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Urologic Cancers

Caner Z Dinlenc, MD
Erik T. Goluboff, MD
Aaron B. Grotas, MD

With a Urologic Oncologist on staff, the Sol and Margaret Berger Department of Urology at Mount Sinai Beth Israel in Manhattan, New York City treats the entire spectrum of urologic cancers with a team approach of highly trained urologic surgeons, laparoscopic surgeons, radiation oncologists, urologic fertility experts, pathologists, radiologists, and oncology nurses. The department works closely with Continuum Cancer Centers of New York, the multi-specialty cancer treatment center for both Mount Sinai Beth Israel and Mount Sinai St. Luke's Roosevelt. Support staff and services including individual, family, and group support counseling are offered as part of our comprehensive treatment plan.

Dr. Caner Dinlenc of the Berger Department of Urology at Mount Sinai Beth Israel recently performed a live webcast of a robotic prostatectomy, showcasing our expertise in minimally-invasive solutions to cancerous prostate removal. To view the webcast, email questions to the surgeons and learn the tremendous patient benefits of robotic prostatectomy, click here.

PROSTATE CANCER
TESTICULAR CANCER
BLADDER CANCER
KIDNEY CANCER
ADRENAL CANCER

TESTICULAR CANCER
The testicles are responsible for producing sperm, which fertilizes the female egg for reproduction, and testosterone, which is the hormone accounting for most male sexual characteristics. The testicles lie within the scrotal sac. They are normally smooth and roughly of equal size. It is common that one testicle lies lower than the other testicle. A soft tube-like structure called the epididymis lies behind the testicle and collects the sperm. The sperm travels up the vas deferens and is deposited in the prostate during sexual activity at the time of orgasm.

Testicular cancer is one of the most common cancer of men ages 15-34. Approximately 7,400 young men develop testicular cancer yearly. Men with a past history of having a testicle that is not completely descended into the scrotum at birth are at a much higher risk of developing testicular cancer. Men with either a father or a brother with testicular cancer are also at higher risk.

If discovered in the early stages, testicular cancer can be treated very effectively. Remarkable strides have been made in treating testicular cancer; cure rates are now above 95%. It's important for you to take time to learn the basic facts about this type of cancer - it's symptoms, treatment, and what you can do to get the help you need when it counts.

Symptoms
The first signs of testicular cancer can be subtle. You may simply notice a slight enlargement of one of the testes or a change in its consistency. Pain may be absent, but at times there is a dull ache in the lower abdomen and groin, together with a sensation of dragging and heaviness. Some men feel a hard lump or nodule in the testicle. Sometimes, a sign is breast discharge or tenderness.

Your best hope for early detection of testicular cancer is a simple monthly examination which only takes a minute. The best time is after a warm bath or shower, when the scrotal skin is most relaxed. Roll each testicle gently between the thumb and fingers of both hands. If you find any hard lumps or nodules, you should see your doctor promptly. They may not be malignant, but only your doctor can make the diagnosis. Following a thorough physical examination, your doctor may perform certain X-ray studies to make the most accurate diagnosis possible.

Diagnosis
If a patient presents with symptoms of testicular cancer, more thorough testing is needed. A history will be taken to determine risk factors, and a thorough physical exam will be done. Diagnostic tests such as ultrasound and CT scans are used to determine the size and type of mass, and blood tests will look for cancerous markers. If the above tests cannot determine the type of mass found, a biopsy will be done to determine if it is benign or cancerous.

Treatment
Surgery is usually the initial form of treatment and typically requires removal of the testicle. Depending on the type of cancer present, additional surgical treatment to remove lymph nodes, radiation treatment, or chemotherapy is sometimes necessary. If additional therapy is necessary, there can be effects on future fertility. You should discuss fertility issues and concerns with your doctor before treatment.

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ADRENAL CANCER
Adrenal Cancer is a rare urologic cancer (about 1 person/million), and affects the adrenal glands, which control the production of certain hormones. The adrenal glands are located on the top of the kidneys. Most adrenal tumors are non-cancerous (benign) and do not require treatment. Its cause is unknown, with heredity being a risk factor for individuals with a family history of the disease. Cancers in other areas may also metastasize (spread) to the adrenal glands.

Types of Adrenal Cancers
Pheochromocytoma (usually found in ages 30-50)
Neuroblastoma (usually found in infants and children)
Adrenocortical Carcinoma

Symptoms
Some adrenal cancers produce no symptoms, but for those that do, symptoms vary on whether the tumor is functioning (overproducing hormones) or non-functioning (does not produce hormones), and by the particular hormone that is being overproduced.

Some individual symptoms of functional tumors are: fever, constant abdominal pain, unexplained weight loss, gynemasticoma (breast enlargement in men), abnormal hair growth in women or children, hyperglycemia (abnormal blood sugar/diabetes), early puberty in children.

Some adrenal cancers have symptoms that are exclusive to them. The types and their particular symptoms are:

Cushing’s Syndrome
Bruising easily, absence of menstruation, abnormal hair growth in women, osteoporosis,
severe acne, slowed growth rate in children, muscle weakness, flushing (redness), hyperglycemia

Conn’s Syndrome
Chronic thirst, hyperglycemia, excessive urination, low potassium level in the blood

Pheochromocytoma
Sustained high blood pressure that is resistant to treatment, severe headaches, sweating, rapid pulse, nausea

Diagnosis
Diagnosis for adrenal cancer involves a medical history, a physical exam, imaging (CT and MRI) tests to view the adrenal gland and look for growths, and a blood and urine test to test for abnormal hormone levels. If necessary, a biopsy will be done to determine if any growths are benign or cancerous.

Treatment
Treatment for adrenal cancer will depend on the stage of the cancer at time of diagnosis and the symptoms shown, as some symptoms of adrenal cancer must be under control before undertaking further treatment.

Treatment options are:

  • Medical management - to control the symptoms of increased hormone production
  • Chemotherapy - using drugs to destroy cancer cells or suppress adrenal gland function
  • Radiation - using focused X-rays to destroy cancer cells (not a primary treatment)
  • Surgery - removal of the adrenal gland, the only cure for the disease

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BLADDER CANCER
Bladder cancer primarily involves tumors in the layers of the bladder lining, and accounts for 90% of the cancers of the urinary tract. Tumors are categorized as either superficial or invasive, depending on their location in the bladder lining.

Incidence of bladder cancer is highest in industrialized nations, and is three times more common in men than women, with the average age at diagnosis being 65.

Development of bladder cancer may originate with cancer-causing agents in the urine, with smoking contributing to 50% of the cases. Other risk factors are a diet high in saturated fat, family history, race (caucasians have higher risk), and parasitic infection. Certain occupations may also increase your risk for bladder cancer through repeated exposure to chemicals used in paints, inks, hair dyes, chemotherapy drugs, leather, rubber and textiles.

Symptoms
The primary symptom of bladder cancer is blood in the urine (hematuria). Hematuria may be visible or microscopic (visible only under a microscope) and is usually painless. Other symptoms may include frequent urination and painful urination (dysuria).

Diagnosis
Diagnosis for bladder cancer involves a medical history (to determine risk factors), urine tests (to test for blood, cancer cells or infection), and imaging tests. The primary imaging test for bladder cancer is the Intravenous Pyelogram (IVP), in which a radiopaque dye is administered intravenously and X-rays are taken as the dye moves through the urinary tract. This test provides information about the structure and function of the entire urinary tract. Other imaging tests that may be used in diagnosis are a CT scan, MRI scan, bone scan, and ultrasound.

If cancer is suspected, a cytoscopy (a small telescope used to evaluate the bladder walls, inserted via the urethra) will be performed or a biopsy will be taken of the tumor to check for cancerous cells.

Treatment
Treatment for bladder cancer will depend on the stage of the cancer at time of diagnosis and other factors, such as age and health of the patient.

There are four treatment options for bladder cancer; chemotherapy, radiation, immunotherapy, and surgery, with some of these treatments being combined in certain cases.

  • Chemotherapy - Using drugs to destroy cancer cells. These may be delivered orally, intravenously, or in early stage cases, by direct infusion into the bladder.
  • Radiation - Using focused X-rays to destroy cancer cells, delivered to the bladder by external beam or by radioactive seed implant.
  • Immunotherapy – Using a vaccine, delivered via infusion, to build up the immune system and it’s ability to fight cancer. This treatment is used in early-stage superficial cases.
  • Surgery - Surgical treatment will depend on the stage of the disease. Early-stage tumor removal can be accomplished on a minimally invasive basis, preserving the bladder. Later-stage cases may involve either partial or total removal of the bladder, as well as surrounding lymph nodes. This will result in the patient permanently having a urostomy or other urinary diversion to remove urine from the body.

Bladder cancer does have a high rate of recurrence, so it is very important to be evaluated closely in the first two years after treatment to check for any new occurrence of the disease. You should be re-evaluated every six months to one year thereafter.

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KIDNEY CANCER
The kidneys act as a 'filter' for the body, removing waste products from the bloodstream and removing these waste products from the body in the form of urine. The kidneys also produce hormones that regulate blood pressure, calcium absorption and the production of red blood cells in bones. Renal Cell Carcinoma (RCC) is a form of kidney cancer that accounts for the vast majority (85%) of cases of the disease. With RCC, cancerous cells grow on the inside of the kidney’s tubules and eventually form a tumor.

In the United States, there are about 30,000 new cases of kidney cancer every year. As with most other cancers, if diagnosed early, kidney cancer is highly curable, and tumors that are discovered early respond very well to treatment. Generally, the disease affects men and women between the ages of 50 and 70, affecting men about two times more than women.

Symptoms
There are numerous symptoms to kidney cancer, with the following being most common:

  • Blood in the urine (hematuria)
  • A mass or lump in the abdomen, or persistent pain in that area
  • Unexplained fever
  • High blood pressure
  • Constant fatigue
  • Swelling of the legs and ankles
  • Rapid, unexplained weight loss

Diagnosis
If symptoms of a patient indicate a possibility of kidney cancer, numerous tests must be done to confirm that diagnosis. These begin with:

  • A physical and medical history (to determine risk factors)
  • Laboratory tests, which may include:
  • A urine test (to test for blood in the urine, cancer cells or infection)
  • A blood test (to test for too few ((anemia)) or too many red blood cells or elevated calcium or liver enzymes)
  • Imaging tests, such as a CT scan, MRI scan, bone scan, X-ray, Intravenous Pyelogram (IVP), and ultrasound are used to provide a visual picture of the kidney and any abnormalities.
  • Biopsy of the tumor, for microscopic analysis

Treatment
Treatment for kidney cancer will depend on the stage of the cancer, location (one or both kidneys) and other factors, such as age and health of the patient. There are few treatment options for kidney cancer, and generally involve surgery with or without immunotherapy. Surgery remains the mainstay of treatment, as the majority of tumors are resistant to chemotherapy and radiation. Kidney cancer patients are evaluated closely after treatment to check for any new occurrence of the disease, involving physical exams, X-rays and blood tests.

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