Urological Cancer Program

The Nanavati Max Institute of Cancer Care is a centre of clinical and surgical excellence backed by the expertise of a highly experienced and specialized team of Urological Oncosurgeon, radiation oncologists, medical oncologists, oncopathologists, radiologists, interventional radiologists and nuclear medicine specialists supported by a highly specialized and state of the art infrastructure, working towards ensuring the best outcomes for all patients afflicted with urological and genital cancers.

The urological malignancies represent complex malignancies that affect organs that comprise the urological system in men and women; and the male genital system, including adrenal, kidney, bladder, ureteric, prostate, testicular, penile and urethral cancers as well as retroperitoneal tumours.

We are a tertiary care high volume centre that provides a comprehensive, evidence-based, multidisciplinary, individualized treatment aimed at ensuring the most optimum outcomes in terms of improved cure rates with reduced morbidity, and organ, function, fertility preservation in suitable patients and providing a good quality of life to the patients. We specialize in complex surgical procedures and multiorgan resections for urogenital cancers.

We also offer robotic surgery with the state of the art Da Vinci Xi robot for management of urological cancers and endoscopic treatment for bladder cancers. The common surgical procedures carried out in our centre include partial nephrectomy (nephron sparing surgery), radical nephrectomy, IVC thrombectomy, metastasectomy for kidney cancer, radical cystectomy with urinary diversion/reconstruction, transurethral resection for bladder cancer, robot assisted radical prostatectomy for prostate cancer, partial or total penectomy as well as conservative surgery and groin node dissection for penile cancer, inguinal orchidectomy and nerve sparing retroperitoneal lymph node dissection for testicular cancer; and adrenal mass excision for adrenal tumours.

Types of Urogenital Cancers

There are several types of urological and genital cancers, depending on the organ of origin. They are as follows:

• Kidney cancer: It is of two main varieties viz. renal cell carcinoma and urothelial carcinoma of the renal pelvis. Traditionally considered a disease of middle aged and elderly, it is now seen more and more commonly in the younger age group. Majority are asymptomatic in nature and are often diagnosed incidentally by ultrasonography as a part of health check up or during a course of investigations for some other ailment.
• Bladder cancer: Second commonest urological cancer. Seen commonly in the older age group and more prevalent in males. More common among smokers and those with long-term contact with certain dyes and chemicals.
• Prostate cancer: Commonest urological cancer and second most common cancer among males. Usually seen after the age of 60 years. A blood protein (tumour marker) prostatic specific antigen (PSA) can help to diagnose this disease early. Can be genetically transmitted.
• Testicular cancer: Develops in the germ cells of the testis. It is a cancer of the young men where preservation of fertility and sexual function are as important as cure from the disease. They are further broadly classified into seminomas and non-seminomas.
• Penile cancer: An uncommon cancer seen in middle aged and elderly patients. Phimosis (inability to retract the penile skin) is a high risk factor for this cancer.
• Ureteric cancer: is the cancer that arises in the tubes that drain the urine from the kidneys to the bladder.
• Urethral cancer: Arises in the outflow tube that carries urine from the bladder to outside.
• Adrenal tumours: Adrenal glands are situated above the kidneys like a cap. Cancers arising in these are called adrenocortical carcinomas or malignant pheochromocytomas.
• Retroperitoneal tumours: Situated behind the bowels in the vicinity of major blood vessels and can be of various types eg sarcomas, lymphomas, metastatic cancers etc.

Urogenital Cancers Symptoms

While the symptoms of each of these cancers are specific, there are several common symptoms and signs, which may indicate the presence of these cancers, viz.

1. Painless haematuria (blood in the urine), which may be episodic or persistent
2. Difficulty in passing urine, frequency of urination, burning or pain during urination, weak urinary stream, urgency, hesitancy and sense of incomplete evacuation of urine
3. Inability to void urine or urinary retention
4. Abdominal, pelvic pain or backache of recent origin
5. Abdominal or pelvic mass
6. Testicular swelling
7. Lump or swelling in the groin
8. Penile growth or ulcer on penis that does not heal with medical treatment
9. Abdominal distension or bloating
10. Swelling (oedema) of the lower extremities
11. Cough, breathlessness, blood in the sputum
12. Loss of appetite
13. Sudden or unexplained weight loss
14. Weakness, fatigue
15. Bone pains
16. Nausea, vomiting
17. Fever of unknown origin which is persistent or recurrent

Urogenital Cancers Causes

Although the precise cause is not known, there are certain associated factors or conditions that predispose to these cancers;

1. Smoking or tobacco use
2. Contact with dyes or chemicals
3. Infections like schistosomiasis
4. Chronic irritation of urinary tract with stones, repeated inflammation etc.
5. Human papilloma virus infection
6. Advancing age
7. Obesity
8. Lack of physical activity
9. Consumption of fatty or processed food and red meat
10. Family history of cancer especially for prostate cancer

Urogenital Cancers Treatment Options

The management of urological cancers is multimodal, with surgery as the mainstay of treatment, supported by systemic chemotherapy or immunotherapy and radiation therapy.

Surgery

Surgical treatment of urological cancers is often complex and requires a high degree of expertise, precision and experience. Prostate cancers and some renal cancers are managed by advanced robotic surgery, which reduces the recovery time and hospital stay; and ensures a faster return to full daily activities.

Our surgical team has a huge experience in treating these cancers for over 35 years, with excellent outcomes. In fact, our urologic surgical oncologist has been an important member of the team that has pioneered and standardized these surgeries and other treatment approaches in India. Many patients from across the country that need extensive or complex surgical options are referred to our centre for surgical treatment.

Prostate cancers and some renal cancers are managed by advanced robotic surgery, which reduces the recovery time and hospital stay; and ensures a faster return to full daily activities. Our focus is also on organ and function preservation through conservative surgery (for renal and penile cancers) or with use of non-surgical modalities of treatment (for bladder and prostate cancers).

At our centre, we offer a comprehensive array of surgical interventions including but not limited to the following:

• Kidney cancer: Partial nephrectomy (nephron sparing surgery), Radical nephrectomy, Nephroureterectomy, IVC thrombus excision, Metastasectomy
• Bladder cancer: Transurethral resection, Radical cystectomy with urinary diversion, Partial cystectomy, Urethrectomy
• Prostate cancer: Robot assisted radical prostatectomy
• Penile cancer: Conservative surgery (wide excision, glansectomy), partial or total penectomy, radical or modified inguinal node dissection
• Testicular cancer: High inguinal orchidectomy, Retroperitoneal lymph node dissection
• Adrenal tumours: Excision of adrenal tumours

Systemic Chemotherapy

Chemotherapy involves the use of a combination of drugs that make the existing tumours smaller by killing the cancer cells and/or prevent growth of new cancer cells. Since these drugs are injected into the bloodstream, they reach all parts of the body and act on cancer cells even at sites distant from the primary tumours. In urological cancers management, chemotherapy is used either before surgical treatment or after surgical treatment to improve the outcomes. It can also be used with radiation therapy in bladder preservation protocols. It is the main line of treatment when the cancer has spread to distant organs.

Radiation Therapy

Can be given externally for prostate and bladder cancers or internally using radioactive material delivered through special equipment for conservative treatment of penile cancer. With modern radiotherapy machines and advanced techniques of radiation delivery, the results of radiation therapy in properly selected patients are good in terms of survival and side effects.

Immunotherapy

This boosts the patient’s own immune system to target and destroy cancer cells. It is now being increasingly used in the treatment of kidney, bladder, and prostate cancers.

Other Novel Therapies

Targeted drug therapy implies the use of drugs that target specific molecular targets associated with certain cancers e.g. kidney cancer. Radio-isotope therapy with Lutetium (theranostics) is used to alleviate pain and control disease in patients with advanced metastatic prostate cancer.

What Factors Should Be Considered When Choosing a Urologic Cancer Hospital?

When choosing a urologic cancer hospital, several factors should be considered, including the hospital's experience and expertise in treating urologic cancers, the availability of advanced diagnostic and treatment technologies, the hospital's location and accessibility, and the quality of its support services, such as nursing care, rehabilitation, and counselling.

What are The Long-Term Outcomes for Urologic Cancer Patients?

The long-term outcomes for urologic cancer patients depend on factors like the type and stage of cancer, the patient's age and health, and effectiveness of the chosen treatment. With appropriate treatment at Nanavati Max Hospital, many patients with urologic cancer can achieve long-term remission and maintain a good quality of life.