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Renal Cancer

Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

Smoking and misuse of certain pain medicines can affect the risk of renal cell cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for renal cell cancer include the following:

  • Smoking.
  • Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.
  • Being overweight.
  • Having high blood pressure.
  • Having a family history of renal cell cancer.
  • Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.

Signs of renal cell cancer include blood in the urine and a lump in the abdomen.

These and other signs and symptoms may be caused by renal cell cancer or by other conditions. There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following:

  • Blood in the urine.
  • A lump in the abdomen.
  • A pain in the side that doesn't go away.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Anemia.

Tests that examine the abdomen and kidneys are used to detect (find) and diagnose renal cell cancer.

The following tests and procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Urinalysis : A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
  • Liver function test : A procedure in which a sample of blood is checked to measure the amounts of enzymes released into it by the liver. An abnormal amount of an enzyme can be a sign that cancer has spread to the liver. Certain conditions that are not cancer may also increase liver enzyme levels.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. To do a biopsy for renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is withdrawn.

Urinary Bladder Cancer

Bladder cancer can often be found early because it causes blood in the urine or other urinary symptoms. In most cases, blood in the urine (called hematuria) is the first sign of bladder cancer. Sometimes, there is enough blood to change the color of the urine to orange, pink, or, less often, darker red. Sometimes, the color of the urine is normal but small amounts of blood are found when a urine test (urinalysis) is done because of other symptoms or as part of a general medical checkup.

Blood may be present one day and absent the next, with the urine remaining clear for weeks or months. If a person has bladder cancer, blood eventually reappears. Usually, the early stages of bladder cancer cause bleeding but little or no pain or other symptoms. Blood in the urine does not always mean you have bladder cancer. More often it is caused by other things like an infection, benign (non-cancerous) tumors, stones in the kidney or bladder, or other benign kidney diseases. But it’s important to have it checked by a doctor so the cause can be found.

Changes in bladder habits or symptoms of irritation

Bladder cancer can sometimes cause changes in urination, such as:

  • Having to urinate more often than usual
  • Pain or burning during urination
  • Feeling as if you need to go right away, even when the bladder is not full
  • Having trouble urinating or having a weak urine stream
  • These symptoms are also more likely to be caused by a urinary tract infection (UTI), bladder stones, an overactive bladder, or an enlarged prostate (in men). Still, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Symptoms of advanced bladder cancer

Bladder cancers that have grown large enough or have spread to other parts of the body can sometimes cause other symptoms, such as:

  • Being unable to urinate
  • Lower back pain on one side
  • Loss of appetite and weight loss
  • Feeling tired or weak
  • Swelling in the feet
  • Bone pain
  • Again, many of these symptoms are more likely to be caused by something other than bladder cancer, but it’s important to have them checked so that the cause can be found and treated, if needed.

Which treatments are used for bladder cancer?

Depending on the stage of the cancer and other factors, treatment options for people with bladder cancer can include:

  • Surgery
  • Intravesical therapy
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy

Sometimes, the best option might include more than one of type of treatment. Surgery, alone or with other treatments, is part of the treatment for most bladder cancers. Surgery can often remove early-stage bladder tumors. But a major concern in people with early-stage bladder cancer is that new cancers often form in other parts of the bladder over time. Removing the entire bladder (known as a radical cystectomy) is one way to avoid this, but it can have major side effects. If the entire bladder is not removed, other treatments may be given to try to reduce the risk of new cancers. Whether or not other treatments are given, close follow-up is needed to look for signs of new cancers in the bladder.

Which doctors treat bladder cancer?

Depending on your options, you can have different types of doctors on your treatment team. The types of doctors who treat bladder cancers include:

  • Urologists: surgeons who specialize in treating diseases of the urinary system and male reproductive system
  • Radiation oncologists: doctors who treat cancer with radiation therapy
  • Medical oncologists: doctors who treat cancer with medicines such as chemotherapy and immunotherapy

Prostate Cancer

Prostate cancer is cancer that occurs in the prostate — a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm.
Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly.
Prostate cancer that's detected early — when it's still confined to the prostate gland— has a better chance of successful treatment.

Symptoms

Prostate cancer may cause no signs or symptoms in its early stages.

Prostate cancer that's more advanced may cause signs and symptoms such as:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in semen
  • Discomfort in the pelvic area
  • Bone pain
  • Erectile dysfunction

Risk factors

Factors that can increase your risk of prostate cancer include:

  • Age. Your risk of prostate cancer increases as you age.
  • Race. For reasons not yet determined, black men carry a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced.
  • Family history. If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher.
  • Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that's more difficult to treat.

Treatment

Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, how much it has spread and your overall health, as well as the potential benefits or side effects of the treatment.

For men diagnosed with low-risk prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance.
In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation.
Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult.

Surgery to remove the prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Radical prostatectomy can be performed in several ways:

  • Using a robot to assist with surgery. During robot-assisted surgery, the instruments are attached to a mechanical device (robot) and inserted into your abdomen through several small incisions. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Robotic prostatectomy may allow the surgeon to make more-precise movements with surgical tools than is possible with traditional minimally invasive surgery.
  • Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen.

Radiation therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:

  • Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks.
  • Radiation placed inside your body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop emitting radiation and don't need to be removed.

Hormone therapy

Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.

Hormone therapy options include:

  • Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone.
  • Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells.
  • Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body.

Freezing prostate tissue

Cryosurgery or cryoablation involves freezing tissue to kill cancer cells.
During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue.

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both.
Chemotherapy may be a treatment option for men with prostate cancer that has spread to remote body locations. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Biological therapy

Biological therapy (immunotherapy) uses your body's immune system to fight cancer cells. One type of biological therapy called sipuleucel-T (Provenge) has been developed to treat advanced, recurrent prostate cancer.


Testicular Cancer

Testicular cancer starts as an abnormal growth or tumour in a testis. A cancer will usually appear as a painless lump in a testis. If a man sees a doctor as soon as a lump, swelling or pain in a testis is noticed, the cancer can remain localised (remain within the testis). However, if not treated, the cancer typically spreads to other parts of the body via the blood or lymphatic system. Testicular cancer has a very good cure rate (about 95 per cent).

Risk Factors

Young men (about 20 to 40 years of age) are most at risk of developing testicular cancer.

Due to the higher risk of testicular cancer in men with a history of undescended testes, it is important for families to share details of medical history with boys in early adolescence so they are aware of the need to regularly check their testes.

Symptoms of Testicular Cancer

A hard lump in either testis is the usual symptom of testicular cancer. The lump is usually painless but in about one in 10 men it is painful or tender. In a few men, constant backache, coughing or breathlessness, and enlarged or tender nipples may mean that the cancer has spread. A man with any of these symptoms should see a doctor straight away; however, there may be many other reasons for these symptoms.

Treatment

The treatment options for testicular cancer depend on the type and stage of cancer.
An orchidectomy (surgical removal of the affected testis) is the first stage of treatment for all suspected cases of testicular cancer. The removed testis is then sent to a pathology laboratory to confirm the stage and type of cancer.
In recent years, surveillance (careful monitoring) has become a more popular option after orchidectomy for localised testicular cancer. This is where the man is checked regularly to assess whether the cancer has moved elsewhere in the body, including the other testis.
Chemotherapy or radiotherapy may be given after surgery to kill off any cancer cells that may have spread to other parts of the body. The level or amount of chemotherapy and radiotherapy will be different for each man and will depend on the stage and type of cancer.
The doctor will look at each case individually to assess the chance of the cancer moving from the testes before deciding on the best treatment.

Surgery

  • Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, your surgeon makes an incision in your groin and extracts the entire testicle through the opening. A prosthetic, saline-filled testicle can be inserted if you choose. In cases of early-stage testicular cancer, surgical removal of the testicle may be the only treatment needed.
  • Surgery to remove nearby lymph nodes (retroperitoneal lymph node dissection) is performed through an incision in your abdomen. Your surgeon takes care to avoid damaging nerves surrounding the lymph nodes, but in some cases harm to the nerves may be unavoidable. Damaged nerves can cause difficulty with ejaculation, but won't prevent you from having an erection.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body.
Radiation therapy is a treatment option that's sometimes used in people who have the seminoma type of testicular cancer. Radiation therapy may be recommended after surgery to remove your testicle.
Side effects may include nausea and fatigue, as well as skin redness and irritation in your abdominal and groin areas. Radiation therapy is also likely to temporarily reduce sperm counts and may impact fertility in some men. Talk to your doctor about your options for preserving your sperm before beginning radiation therapy.

Chemotherapy

Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor.
Chemotherapy may be your only treatment, or it may be recommended before or after lymph node removal surgery.
Side effects of chemotherapy depend on the specific drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.
Chemotherapy may also lead to infertility in some men, which can be permanent in some cases. Talk to your doctor about your options for preserving your sperm before beginning chemotherapy.


Penile Cancer

The penis is a rod-shaped male reproductive organ that passes sperm and urine from the body. It contains two types of erectile tissue (spongy tissue with blood vessels that fill with blood to make an erection):

Corpora cavernosa: The two columns of erectile tissue that form most of the penis.

Corpus spongiosum: The single column of erectile tissue that forms a small portion of the penis. The corpus spongiosum surrounds the urethra (the tube through which urine and sperm pass from the body).

The erectile tissue is wrapped in connective tissue and covered with skin. The glans (head of the penis) is covered with loose skin called the foreskin.

Signs and Symptoms

The signs and symptoms below don’t always mean a man has penile cancer. In fact, many of them are more likely to be caused by other conditions. Still, if you have any of these signs or symptoms, see your doctor right away so the cause can be found and treated, if needed. The sooner a diagnosis is made, the sooner you can start treatment and the more effective it is likely to be.

Skin changes

  • An area of skin becoming thicker and/or changing color
  • A lump on the penis
  • An ulcer (sore) that might bleed
  • A reddish, velvety rash
  • Small, crusty bumps
  • Flat, bluish-brown growths
  • Smelly discharge (fluid) under the foreskin

Swelling

Swelling at the end of the penis, especially when the foreskin is constricted, is another possible sign of penile cancer.

Lumps under the skin in the groin area

If the cancer spreads from the penis, it most often travels first to lymph nodes in the groin. This can make those lymph nodes swell. Lymph nodes are collections of immune system cells. Normally, they are bean-sized and can barely be felt at all. If they are swollen, the lymph nodes may be felt as lumps under the skin.

Treatment

The main types of treatments used to treat penile cancers are:

  • Surgery
  • Local therapy (other than surgery) for some very early penile cancers
  • Radiation therapy
  • Chemotherapy

Surgery is the main treatment for most penile cancers, but sometimes radiation therapy may be used, either instead of or in addition to surgery. Other local treatments might also be used for early-stage tumors. Chemotherapy may be given for some larger tumors or if the cancer has spread.

Depending on the type and stage of your cancer and your treatment options, you might have different types of doctors on your treatment team, including:

  • A urologist: a surgeon who specializes in diseases of the male genitals and urinary tract
  • A radiation oncologist: a doctor who uses radiation to treat cancer
  • A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

Many other specialists might be part of your treatment team as well, including other doctors, physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, social workers, rehabilitation specialists, and other health professionals. See Health Professionals Associated With Cancer Care for more on this. The goal of your cancer care team is to treat the cancer while limiting the treatment’s effects on the function and appearance of the penis. If the cancer can’t be cured, the goal may be to remove or destroy as much of the cancer as possible and to prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms, such as pain or bleeding, even if you might not be cured.