Urologic Cancers

   
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  Urologic cancers encompass cancers of the kidney, ureters, urinary bladder, prostate and testes.
   
  Kidney Cancer:
 

Most kidney tumors are diagnosed incidentally or following blood in the urine.

Initial investigations are CT scan for the diagnosis as well as to rule out secondaries elsewhere.

Surgery being the mainstay of treating these cancers can be carried out laparoscopiclly or tradional open surgery depending on the type, location and size of the tumour.

Tumors with size less than 7-cm and there are no large nodes in the retroperitoneum can be managed laparoscopically.

For larger tumors, those with large nodes and those with a thrombus in the renal vein or IVC we prefer to do them by the standard open approach.

Duration of stay and post operative course-
Following radical nephrectomy for these cancers most patients are able to go home in 5-7 days.

   
  Bladder Cancers:
  These cancers require an initial cystoscopic evaluation with resection of the tumor cystoscopically.
 

Cystoscopic removal is done if cancer is superficial followed by instillation of chemotherapy drugs or BCG into the bladder.

   
  Regular follow ups with cystoscopy might be required inpatients with superficial bladder cancers.
 

In patients having muscle-invasive cancers or those with progression of superficial bladder cancer to muscle invasive cancer a radical cystectomy i.e. removal of the complete urinary bladder might be required. Following which reconstructions might be required.

   
 

Reconstruction:

 

The standard one is the ileal conduit, which requires a stoma on the abdominal wall and urine is collected in a bag.

Neobladders that is the making of a new bladder from the patients gut can also be done. Following this procedure there is no external opening and the patient passes urine by the normal passage.

   
 

Most patients following radical cystectomy go home in 10-14 days depending on the reconstruction done.

   
 
  Prostate Cancer:
 

These cancers are usually diagnosed in elderly.

 

A clinical evaluation,

High PSA (tumor marker),

TRUS biopsy is required for confirming the diagnosis.
Bone scan if disease is localized
   
 

If disease is confirmed and localized a radical prostatectomy may be offered to the patient. This can be done laparoscopically or traditional open depending on the disease and morbidities of the patient.

For locally advanced cancers either only radiotherapy or a combination of hormonal manipulation and radiotherapy may be done. For metastatic disease hormonal manipulation is done.

   
  Testicular Cancer:
 

These are cancers of the young men.

Proper evaluation, staging and treatment plan yield good prognosis and high percentage of cures. This cancer requires a multidisciplinary approach.