladder, even though the bladder is not removed. This procedure may help prevent or treat blockage of urine flow. f the bladder is removed, a surgeon has several options for establishing a way for the body to expel urine. They include:
Ileal conduit: In this approach, a small piece of intestine is connected to the ureters, creating a passageway for urine to pass out of the body from the kidneys. An opening, or a urostomy (or stoma), is created on the front of the abdomen, and the conduit is connected to this hole.
Continent diversion: In this procedure, a pouch is made from a piece of intestine, and a valve is created in the pouch. Urine is stored in the pouch and emptied through the valve into a catheter attached to a stoma. With this approach, the patient does not have to wear a bag on the outside of the body.
Neobladder: This approach allows urination through the urethra. In this procedure, a piece of intestine is used to create a storage area for urine. The ureters are connected to the new bladder. The difference between this approach and the others is that the neobladder is sewn to the urethra, which allows for normal urination.
Surgeries that may be performed to treat kidney cancer include:
Radical nephrectomy: This is a procedure to remove the entire affected kidney. The adrenal gland may also be removed if it is involved with, or very close to, the tumor. During this type of surgery, the oncologist may make incisions in the abdomen, under the ribs, or in the back to remove the entire kidney.
Laparoscopic radical nephrectomy (LRN): This surgery is performed by making a few small incisions, instead of one large incision. One of the incisions is slightly larger than the others to allow the removed kidney to pass through. LRN may require less recovery time and cause less bleeding and scarring.
Partial nephrectomy: During this procedure, the surgeon removes only the part of the kidney that contains cancer. This type of kidney cancer surgery may be required to preserve kidney function in patients who have cancer in both kidneys, who have low kidney function, or who have one kidney.
The two primary types of surgery for testicular cancer are:
Radical inguinal orchiectomy: With this procedure, the surgeon will remove the testicle with the tumor, as well as the spermatic cord that connects the testicle to the abdomen.
Retroperitoneal lymph node dissection: If your doctor suspects that the cancer cells may have spread to nearby lymph nodes, this procedure may be performed at the same time, or during, a second surgery.