Urological cancers refer to malignant diseases affecting the urinary system, which include the kidneys, bladder, prostate, and testicles. These cancers can cause symptoms such as blood in the urine, changes in urination patterns, pelvic pain, or unexplained weight loss. While some urological cancers grow slowly, other cancers can be aggressive and can be life-threatening if not detected in time.

Prostate cancer is the most common urological cancer in men, while bladder and kidney cancers affect both men and women. Factors such as age, genetics, smoking, and lifestyle habits can increase the risk.

Early detection through regular screenings such as PSA testing for prostate cancer or urine testing for bladder cancer significantly improves treatment outcomes. Modern treatment options, including surgery, radiation, and targeted therapies, offer hope for a better life and survival.

Recognizing the warning signs in time and getting prompt medical care can help save lives. Keep yourself informed and proactive, and your health should be your priority.

At Apollo Hospital, Jabalpur, we are dedicated to delivering comprehensive and compassionate care for urological cancer patients. Our focus on patient-centred care guarantees that each person receives individualized attention and support throughout their treatment journey.

Backed by advanced diagnostic and treatment technologies, we strive to provide the most effective care with minimally invasive options for better outcomes. Our multidisciplinary team of urologists, oncologists, radiologists, and support staff collaborates to create tailored treatment plans that address each patient’s unique needs.

We are committed to healing with empathy, empowering patients and their families with the best possible care at every step.

Types of Urological Cancers:

Kidney Cancer

Kidney cancer, also known as renal cancer, originates in the kidneys — two bean-shaped organs responsible for filtering blood and removing waste through urine. It is one of the most common urological cancers, and its early detection is crucial for effective treatment. The main types of kidney cancer are:

1. Renal Cell Carcinoma (RCC)

Renal Cell Carcinoma is the most prevalent type of kidney cancer, representing almost 90% of cases. It usually starts in the lining of the small tubes (renal tubules) found in the kidney. RCC is further classified into subtypes based on the appearance of cancer cells under a microscope:

• Clear Cell RCC: The most prevalent subtype, characterized by cells that appear pale or clear.
• Papillary RCC: The second most common subtype, where cells form small, finger-like projections.
• Chromophobe RCC: A rare subtype with cells that appear large and pale under the microscope.
• Collecting Duct RCC: An aggressive and rare form of RCC that originates in the collecting ducts of the kidney.
• Unclassified RCC: This category encompasses tumours that do not align with the typical subtypes.

2. Urothelial Carcinoma of the Renal Pelvis

This type of kidney cancer originates in the renal pelvis, the part of the kidney where urine collects before moving to the bladder. Urothelial carcinoma shares similarities with bladder cancer and is often caused by smoking or exposure to harmful chemicals.

3. Wilms’ Tumour (Nephroblastoma)

Wilms’ tumour is an uncommon form of kidney cancer that mainly occurs in children. It typically occurs in children aged 3 to 4 years and is highly treatable with early intervention. Wilms’ tumour is usually detected due to an abdominal mass or swelling.

4. Renal Sarcoma

Renal sarcoma is a very uncommon type of kidney cancer that originates in the kidney’s connective tissues. It accounts for less than 1% of all kidney cancers and requires specialized treatment.

Risk Factors for Kidney Cancer

• Smoking: Increases the risk of developing RCC.
• Obesity: Carrying excess weight is associated with an increased risk.
• High Blood Pressure: Hypertension has been linked to kidney cancer.
• Family History: A family history of kidney cancer may raise the risk.
• Exposure to Chemicals: Prolonged exposure to harmful substances like asbestos and cadmium.

Symptoms of Kidney Cancer

• Blood in the urine (haematuria)
• Persistent lower back pain on one side
• Unexplained weight loss
• Fatigue
• Fever that isn’t caused by infection

Bladder Cancer

Bladder cancer is a common urological cancer that begins in the tissues of the bladder, the organ responsible for storing urine. It is classified based on how deeply the cancer invades the bladder wall and the type of cells involved. Early detection is crucial for enhancing survival rates.

1. Superficial (Non-Muscle-Invasive) Bladder Cancer

This type of bladder cancer is confined to the inner lining of the bladder and has not spread into the bladder’s muscular wall. It is the most common form of bladder cancer and tends to have a good prognosis with appropriate treatment. Subtypes include:

Papillary Carcinoma: Tumours develop as slender, finger-like projections from the bladder’s inner wall.

Flat Carcinoma (Carcinoma in Situ): A flat, non-invasive cancer that remains on the bladder lining and can become more aggressive if untreated.

Treatment for superficial bladder cancer typically includes:

Transurethral Resection of Bladder Tumour (TURBT): A minimally invasive technique for tumour removal.

Intravesical Therapy: Medication delivered directly into the bladder to reduce recurrence.

2. Muscle-Invasive Bladder Cancer (MIBC)

Muscle-invasive bladder cancer has spread into the muscular layer of the bladder wall. It is more aggressive and has a higher chance of spreading to other parts of the body. Types of MIBC include:

Invasive Urothelial Carcinoma: The most common type, originating from the urothelial cells lining the bladder.

Squamous Cell Carcinoma: A rare form of bladder cancer often linked to chronic irritation or infections.

Adenocarcinoma: Another rare type that originates from glandular cells in the bladder.

Treatment for MIBC may involve:

Radical Cystectomy: Complete surgical removal of the bladder.

Chemotherapy: To shrink the tumour before surgery or to treat cancer that has spread.

Radiation Therapy: Used as an alternative to surgery or alongside other treatments.

3. Metastatic Bladder Cancer

Metastatic bladder cancer occurs when the cancer spreads beyond the bladder to other parts of the body, such as lymph nodes, bones, lungs, or liver. It is treated with systemic therapies, including:

Chemotherapy: Used to slow cancer progression and alleviate symptoms.

Immunotherapy: Boosting the immune system to fight cancer.

Targeted Therapy: Drugs designed to attack specific cancer cells.

Risk Factors for Bladder Cancer

Smoking: The leading cause of bladder cancer.

Chemical Exposure: Prolonged exposure to industrial chemicals, such as those used in dye, rubber, and leather industries.

Chronic Bladder Infections: Prolonged bladder irritation or infections can raise the risk.

Age and Gender: Bladder cancer is more prevalent among older individuals and men.

Symptoms of Bladder Cancer

• Blood in the urine (haematuria)
• Frequent or painful urination
• Urgency to urinate without producing much urine
• Lower back pain
• Prostate Cancer

Prostate Cancer

Prostate cancer is one of the most common cancers affecting men. It develops in the prostate gland, a small walnut-shaped gland located below the bladder and in front of the rectum. The prostate produces seminal fluid, which nourishes and transports sperm. Early detection and treatment are critical to improving outcomes.

Types of Prostate Cancer

• Adenocarcinoma: The most common type, originating in the gland cells of the prostate.
• Small Cell Carcinoma: A rare, aggressive form of prostate cancer.
• Neuroendocrine Tumours: A rare group of cancers that start in neuroendocrine cells.

Risk Factors for Prostate Cancer

• Age: The risk increases significantly after the age of 50.
• Family History: A family history of prostate cancer increases risk.
• Race: African-American men are at a higher risk of developing prostate cancer.
• Diet: A diet high in red meat and high-fat dairy products may increase risk.

Symptoms of Prostate Cancer

• Frequent urination, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted urine flow
• Blood in urine or semen
• Erectile dysfunction
• Pain in the hips, back, or chest (advanced stages)

Screening Options

Early detection is essential for successful treatment. The most common screening methods include:

1. Prostate-Specific Antigen (PSA) Test

The PSA test measures the level of PSA, a protein produced by the prostate gland, in the blood. Elevated PSA levels may indicate prostate cancer, but they can also be caused by other prostate conditions.

2. Digital Rectal Exam (DRE)

In this physical exam, a healthcare provider inserts a gloved, lubricated finger into the rectum to check for abnormalities in the prostate gland. It is often used alongside the PSA test.

Testicular Cancer

Testicular cancer occurs in the testicles (testes), which are part of the male reproductive system. It is relatively rare but is one of the most common cancers in younger men, particularly between the ages of 15 and 35 years.

Early detection significantly increases the chances of a full recovery.

Risk Factors for Testicular Cancer

Several factors may increase the risk of developing testicular cancer:

1. Undescended Testicle (Cryptorchidism)

Men born with an undescended testicle have a higher risk of testicular cancer, even if surgery was done to correct it.

2. Family History

If a close relative (father or brother) has had testicular cancer, the risk increases.

3. Age

Testicular cancer is most commonly diagnosed in men aged 15 to 35, but it can occur at any age.

4. Race and Ethnicity

White men have a higher risk of testicular cancer compared to men of other races.

5. Personal History of Testicular Cancer

Men who have had testicular cancer in one testicle are at a higher risk of developing it in the other testicle.

6. HIV Infection

Men with HIV, especially those with AIDS, are at an increased risk of developing testicular cancer.

Symptoms of Testicular Cancer

Common signs and symptoms of testicular cancer include:

• A painless lump or swelling in one testicle.
• A feeling of heaviness in the scrotum.
• A dull ache in the lower abdomen or groin.
• Sudden fluid buildup in the scrotum.
• Pain or discomfort in the testicle or scrotum.
• Enlargement or tenderness of breast tissue (due to hormonal changes).

Note: Not all lumps in the testicles are cancerous, but they should always be checked by a doctor.

Treatment Options for Urological Cancer:

Surgery

Urological cancers include prostate cancer, bladder cancer, kidney cancer, and testicular cancer. Surgery is often a key component of treatment, aiming to remove cancerous tissue and preserve organ function. Depending on the type and stage of cancer, different surgical approaches may be used.

Types of Surgical Procedures for Urological Cancer

1️. Open Surgery

This is the traditional approach where the surgeon makes a large incision to access the affected organ.

Advantages:

• Suitable for complex cases with extensive tumours.
• Allows the surgeon to manually inspect and feel the affected area.
• Proven long-term outcomes for many urological cancers.

Disadvantages:

• Longer recovery time due to the large incision.
• Higher risk of infection, bleeding, and pain.
• Larger scar compared to minimally invasive techniques.

2️. Laparoscopic Surgery

A minimally invasive procedure where the surgeon makes small incisions and uses a camera (laparoscope) to operate.

Advantages:

• Smaller incisions mean less pain and faster recovery.
• Reduced blood loss during surgery.
• Shorter hospital stays and quicker return to daily activities.
• Effective for procedures like radical nephrectomy (kidney removal) and prostatectomy (prostate removal).

Disadvantages:

• Longer operating time due to the complexity of the technique.
• Requires advanced surgical expertise.
• Limited tactile feedback for the surgeon compared to open surgery.

3️. Robotic-Assisted Surgery

An advanced form of laparoscopic surgery where the surgeon uses robotic arms to perform the procedure with greater precision.

Advantages:

• High precision reduces the risk of damaging surrounding tissues.
• 3D visualization of the surgical site improves accuracy.
• Less postoperative pain and shorter recovery time.
• Ideal for delicate procedures like robotic prostatectomy and partial nephrectomy.

Disadvantages:

• Expensive due to the cost of the robotic system.
• Requires specialized training for the surgeon.
• Not available in all hospitals.

4️. Transurethral Resection (TUR) Surgery

A common procedure for bladder cancer, where the surgeon removes cancerous tissue through the urethra without making an incision.

Advantages:

• No external incision, resulting in less pain and quick recovery.
• Suitable for early-stage bladder cancer.
• Can be performed multiple times if cancer recurs.

Disadvantages:

• May require repeated procedures if cancer returns.
• Limited to early-stage tumours.

5️. Cryosurgery

A technique used to freeze and destroy cancer cells, commonly for prostate cancer and kidney cancer.

Advantages:

• Minimally invasive with fewer complications.
• Suitable for patients who cannot undergo major surgery.
• Can preserve healthy tissue.

Disadvantages:

• Limited long-term data on effectiveness.
• Not suitable for large tumours.
• Potential for nerve damage and urinary issues.

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill or slow the growth of cancer cells. It is often used in combination with surgery or radiation therapy, especially for advanced-stage cancers or cancers that have spread to other parts of the body.

Chemotherapy is a crucial treatment option for various urological cancers, with different drugs and regimens tailored to each cancer type. While it can cause side effects, effective management strategies can improve the patient’s quality of life during treatment.

Radiation Therapy

Radiation therapy uses high-energy rays or particles to target and kill cancer cells. It can be used as a primary treatment, after surgery to eliminate remaining cancer cells, or to relieve symptoms in advanced cancer cases.

Types of Radiation Therapy

There are two main types of radiation therapy used for urological cancers:
1️. External Beam Radiation Therapy (EBRT)
2️. Brachytherapy (Internal Radiation)

Let’s explore each type in detail:

External Beam Radiation Therapy (EBRT)

In EBRT, a machine called a linear accelerator directs high-energy X-rays or protons at the cancer from outside the body. The radiation is carefully targeted to minimize damage to surrounding healthy tissue.

Types of EBRT:

3D Conformal Radiation Therapy (3D-CRT): Uses imaging to shape the radiation beams to the tumour.

Intensity-Modulated Radiation Therapy (IMRT): Allows the radiation dose to be adjusted, reducing exposure to nearby organs.

Proton Beam Therapy: Uses protons instead of X-rays, which can deliver more precise doses to the tumour.

Advantages of EBRT:

• Non-invasive procedure.
• Suitable for early-stage and advanced cancers.
• Can treat larger areas and metastatic cancers.
• Painless and requires no recovery time after each session.

Disadvantages of EBRT:

• Requires multiple sessions over several weeks.
• Can cause side effects like fatigue, skin irritation, and urinary issues.
• Risk of damage to surrounding tissues, such as the bladder or rectum.

2️. Brachytherapy (Internal Radiation Therapy)

In brachytherapy, radioactive seeds or pellets are implanted directly into or near the tumour. The radiation is released slowly over time to kill cancer cells.

Types of Brachytherapy:

Low-Dose Rate (LDR) Brachytherapy: Radioactive seeds are implanted permanently in the prostate, releasing radiation over several months.

High-Dose Rate (HDR) Brachytherapy: Temporary radioactive catheters are placed inside the tumour for a short period and then removed.

Advantages of Brachytherapy:

• Delivers a high dose of radiation directly to the tumour while sparing surrounding tissues.
• Requires fewer sessions than EBRT.
• Suitable for localized prostate cancer.
• Minimal impact on daily activities after recovery.

Disadvantages of Brachytherapy:

• Involves a minor surgical procedure to implant the seeds or catheters.
• Can cause urinary and sexual side effects.
• Not suitable for advanced or metastatic cancers.
• Radiation exposure risk to others if seeds are implanted permanently.

Immunotherapy for Urological Cancers

Immunotherapy is a biological therapy that helps the body’s immune system recognize and destroy cancer cells. It is especially used for advanced-stage cancers or cancers resistant to conventional treatments like surgery and chemotherapy.

Types of Immunotherapies

1️. Checkpoint Inhibitors

Checkpoint inhibitors block immune checkpoints, which are proteins that cancer cells use to avoid being attacked by the immune system. By inhibiting these checkpoints, the immune system can better detect and kill cancer cells.

Advantages:

• Effective for advanced and metastatic cancers.
• Can produce long-term cancer remission in some patients.
• Less toxic than traditional chemotherapy.

Disadvantages:

• Not effective for all patients.
• Can cause immune-related side effects (e.g., inflammation of organs).

2️. Cancer Vaccines

Cancer vaccines stimulate the immune system to target cancer cells. Unlike traditional vaccines that prevent disease, cancer vaccines treat existing cancer.

BCG Vaccine for Bladder Cancer:

BCG is a live bacterial vaccine inserted directly into the bladder to trigger an immune response that targets bladder cancer cells.

Advantages:

• Highly effective for non-muscle-invasive bladder cancer.
• Can prevent recurrence after surgery.

Disadvantages:

May cause flu-like symptoms and bladder irritation.

3️. Cytokine Therapy

Cytokines are proteins that boost the immune system’s ability to fight cancer.
Two main cytokines used are Interleukin-2 (IL-2) and Interferon-alpha.

Advantages:

Can lead to complete remission in some kidney cancer cases.

Disadvantages:

High toxicity with severe side effects, including flu-like symptoms and low blood pressure.

Targeted Therapy for Urological Cancers

Targeted therapy is a precision medicine approach that targets specific genes, proteins, or tissue environments involved in cancer growth. Unlike chemotherapy, it attacks cancer-specific targets without affecting healthy cells.

How Targeted Therapy Works

Targeted therapy works by blocking the molecular pathways that cancer cells use to grow and spread. It’s often used for cancers that are resistant to chemotherapy or have specific genetic mutations.

Types of Targeted Therapy

1️. Tyrosine Kinase Inhibitors (TKIs)

TKIs block tyrosine kinase enzymes, which are involved in the signalling pathways that promote cancer cell growth.

Advantages:

• Effective in advanced kidney cancer.
• Can shrink tumours and slow cancer progression.

Disadvantages:

• Can cause high blood pressure, fatigue, and diarrhoea.
• May require long-term treatment.

2️. mTOR Inhibitors

mTOR inhibitors block the mTOR pathway, which controls cell growth and division.

Advantages:

• Useful for advanced kidney cancer.
• Can be used when TKIs are no longer effective.

Disadvantages:

• Can cause mouth sores, fatigue, and infections.
• Requires regular monitoring.

3️. Monoclonal Antibodies

Monoclonal antibodies are lab-made proteins that bind to specific targets on cancer cells.

Advantages:

• Helps block blood supply to the tumour (anti-angiogenesis).
• Can be used in combination with other therapies.

Disadvantages:

• Can cause bleeding, high blood pressure, and slow wound healing.