Urological Cancer

Penile cancer occurs when malignant (cancerous) cells are found on the skin and in the tissues of the penis. Over 95% of penile cancers develop from flat, scale-like skin cells called squamous cells.

Risk Factors of Penile Cancer

The causes of penile cancer are not well known. Factors that may increase the risk of this disease include:

  • Circumcision: Men who are not circumcised at birth may have a higher risk for getting penile cancer. A circumcision is an operation where the doctor takes away part or all of the foreskin from the head of the penis (or glans). 
  • Human Papillomavirus Infection (HPV): Certain HPV types can infect the male and female genital organs and the anal area. HPVs are passed from one person to another during sexual contact. Practicing sexual intercourse at an early age, having multiple sexual partners, having sex with a partner who has had multiple other partners, and having unprotected sex (not using a condom) at any age increase a person's risk of getting HPV infection.
  • Smoking: Men who smoke are at an increased risk of developing penile cancer. 
  • Treatment of Psoriasis: Men with the skin condition psoriasis, who have been treated with a combination of the drug psoralen and exposure to ultraviolet light are at an increased for developing penile cancer. 
  • Smegma: Smegma is a thick, odorous substance made up of oily secretions and dead skin cells collected under the foreskin of the penis. If uncircumcised men do not retract the foreskin and thoroughly wash the entire penis, the presence of smegma may cause irritation and an increased risk for developing penile cancer.
  • Phimosis: Phimosis is when the foreskin becomes constricted, or difficult to retract due to the build-up of smegma. As a result, men with phimosis are less likely to clean the penis thoroughly causing an increased risk for developing penile cancer.
  • Age: Most cases of penile cancer are diagnosed in men 50 and over. 

Treatment Options for Penile Cancer
Your will doctor work with you to develop a treatment plan that fits your needs. Treatment options for penile cancer depend on the stage of the disease and the grade of the tumor, how abnormal the cells look and how likely they are to grow or spread.

Bladder Cancer 
Bladder cancer is a disease in which cancer cells grow in the bladder. The bladder, which is located in the lower abdomen, is a hollow organ with flexible muscular walls. Its primary function is to store urine until a person is ready to urinate.

Cancer occurs when cells in the body (in this case bladder cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue, called a growth or tumor, forms. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

There are three main types of cancer that affect the bladder. They are named for the type of cell that becomes cancerous:

  • Transitional cell (urothelial) carcinoma accounts for more than 90% of bladder cancers
  • Squamous cell carcinoma accounts for about 4% of bladder cancers
  • Adenocarcinoma accounts for about 1%-2% of bladder cancers

Causes

The cause of bladder cancer is unknown. However, several risk factors have been identified.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing bladder cancer:

  • Smoking
  • Increasing age: The majority of people with bladder cancer are between 65-85 years old.
  • Occupation (due to occupational exposures to certain substances)

Those at risk include: 

  • Rubber, leather, and textile workers
  • Painters
  • Hairdressers
  • Machinists
  • Printers
  • Truck drivers
  • Petroleum industry workers
  • Race: White
  • Sex: male
  • Genetics
  • Chronic bladder inflammation or infection (eg, schistosomiasis, an infection caused by a parasitic worm)
  • Personal or family history of bladder cancer
  • Chemotherapeutic drugs : cyclophosphamide and ifosfamide
  • Exposure to arsenic
  • Radiation treatment of the pelvis
  • Bladder birth defects
  • Chemicals (eg, nitrosamines, benzidine)
  • Urinary stones for many years
  • Indwelling catheter for many years
  • Bladder diverticuli: an area of weakness in the bladder wall through which some of the lining of the bladder is forced out
  • Metastasis from another cancer

Symptoms include:

  • Blood in the urine (hematuria)
  • Frequent urination, or feeling the need to urinate without being able
  • Painful urination
  • Lower back pain
  • Weight loss, bone pain, or abdominal pain in advanced cases

These symptoms may be caused by other less serious health conditions, such as bladder stones or infection. If you are experiencing any of these symptoms, see your physician.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. During the exam, your doctor will feel the abdomen and pelvis for abnormalities. The physical exam may include a rectal or vaginal exam.

Tests include:

  • Urine cytology: A sample of urine is examined under a microscope to look for cancerous or precancerous cells
  • Urine culture: A sample of urine is cultured to look for signs of infection (ie, bacteria)
  • Cystoscopy: A procedure in which a doctor looks into the bladder through the urethra using a cystoscope (a slender tube with a lens and light)
  • Intravenous pyelogram (IVP): X-rays of the bladder, kidneys, and ureters taken after contrast is injected into the bloodstream
  • CT scan: A type of x-ray that uses a computer to make pictures of the inside of the bladder and surrounding structures
  • Magnetic resonance imaging (MRI) scan: A test that uses magnetic waves to make pictures of the inside of the bladder and surrounding structures
  • Ultrasound: A test that uses sound waves to examine the bladder
  • Bone scan: A type of gamma-ray that uses a computer and a special gamma-rays detector to make pictures of the bone if metastases is suspected
  • Biopsy: Removal of a sample of bladder tissue to test for cancer cells

Treatment

Once bladder cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what parts of the body. Treatments for bladder cancer depend on the stage of the cancer. The stages of bladder cancer are as follows:

  • Stage 0: Cancer cells are found only on the surface of the inner lining of the bladder.
  • Stage 1: Cancer cells are found deep in the inner lining of the bladder; no lymph nodes are involved.
  • Stage 2: Cancer cells have spread to the muscle of the bladder; no lymph nodes are involved.
  • Stage 3: Cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder OR possibly to the reproductive organs including the prostate glands; no lymph nodes are involved.
  • Stage 4: Cancer cells extending outside the bladder to the wall of the abdomen or to the wall of the pelvis without lymph node involvement OR have spread to one or more lymph nodes and other parts of the body.

Treatment options include the following:

Surgery involves removal of cancerous cells and nearby tissue. Types of surgery to treat bladder cancer include transurethral resection and cystectomy.

  • Transurethral resection: This is done for early stage or superficial bladder cancer. A cystoscope is placed into the bladder through the urethra. At the end of the cystoscope is a small wire loop, which is used to remove cancer cells. Also, fulguration (using electrical current to burn away remaining cancer cells) can be done during this procedure.
  • Cystectomy (surgical removal of all or part of the bladder): This is done when bladder cancer is invasive. Segmental (partial) cystectomy is the removal of part of the bladder, while radical cystectomy is the removal of the entire bladder and nearby lymph nodes. In men, the prostate is usually also removed. In women, the uterus, ovaries, part of the vagina, and the fallopian tubes may be removed as well. When the bladder is removed, a form of urinary diversion must be created to store the urine.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:

  • External radiation therapy: Radiation is directed at the tumor from a source outside the body.
  • Internal radiation therapy: Radioactive materials are placed near the cancer cells in the bladder through the urethra or through an incision in the abdomen.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including pill, injection, or via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. For bladder cancer, chemotherapy is often administered directly into the bladder, called intravesical chemotherapy.

Biologic Therapy (Immunotherapy)

Biologic therapy is the use of the body's immune system to fight cancer. Substances made by the body or in a laboratory are administered directly into the bladder to help boost, direct, or restore the body's defenses against the cancer. This type of therapy is used only for superficial low-grade cancers that have been resected transurethrally.

Prevention

The following steps can reduce your risk of getting bladder cancer: 

  • Don't smoke or use tobacco products. If you do, quit
  • Avoid or minimize occupational exposure to certain chemicals; follow good work safety practices.
  • Eat a diet rich in fruits and vegetables.
  • Avoid excess intake of high fat or high cholesterol.
  • Minimize the use of phenacetin, a medication.

Prostate Cancer

Prostate cancer is cancer of the small walnut-shaped gland in males that produces seminal fluid, the fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States. A diagnosis of prostate cancer can be scary not only because it can be life-threatening, but also because treatments can cause side effects such as bladder control problems and erectile dysfunction (impotence). But diagnosis and treatment of prostate cancer have gotten much better in recent years.

Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. If prostate cancer is detected early — when it's still confined to the prostate gland — you have a better chance of successful treatment.

Many doctors believe that prostate cancer begins with a pre-cancerous condition called prostatic intraepithelial neoplasia (PIN). PIN begins to appear in the prostates of some men as early as their 20s. Almost half of all men have PIN by the time they reach 50. In this condition, there are changes in how the prostate gland cells look under the microscope, but the cells are basically still in place -- they don't look like they've invaded other parts of the prostate (like cancer cells would). The changes are classified as either low-grade, meaning the patterns of prostate cells appear almost normal, or high-grade, meaning they look more abnormal.

Treatment options vary based on the stage of the tumor. In the early stages, surgery and radiation therapy may be used to remove or kill the tumor.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.

Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis.

At Halifax Health, robotic-trained urologic surgeons are ready to treat you with the da Vinci S Surgical System, a minimally-invasive surgical approach. da Vinci Robotic Surgery