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Oncology

Cancer, Bladder
Cancer, Kidney
Cancer, Prostate
Cancer, Testicular

Cancer, Bladder

1. What is Bladder Cancer?

Bladder cancer is the sixth most common cancer in the United States. It is cancer of the bladder. The cancer may be only in the lining of the bladder, or more extensively could be in the muscular wall of the bladder. The most aggressive type of bladder cancer may grow through the bladder wall and spread to nearby organs. Bladder cancer is more common among whites and men and usually occurs among people in their 60's.

There are a number of risk factors that are attributed to bladder cancer. Here are the most common risk factors:

  • Smoking
  • Industrial chemicals
  • Chronic bladder inflammation

2. What are the signs and symptoms of Bladder Cancer?

Bladder cancer often doesn't produce signs or symptoms in its early stages. The first warning sign is usually blood in the urine. However, signs and symptoms of bladder cancer may be:

  • Blood in urine
  • Pelvic Pain
  • Frequent urination
  • Sensation for the need to urinate without results
  • Slowing of the urinary stream

These signs and symptoms are the same as other diseases, so you should see your physician.

3. How is Bladder Cancer diagnosed?

The physician will ask for a medical history and perform a physical exam. In addition, a urine sample will be examined, and possibly sent on to a laboratory for the testing of blood cells and cancer cells. An intravenous pyelography (IVP) will be ordered, and a cystoscopic procedure will be performed. The cystoscopy will enable the urologist to look inside the bladder and perform a biopsy.

4. How is Bladder Cancer treated?

Treatment for bladder cancer is dependent upon the degree of the cancer. For very superficial cancer, i.e. just the lining of the bladder, biological therapy would be used.

  • Biological Therapy is a form of treatment that uses the body's natural ability to fight cancer. Biological therapy may be used alone or after surgery to help prevent the cancer from recurring. This treatment consists of placing a solution into the bladder. The bladder is stimulated by the immune system. The medicine stays in the bladder for about 2 hours before the patient is allowed to empty their bladder. The treatment is continued for approximately 6 weeks, once a week.
  • Surgery - There are basically two types of surgery for bladder cancer. The less extensive option is where the physician will burn away the cancer cells. The procedure will be done on an outpatient bases for the most part, with anesthesia.
    There is also a surgery to remove the bladder called a Cystectomy. This surgery may be done when the bladder cancer invades the muscle wall.
  • Chemotherapy
  • Radiation Therapy

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Cancer, Kidney

1. What is Kidney Cancer?

The majority of kidney cancers are of the type known as renal cell carcinoma, which affect the "meat" of the kidney, rather than the drainage system of the kidney. A number of the kidney cancers have a heredity influence associated with diseases such as von Hippel-Lindau, adult polycystic kidney disease, tuberous sclerosis and a few others. Men are twice as likely to have kidney cancer than women.

2. What are the symptoms?

  • Blood in urine
  • Pain
  • Mass
  • Fever
  • Weight loss
  • Hypertension
  • Varicocele (Abnormal dilation of the veins of the spermatic cord)

3. How is Kidney Cancer diagnosed?

The most common way to diagnose kidney cancer is with contrast studies such as intravenous pyelogram (IVP) and CT scans. The diagnosis can also be made with a renal ultrasound. The MRI is a useful diagnostic test that may also be used.

What are the treatments for Kidney Cancer?

Treatment options are almost exclusively surgical, the removal of the entire or partially affected kidney.

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Cancer, Prostate

1. What is Prostate Cancer?

Prostate cancer begins inside the prostate and may grow to involve the entire gland and then spread outside the gland. Cancer of the prostate is the second most common cancer in men, after skin cancer. It is the second leading cause of cancer deaths in men, after lung cancer.

2. Who is at higher risk?

Prostate cancer is the most common type of cancer found in American men. Here are some facts about what may increase the risk of prostate cancer:

  • Prostate cancer is most likely to develop after the age of 55, with the highest incidence after age 65.
  • African-American men have the highest rate of prostate cancer.
  • Family history (father, brother, uncle) of prostate cancer increase one's risk.
  • Exposure to cadmium in the workplace (welding, battery making, electroplating) increases one's risk for prostate cancer.

The cause of prostate cancer is unknown.

3. What are the symptoms of Prostate Cancer?

In its earliest stage, prostate cancer may produce no signs or symptoms. As the tumor grows, certain signs or symptoms may be noticed, including:

  • Difficulty starting or stopping urinating
  • Decreased strength of urinary stream
  • Dribbling at the end of urination
  • Painful or burning urination
  • Frequent urination, especially at night
  • Painful ejaculation
  • Blood in the urine
  • An inability to urinate
  • Continuing pain in the lower back, pelvis, or upper thigh

4. Is early detection important?

As with many types of cancer, early detection and treatment of prostate cancer increase the chance of a cure. The five-year survival rate for prostate cancer patients whose cancers are discovered while in a localized stage (cancer remains in a contained area of the prostate) is 85%.

Cancer of the prostate is often a slow-growing type of cancer. When it develops very late in life, as is frequently the case, the impact of the disease is often minimal. In fact, many men with prostate cancer eventually die of causes unrelated to the prostate cancer itself.

5. How is Prostate Cancer diagnosed?

The only way to determine whether or not a suspicious lump or an elevated prostate specific antigen (PSA) is associated with prostate cancer is to microscopically examine a sample of tissue taken from the prostate. This tissue sample may be removed by a needle placed directly in the prostate gland. Laboratory tests and bone scans may be useful in determining the extent of the disease.

6. How is Prostate Cancer treated?

Treatment of prostate cancer is highly individualized. Many factors must be considered before a physician recommends a course of action. These factors include the severity of the cancer, the patient's general health and medical history, anticipated side effects the patient may experience from various treatments, and the patient's age and expected life span.

Surgery:

Radical Prostatectomy - This surgery is considered the preferred choice of therapy for localized disease and in theory, if the cancer is completely confined, then surgically removing the prostate should result in a cure. There are limitations to surgery and its ability to cure the patient of cancer, which are related to the severity and aggressiveness of the cancer.

The side effects of prostate removal are usually temporary, but in some cases can be permanent. They may include impotence (the inability to have or maintain an erection.) and urinary incontinence (the inability to control urinary function.).

Brachytherapy/Seed Implants - This is another surgical option for the treatment of prostate cancer. A urologist works with an oncologist to implant radioactive seeds into the prostate to stop or slow the growth of cancer cells. This treatment is still considered experimental.

If your urologist feels surgery is not the best option for your care, there are alternative choices.

Non-Surgical Therapies:

Radiation Therapy - Patients who elect to have some form of radiation therapy which is intended to cure their prostate cancer should have cancer that is confined to the prostate and/or the surrounding tissues. So-called "definitive" radiation therapy is delivered using an external beam of x-rays carefully directed to the areas of the pelvis that includes the prostate.

Like surgery, all forms of radiation therapy have complications including inflammation of the bladder, rectum and intestines. In addition, many radiation therapy patients have side effects like urinary and sexual problems.

Hormone Therapies - This therapy is primarily used to treat patients who have prostate cancer which is not confined to the prostate or a recurrence of cancer. It is not curative. The intent of hormone therapy is first to delay the progression of the cancer and second, increase the patient's survival while improving his quality of life. There are an increasing number of options available as methods for implementing hormone therapy. These are as follows:

  • The surgical removal of the testes to prevent the production of testosterone.
  • The use of various hormonally active drugs called LHRH agonists. These drugs lower the levels of testosterone in the bloodstream.
  • The use of "antiandrogens" to suppress the activity of a male hormone known as dihydrotestosterone.
  • The use of other techniques or drugs to suppress the hormones made by the adrenal gland.
  • The combined use of LHRH agonists and antiandrogens.
  • Use of hormonal therapy prior to surgery or radiation therapy.

The important factors in choosing a particular form of hormone therapy can include the cost of the treatment, the effectiveness and safety of the various treatment options, and the patient's quality of life.

Cryotherapy: This is an old technique that is having a comeback due to the advances in technical capability. Cryotherapy is a method of freezing the prostate and other appropriate nearby tissues to extremely low temperatures with liquid nitrogen. This technique is designed to kill all prostate cancer tissue without having to take the risks involved in carrying out surgery.

While cryotherapy is certainly an interesting and potentially important addition to the options which physicians can offer patients with prostate cancer, it should still be considered an experimental technique at this time, and used mostly as salvage treatment for recurrence.

The known side effects of cryotherapy can include impotence, scarring of the urethra and urinary system, and irritation of the bladder, the urethra, the rectal wall and the genitalia. This last group of side effects can include pain on urination, a burning sensation during urination, frequent and unexpected urination, blood in the urine, and swelling of the penis or the scrotum.

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Cancer, Testicular

1. What is Testicular Cancer?

Testicular cancer is cancer of the testes. Usually only one testicle is involved. The risk factors associated with testicular cancer are as follows:

  • Undescended testicles in infants and young children.
  • An identical twin with testicular cancer or family history of testicular cancer.
  • Atrophy of testicles due to mumps or viral infection.

2. How is Testicular Cancer diagnosed?

The best way to diagnose testicular cancer is through self-examinations. The first finding is usually a painless lump in or on the testis, or a hardness or enlargement of the testis. Less commonly there is associated pain and tenderness. Upon seeing the urologist, the urologist will usually order a testicular ultrasound.

3. How is Testicular Cancer treated?

After the diagnosis of a solid testicular mass has been made, the initial management is to remove the testis and its associated cord, an orchiectomy. Depending on the type of cancer cells that are present, other therapies such as additional surgery, radiation therapy or possible chemotherapy may be indicated.

Using a combination of these therapies, testicular cancer has one of the highest cure rates of all cancers. Cures from testicular cancer can even be achieved in individuals who have had it spread into other parts of the body.

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