Uro-Oncology

What is Uro-oncology

Uro-oncology is a sub-specialty field within urology that focuses on diagnosing and treating the cancers of the urinary system in both males and females, as well as cancers affecting the male reproductive organs. Cancer of the urological system exerts a substantial strain on our healthcare system, and this issue has elevated the importance of this ailment in the context of our aging society. Read on to enhance your understanding of common urological cancers.

Common Types

• Prostate Cancer: Prostate cancer accounts for 14.1% of male malignancies and contributes to 6.8% of cancer-related deaths (holding the fifth position) and primarily targets men aged 45 to 60. This malignancy serves as the leading cancer mortality in Western countries, manifesting either in localized or advanced forms.
• Bladder Cancer: Bladder cancer (BCa) is the most prevalent urinary tract malignancy, representing about 3% of new cancer cases and 2.1% of cancer deaths affecting male and female populations.
• Kidney Cancer: Renal cell carcinoma (RCC), commonly referred to as kidney cancer, exhibits a higher prevalence in the male population. It is characterized by aggressive histology, larger tumor size, elevated grade and stage, and an unfavorable prognosis. The incidence rates for this condition stand at 5% among men and 3% among women.
• Testicular Cancer (Tca) and Penile Cancer (PeC): These are relatively rare, each accounting for 0.4% and 0.2%, respectively, of all cancers in men. These cancers are responsible for approximately 0.1% of cancer-related mortality in men.

Causes

The exact cause of urological cancer remains unclear. Some of its risk factors include:

• Gene mutation
• Smoking
• Schistosoma haematobium infection
• Work exposure to polycyclic aromatic hydrocarbons
• Consumption of tap water containing chlorine/chlorination byproducts or arsenic contamination
• Family history
• Age
• Gender (Men have over double the risk of urological cancer compared to women)
• Obesity
• High blood pressure
• Advanced kidney disease and prolonged kidney dialysis

Common Symptoms 

The symptoms of urological cancer vary as per organ affected. Some of them are listed below:

• Hematuria
• Erectile dysfunction
• Lower back pain 
• Painful or frequent urination
• Blood at the opening of the penis
• Anemia
• Loss of appetite and weight loss
• Hypertension
• Ankles and leg swelling 
• Breast tenderness or growth in men 
• Variations in size or firmness of testicles
• Pain in a testicle or the scrotum
• Disturbed urine flow
• Lump or cyst near penis or testicle

Diagnostics 

Urologists use comprehensive diagnostic procedures to grade cancer into tumors, lymph nodes, and metastasis. Some commonly used diagnostic tests include:

• X-ray
• Prostate-specific antigen (PSA) test (used to determine the stage of prostate cancer)
• Core needle biopsy
• Magnetic resonance imaging (MRI) 
• Computed tomography (CT) scan
• Angiography
• Positron emission tomography (PET) scan

Treatments 

Treatment options for urologic cancers are diverse and depend on factors such as cancer type, stage, and individual patient characteristics. 

• Surgery: Surgery is a first-line treatment option for urological cancer. The different types of surgeries for urological cancers include prostatectomy, radical cystectomy (surgical removal of the bladder), radical orchiectomy (surgical removal of the affected testicle), and partial or total penectomy (complete or partial penis removal).
• Chemotherapy: These drugs destroy or control the growth of cancer cells and are prescribed along with surgery or radiation therapy to alleviate the symptoms of advanced cancer.
• Radiation Therapy: Radiation therapy includes the administration of X-rays externally to destroy cancer cells. It sometimes entails placing radioactive materials inside or close to the malignant area.
• Hormonal Therapy: This therapy is also called androgen deprivation therapy, prescribed especially to treat advanced prostate cancer that helps to stop or decrease the production of testosterone.
• Targeted Therapy: A precision cancer treatment directs drugs to specific features of cancer cells, inhibiting their growth or preventing new cancer cell formation. It is utilized based on advanced genomic testing and other diagnostics to determine if a patient may benefit, sparing normal cells from the damage seen with traditional chemotherapy.
• Immunotherapy: Immunotherapeutic drugs activate the body’s immune system to target and destroy cancer cells. These classes of drugs detect the cancer cells and enable immune responses to eliminate them.

In order to provide individualized care catered to each patient’s needs and preferences, treatment decisions for urologic cancers are best decided through multidisciplinary teamwork comprising urologists, medical oncologists, radiation oncologists, psychologists, and other experts.

Prevention and Lifestyle Modification 

Prevention and lifestyle modifications play crucial roles in reducing the risk of urological cancers:

• Maintain a Healthy Weight: Obesity is a common risk factor for various urological cancers, including kidney and bladder cancer. A balanced diet and regular physical exercise can help maintain a proper weight and reduce cancer risk.
• Avoid Tobacco: Quitting smoking or avoiding tobacco products can significantly lower the risk of developing bladder and other urological cancers.
• Limit Alcohol Consumption: Moderating alcohol intake or abstaining from alcohol can help mitigate the risk of several urological cancers.
• Stay Hydrated: Staying hydrated may reduce the risk of developing bladder cancer by diluting potential carcinogens in the urine and promoting frequent urination, which helps flush out toxins.
• Practice Safe Sex: Penile cancer has been linked to certain sexually transmitted infections, including the human papillomavirus (HPV). The chance of developing penile and other urological malignancies can be decreased by using condoms and engaging in safe sexual behavior.
• Protect Against Occupational Exposures: Workers in industries with potential exposure to carcinogens like polycyclic aromatic hydrocarbons must use proper protective gear and follow safety procedures to minimize risk. 

Early detection, personalized treatment, and regular follow-up are essential to improve outcomes in urological cancer management. Also, individuals with risk factors are encouraged to enroll in screening programs and adopt preventive measures for their overall well-being.