Uro-oncology, also known as urological oncology, is a specialised discipline of oncology that focuses on cancers of the urinary tract in both men and women, as well as tumours of the male reproductive organs.

This discipline comprises the risk assessment, prevention, screening, diagnosis, treatment and palliative care of patients with urological cancers.

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Types of Urological Cancers

1. Adrenal Cancer: Adrenal cancer is a rare type of cancer that forms in the adrenal glands, which are the triangular glands that are located on top of both kidneys. Cortex and medulla are the two parts of the adrenal glands, and adrenal cancers usually form in the cortex.

2. Bladder Cancer: Bladder cancer occurs when the cells present in the lining of the bladder start growing abnormally. One of the first symptoms of bladder cancer is the presence of blood in the urine. Bladder cancer is more common in men than women.

3. Kidney Cancer: Also known as renal cancer, kidney cancer is a rare form of cancer that happens when the cells present in the kidneys start dividing uncontrollably. Smoking is one of the risk factors for kidney cancers. If detected early, kidney cancers can be treated successfully.

4. Prostate Cancer: Prostate cancer is one of the common cancers among Indian men. Prostate cancer occurs when the cells of the prostate gland divide uncontrollably. It is one of the highly treatable cancers that can be caught in the early stages through regular screening.

5. Testicular Cancer: Testicular cancer occurs when the cells present in the testicles or testes start dividing uncontrollably. It is one of the rare cancers, and it is more common among men aged between 15 and 45 years. Testicular cancers can be treated with positive clinical outcomes if detected in the early stages.

6. Urethral Cancer: This is a rare type of cancer that occurs when the cells present in the urethra (a tube through which urine is expelled out of the body) start dividing abnormally. Initially, the patient may not show any symptoms; however, as the disease progresses, the patient may have problems related to urination.

7. Penile Cancer: Penile cancer is one of the rare cancers, and it is more common among uncircumcised men. Chronic HPV infection is also a risk factor for penile cancer. Penile cancers are treated best when they are detected in their early stages. Patients need to be mindful of the changes in the colour, texture of the organ and presence of lesions, as these could be the signs of penile cancer.

Diagnosis and Treatment

Diagnosis of Urological Cancers

To be treated with positive clinical outcomes, urological cancers have to be diagnosed in the early stages. A few urological cancers cause early symptoms, and they must not be ignored.

Some of the primary symptoms associated with urological cancers include blood in the urine, problems related to urination, lower back pain, unusual discharge, presence of a lump, swelling caused due to enlarged lymph nodes, etc.

There are multiple tests recommended by specialists for the diagnosis of urological cancers.

Physical Exam and Medical History Assessment: Initially, when a patient presents oneself with symptoms of urological cancers, the doctor conducts a quick physical exam and takes note of the patient’s medical history. Upon examination, if the doctor suspects cancer, additional tests may be recommended.

Cystoscopy or Ureteroscopy: Cystoscopy or ureteroscopy may be recommended to examine the bladder and ureter for the presence of tumours. During these procedures, a thin tube that is fitted with a light source and video camera is inserted through the urethra to examine the urinary tract.

Lab Tests: Specific blood tests, such as the PSA test, could help in the detection of prostate cancer. Blood tests could also be recommended to examine kidney functions. However, it is important to note that there is no possible way to arrive at a definitive diagnosis with lab tests alone, and additional tests will be recommended for a conclusive diagnosis.

Imaging Tests: Imaging tests may be recommended for the diagnosis, staging and surveillance of urological cancers. Most commonly recommended imaging tests include ultrasound scans, PET scans, CT scans and MRI scans. A few of these imaging tests may be written throughout the treatment of urological cancers to study the treatment response shown by patients.

Biopsy: During the biopsy, a small amount of the tissue from the suspected area is carefully collected and examined under a microscope for the presence of cancerous cells. Biopsies may be performed endoscopically or surgically, depending on the organ that is affected by cancer.

Treatment of Urological Cancers

Upon considering multiple factors, such as the stage of the tumour, its grade, the patient’s age, his/her overall health condition and her preferences, specialists devise treatment plans for urological cancers.

The primary treatment options available for urological cancers include surgery, radiation therapy and chemotherapy. A few advanced-stage urological cancers and those cancers that do not show any response to the conventional treatment approaches may be treated with hormone therapy (prostate cancer), immunotherapy and targeted therapy.

Doctors may either employ open or minimally-invasive surgical approaches for the management of urological cancers. Laparoscopic and robotic surgeries are two minimally-invasive approaches that are widely used.

In the case of bladder cancers, an alternate pathway should be created for the patient to expel the urine out of the body. In such cases, the surgeon may create a stoma, which is an artificial opening through which the urine passes. The surgeon may also perform a neobladder reconstruction, wherein a portion of the small intestine is used to build a bladder, which will be later connected to the urethra. Through this procedure, the patients will be able to have normal urination after the treatment.

For testicular and penile cancers, there are options wherein the patients can undergo organ reconstruction surgery that helps in restoring the structure of the cancer-affected organ.

In a few cases where the cancer is in the early stage or if the patient is not able to undergo surgery due to age or any other circumstances, doctors may recommend ‘watchful waiting’ or ‘active surveillance’. During watchful waiting and active surveillance, the patient is regularly monitored with the help of a few tests, and the treatment will be provided only if the disease progresses. These approaches aid in preserving the quality of life among patients.

Uro-Oncology Care at HCG

At HCG, just like other cancers, urological cancers are treated with a multidisciplinary team-based approach. Our multidisciplinary team comprises surgical oncologists, robotic surgeons, medical oncologists and radiation oncologists, along with pain management specialists and onco-dieticians – all together ensure that the patient is provided with compassionate medical attention and care.

Our specialists give utmost importance to delivering patient-centric and personalised care to patients. We use advanced technologies and ground-breaking protocols for the diagnosis and treatment of all urological cancers.

The HCG network has a good number of uro-oncologists who are well-trained and highly experienced in the diagnosis, treatment and management of various urological cancers. The uro-oncology department at HCG is well-equipped with high-end facilities and employs safe and precision-driven treatment approaches, namely minimally-invasive surgeries, robot-assisted surgeries, chemotherapy, radiation therapy, immunotherapy, targeted therapy, etc., for the effective management of urological cancers.

Key treatment services offered at HCG include:

• Open and robotic (minimally-invasive) radical prostatectomy and pelvic lymphadenectomy for prostate cancer
• Open, laparoscopic and robotic partial nephrectomy/nephron-sparing surgery kidney cancers and nephroureterectomy for urothelial carcinoma of kidney and ureter
• Open and robotic radical cystectomy
• Ileal conduit/neobladder reconstruction (to enable the patient to pass urine naturally after removal on the urinary bladder) for bladder cancers
• Open and robotic adrenalectomy for benign tumours and cancers of the adrenal gland
• Open and robotic retroperitoneal lymphadenectomy for testicular cancers
• Open, laparoscopic and robotic video endoscopic inguinal lymphadenectomy for penile cancers
• Salvage surgical procedures
• Orchiectomy – removal of one or both testicles
• High-dose and low-dose chemotherapy
• Hormone therapy (for prostate cancer)
• Immunotherapy (for metastatic urological cancers)
• Targeted therapy (for metastatic urological cancers)
• Radiation therapy (external and internal)

Along with these treatment options, we have also made fertility preservation programmes available as certain treatments can have a negative impact on the patient’s fertility.