Such medical branch as urological oncology deals with benign and malignant neoplasms of female and male urinary system: study, diagnosis and treatment. All excretory organs without exception can be affected by tumor process. Tumors can be primary (growing directly from organs of excretory system) or secondary (metastases of malignant malformations of another location).
Urology Oncology diseases are serious lesions, but with timely detection and comprehensive modern treatment, they are completely curable. Our clinic actively and fruitfully cooperates with the best Israeli oncology centers. We took Israeli medicine as a model of providing medical services becauce it is one of the most effective in the world. Each individual clinical case is monitored not only by the attending oncologist, but also by the head of the department – Dr. Iryna Stefanska and responsible oncologist directly from Israel.
Renal cell cancer ranks 10th among all malignant neoplasms and accounts for 2-3% of registered cases total number per year. Men get sick 1.5 times more often than women. The peak incidence is registered at the age of 60 -70 years. Malignant tumors of renal pelvis and ureter are also rare and account for up to 4% of all malignant neoplasms. Cancer of this localization is registered mainly in men aged 40 to 60 years. Bladder cancer is more common among men. In men, malignant tumors of urinary bladder take the 4th place among the most common oncological lesions. Prostate cancer is the most common malignant disease among men. The peak incidence is 65-70 years.
If necessary, every patient of Maimonides Medical Center can receive financial assistance for treatment, because our clinic works under the patronage of “Keren Or for our Child” the Charitable Foundation. . If someone needs expensive treatment but is unable to pay for it, foundation can fully or partially finance diagnostic or treatment program. The fund's assets are replenished due to voluntary contributions from various global companies and ordinary people who are indifferent to people’s fate around them.
Types of urinary system tumors
1. Renal cell carcinoma is the most common type of kidney cancer. Symptoms may include blood in urine, flank pain, a palpable mass, and fever of unknown origin. However, symptoms are often absent, so diagnosis is usually suspected based on incidental findings on ultrasound.
Diagnosis is confirmed with the help of CT or MRI, sometimes with the help of biopsy . Treatment includes tumor surgical removal in the early stages of process and targeted, experimental or palliative therapy in the later stages. Renal cell cancer, represented by adenocarcinoma , accounts for 90-95% of primary kidney malignant neoplasms. Less common primary kidney tumors include transitional cell carcinoma, Wilms tumor (most common in children), and sarcoma. As a rule, people aged 50-70 years are sick.
Extrarenal tumors can metastasize to kidneys. The most common malignancies that metastasize to kidneys are melanomas and solid tumors, namely tumors of lung, breast, stomach, female reproductive system, intestine, and pancreas. With leukemia and lymphomas, kidneys can also be affected.
2. Cancers of renal pelvis and uretersusually include urothelial carcinoma and occasionally squamous cell carcinoma. Characteristic symptoms are appearance of blood in urine, sometimes pain. Diagnosis is made by CT scan, urinalysis and sometimes biopsy . Treatment is mainly surgical.
3. Bladder cancer is usually represented by transitional cell (urothelial) carcinoma. As a rule, patients, complain blood in urine appearance or imperative urges to urinate. Diagnosis is carried out by cystoscopy and tumor biopsy . Treatment consists of radical surgery, chemotherapy, remote radiation therapy, or a combination of these methods.
Types of bladder cancer include:
- Transitional cell carcinoma (urothelial carcinoma), which accounts for more than 90% of all cases. Most tumors are papillary, have a tendency to superficial localization, high degree differentiation and an exophytic type of growth. Flat tumors are more insidious, prone to earlier invasion and metastasis.
- Squamous cell carcinoma is less common, usually in patients with parasitic invasion of bladder or mucosa chronic inflammation.
- Adenocarcinoma , which can be a primary tumor or, in rare cases, metastases of intestinal cancer. It is necessary to exclude metastatic process.
4. Urethral cancer is rare in both gendedrs and may present as squamous or transitional cell carcinoma or occasionally adenocarcinoma. Most patients are over 50 years old. In some cases, disease is associated with certain strains of human papilloma virus. Urethral tumors grow into neighboring structures in early stages and therefore are usually diagnosed late. External inguinal or pelvic lymph nodes are usually the first point of metastasis.
5. Prostate cancer is usually represented by adenocarcinoma . Symptoms are usually absent until tumor growth causes hematuria and/or urethral obstruction and pain. Diagnosis is usually suspected based on digital rectal examination results or PSA level measurement , confirmed by transrectal ultrasound or biopsy. Treatment consists of prostatectomy, radiation therapy, hormonal therapy, chemotherapy, and palliative measures.
6. Testicular cancer is first detected as a tumor in ortcullis, usually painless. Diagnosis is carried out with the help of ultrasound examination. Treatment consists of tumor surgical removal, radiation therapy, chemotherapy or their combination, depending on tumor histological structure and the stage of process. Testicular cancer is the most common type of solid malignant neoplasm in men aged 15–35 years . In patients with cryptorchidism, disease occurs 2.5-20 times more often.
7. Most cases of penile cancer are represented by squamous cell carcinoma Diagnosis is made on basis of biopsy data. Treatment includes tumor excision. Penile cancer is rare. Human papillomavirus (HPV), especially 16 and 18 types, plays an important role in this type of malignant lesion etiology. Other risk factors include frequent balanitis, lack of circumcision, sexually transmitted infections (especially HIV/AIDS and HPV), poor hygiene, and tobacco use.
Causes and symptoms
The direct cause of any tumor development is a mutation in a certain cell , as a result of which it acquires the ability for uncontrolled growth and division. What exactly causes this breakdown is currently unknown, but there are factors that increase developing risk of malignant neoplasms.
The following risk factors for urinary system cancer are distinguished:
- Smoking(the most common risk factor for bladder cancer).
- Excessive intake of phenacetin(analgesic abuse).
- Long-term use of cyclophosphamide.
- Chronic irritation of urinary bladder mucous membrane (for example, with schistosomiasis, long-term catheterization or bladder stones).
- Exposure to hydrocarbons, tryptophan metabolites, or industrial chemicals, especially aromatic amines (aniline dyes such as naphthylamine used in dye industry) and chemicals used in rubber, electrical cable, and paint industries.
- Infection with human papilloma virus.
- Sexually transmitted infections.
Symptoms of malignant lesions of genitourinary system organs depend on lesion localization. As a rule, there are no manifestations in the early stages, and disease is discovered accidentally during an examination for another reason. In the late stages, the most common symptoms are blood in urine and pain.
Diagnostic methods in urological oncology
The basic rule of diagnosis in oncology: the earlier diagnosis of a malignant tumor is established, the better prognosis and treatment result. . Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern equipment of an expert class, all our doctors perfectly master all examining methods of patients with urinary system malignant neoplasms suspicion. They know how to correctly received data interpret, which helps them create a modern, individual and effective treatment plan.
As a rule, various combinations of following examinations are used:
- Examination by urologist oncologis and complaints, life history and illness collection.
- Various blood and urine tests , if necessary, other specific blood and urine tests, for example, PSA determination (prostate-specific antigen – tumor marker of prostate cancer).
- X-ray (including with contrast of urinary system organs), CT, MRI, PET-CT, PET-MRI, MSCT with and without contrast –medical detailed visualization methods in urology.
- Scintigraphy for distant metastases diagnosis in case of excretory and reproductive system malignant diseases.
- Ultrasound of kidneys, prostate, bladder and blood vessels.
- Neoplasm biopsy and biopsy specimens histological examination to verify diagnosis.
- Cystoscopy, ureteroscopy – organs examination from inside using endoscopic techniques. If necessary, a biopsy or medical procedure is immediately performed, for example, polyp removal in urinary bladder or a stone from ureter, etc.
- Urodynamic studies – allow to diagnose some problems of the urinary bladder. For example, micturition cystography allows to find vesicoureteral reflux, etc.
After biopsy we send all obtained tissue samples to the world's best pathogistological laboratories (Israel, Germany, USA).Thanks to such double checks, we are absolutely sure of diagnosis correctness and effectiveness of the selected treatment tactics.
Innovative molecular genetic tests are also available to our patients after biopsy. . This is a mandatory part of modern diagnosis of oncological diseases. Thanks to molecular genetic diagnostics, we can choose the most effective treatment regimens, because the response to certain drugs action depends on the type of malignant changes.
An example of such modern diagnostics are test systems for molecular genetic testing. Such as the Foundation One and Caris Molecular Testing. These tests make it possible to determine certain types of mutations in tumor cells, as well as certain receptors presence on the surface of these parasitic cells. These data are subsequently used to create individual immunobiological therapy drugs or to select target therapy drugs. In modern medicine this approach is called personalized oncology.
Our patients have access to all this innovative treatment benefits. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Modern treatment in urological oncology
One of significant advantages of urinary system tumors treating at Maimonides Medical Center is a complex treatment approach application. Struggling against tumor, specialist uses the entire available arsenal of methods. Therapy is always a combination of two, three, or even more methods. As a rule, treatment regimen includes tumor surgical removal in combination with chemotherapy and radiation therapy. In some cases, certain innovative treatment methods are added to treatment program(targeted drugs, immunobiological drugs, etc).
The main treatment method of excretory organs malignant neoplasms is surgical removal . Surgeries can be minimally invasive or radical (it all depends on clinical situation). If clinical situation allows, urological surgeons always prefer minimally traumatic and organ-preserving interventions, and in 45% of cases they succeed.
The following modern treatment methods and surgical procedures are widely used in clinic:
- Holmium laser ablation of prostate (HoLEP).
- Transurethral resection (TUR) of prostate neoplasms.
- Laparoscopic radical prostatectomy.
- Laser endoscopic prostate tumors removal.
- Prostate tumors removal using the new TOOKAD method.
- Ultrasonic ablation of tumors with focused high-intensity ultrasound.
- Cryoablation of the prostate gland.
Robotic surgeries using "Da Vinci" device are used in urology for radical robot-assisted prostatectomy. In this procedure, instruments are not in surgeon’s hands, but fixed in manipulators of robotic installation, while doctor is at the control panel. Thanks to this innovative approach, all surgery risks are minimized.
Open prostate removal is used in the most difficult cases, when it is impossible to remove damaged by a malignant tumor prostate gland laparoscopically.
Radiation therapy is actively used for genitourinary system lesions. It can be remote and contact. Remote radiation therapy (radiotherapy) is carried out using the most modern equipment.
Innovative Ethos device allows us to conduct a radiotherapy session for prostate cancer in just 15 minutes. This device not only made radiation safer and faster, but also significantly increased its efficiency, and also provided such possibility like daily monitoring of achieved results. The artificial intelligence of Ethos device helps to take into account every day dynamics and direct particles flow precisely to tumor, increasing the dose exactly where it is needed, and not radiating healthy organs and tissues.
Also, during prostate gland radiation therapy in the clinic, a modern method of special gold labels or markers introducing ("gold grains") into prostate area is used. This allows more precisely focusing radiation at desired point. Together with "golden grains", a special SpaceOAR hydrogelis used, which allows to separate prostate gland from neighboring organs maximally and thereby protect them from possible radiation.
Brachytherapy (contact radiation therapy) is relevant only when localized cancer is detected, since radiation does not spread further than 2 mm from capsule. Brachytherapy is considered an innovative radiation therapy method, which involves radiation source implantation into a pathological focus. If focus is large, then a 3-month course of cytostatics (chemotherapy course) is indicated before brachytherapy.).
Systemic therapy (chemotherapy, immunobiological drugs) is used in complex treatment, for example, of kidney cancer. Medicines reduce the size of tumor and prolong patient’s life. About 10-20% of patients respond to treatment with interferon alpha-2b or IL-2. At late stages of tumor process, many targeted drugs have proven their effectiveness: sunitinib, sorafenib, bevacizumab, pazopanib, cabozantinib, axitinib, and lenvatinib (tyrosine kinase inhibitors).
he most moder systemic treatment methods are immune checkpoint inhibitors (monoclonal antibodies). Effective systemic treatment combinations include axitinib + pembrolizumab, cabozantinib + nivolumab, levantinib + pembrolizumab, and ipilimumab + nivolumab.
In each case, decision on certain treatment methods combination is made jointly by a team of specialists. Each patient and his disease is different, so our doctors, relying on their experience in urinary system tumors treatment, often go beyond the standard protocols, changing treatment regimens and doses of necessary drugs, radiation technique in order to obtain the best possible results for their patients.