Uro-Oncology

What is kidney cancer?

Kidney cancer happens when normal cells in the kidney change into abnormal cells and grow out of control. People have 2 kidneys, 1 on each side of the mid-back. The kidneys' job is to filter the blood and remove waste and excess salt and water. Urine is made up of these ingredients.

What are the symptoms of kidney cancer? — Smaller kidney tumors do not always cause symptoms. But larger tumors and tumors that have spread outside the kidney can cause symptoms, such as:

• Blood in the urine
• Pain on either side of your lower back, in your side, or in your stomach
• A lump in your belly or on the side of your back
• Weight loss that you cannot explain

These symptoms can also be caused by conditions that are not cancer. But if you have these symptoms, you should be checked by a doctor or nurse.

Is there a test for kidney cancer? — Yes. If you have symptoms of kidney cancer, your doctor or nurse might order a test to check your kidneys. These tests can show tumors or abnormal growths. They create images of your kidneys in different ways, and they include:

• CT scan (a type of X-ray)
• MRI (uses magnets to create images)
• Ultrasound (uses sound waves to create images)

Most people find out they have kidney cancer after having an imaging test for an unrelated symptom. For example, people sometimes have a CT scan because they have belly pain and then find out they have a tumor in a kidney.

What is kidney cancer staging? — Cancer staging is a way in which doctors find out how far a cancer has spread.

The right treatment for you will depend a lot on the stage of your cancer.

How is kidney cancer treated?

People with kidney cancer often have one or both of the following treatments:

• Surgery – When cancer is confined to the kidney, it is usually treated with surgery with the goal of taking out the entire tumor. This can involve removing all or part of the affected kidney. The decision about how much to remove depends on different things, including how well the other kidney works and how big the tumor is. In some cases, surgery can help even if the cancer has already spread to other parts of the body.
• Medical treatment – Different medicines can also be used to treat kidney cancer, particularly if it cannot be removed or if there is evidence it has spread. This might include:
• Targeted therapy – This includes medicines that block certain blood vessels or proteins in your body that help the cancer grow.
• Immunotherapy – This is the term doctors use for medicines that work with the body's infection-fighting system (the "immune system") to stop cancer growth.

What happens after treatment?

After treatment, you will be checked every so often to see if the cancer comes back. Follow up tests can include exams, lab tests, and X-ray tests.

What happens if the cancer comes back or spreads?

If the cancer comes back or spreads, you might have more surgery or medical treatment.

Overview of prostate cancer

Prostate cancer is one of the most common types of cancer that is developed in the prostate gland of a male reproductive system. In most of the cases prostate cancers grow slowly; however, some grow relatively quick, it might be possible that cancer cells may spread from the prostate to other parts of the body, majorly in the bones and nodes. As it develops slowly so initially it may cause no symptoms for many years but later it may lead to difficulties such as problem while urinating. Mostly this type of cancer occurs in men older than age 65.

The Prostate is a small gland that is located in a male’s lower abdomen; it is under the bladder that surrounds the urethra. This gland is regulated by the testosterone and produces seminal fluid, also known as semen.

If prostate cancer is detected early and is still confined to the prostate gland has better chances of a successful procedure.

What is bladder cancer?

Bladder cancer happens when normal cells in the bladder change into abnormal cells, and grow out of control.

What are the symptoms of bladder cancer? — Bladder cancer causes mild symptoms that can come and go. These include:

• Blood in the urine, which makes your urine look pink or red
• Pain on the sides of your back or above your pubic area
• Pain when urinating, urinating often, or leaking urine

These symptoms can also be caused by conditions that are not bladder cancer. But if you have any of these symptoms, you should be checked by a doctor or nurse.

Is there a test for bladder cancer?

Yes. Doctors can use different types of tests to look for bladder cancer. These include:

• Urine tests - Urine tests can show what kind of cells are in the urine.
• X-rays, CT scans, or other imaging tests - These tests create images of the entire urinary tract, which includes the kidneys, ureters, and the bladder. They can show tumors or abnormal growths.
• Cystoscopy – Cystoscopy is a procedure that allows the doctor to look directly inside the bladder. To do a cystoscopy, the doctor inserts a small tube into the urethral opening, the opening through which urine leaves the body. Then he or she pushes the tube up into the bladder. The tube has a tiny camera that projects images of the bladder onto a screen. If the doctor sees anything unusual, he or she might take a sample of tissue (called a biopsy) to look at under the microscope

How are bladder cancer treatment decisions made? — Once the diagnosis of bladder cancer is confirmed, the treatment depends on the cancer stage and grade. Cancer staging is a way in which doctors find out how far a cancer has spread. Grading refers to the way the cancer looks under the microscope. The right treatment for you will also depend on how old you are and whether you have any other medical problems.

• Surgery - Bladder cancer is usually treated with surgery. Depending on how large the cancer is and how far it has spread, doctors can do 1 of 3 things: .
• Take out the cancer and leave the bladder in place. In many cases this is done through cystoscopy. Usually this procedure has no impact on the ability to urinate.
• Take out the cancer and a part of the bladder. This option depends on how much of the bladder is involved, and is not done very often. After this procedure, people can often urinate normally.
• Take out the cancer, the bladder, and nearby internal organs. This option might be necessary for people with advanced bladder cancer. With this type of surgery, the surgeon also has to create a new way for urine to leave the body, because the bladder has been removed (figure 2)
• Medical therapy – Medicines are an important part of treatment for people with bladder cancer. Doctors use different medicines depending on the extent of the cancer.
• For people with very early bladder cancer that has not spread into the bladder muscle (called "superficial bladder cancer"), medicine is given directly into the bladder.
• For people with cancer that invades the bladder muscle, chemotherapy should be given before surgery. Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. This can shrink the cancer and make it easier to remove.
• For people with invasive bladder cancer who did not go through chemotherapy before surgery, chemotherapy can be given once they are healed from surgery.
• Radiation therapy – Radiation kills cancer cells. Radiation therapy might be an option for some people instead of surgery. It is often given along with chemotherapy.
• What happens after treatment? — After treatment, you will be checked every so often to see if the cancer comes back. Follow up tests can include urine tests, cystoscopy, and X-rays.
• Tell your doctor or nurse if you have any of the symptoms listed above. Having those symptoms could mean the cancer has come back.
• What happens if the cancer comes back or spreads? — If the cancer comes back or spreads, you might have more surgery, or get chemotherapy or radiation.

Cancers we treat

• The management of urologic cancers have transformed over the years with technical innovations in surgery and radiation, advancements in targeted therapy, hormonal therapy, chemotherapy and immunotherapy.
• The team aims to deliver state-of-the-art disease management by integrating the latest medical technologies, minimally invasive therapies and research.
• The diseases treated include malignancies of Prostate, adrenal, kidney, upper urinary tracts, Urinary bladder, Testis, Penile and urethral cancers
• In early stage cancer different surgical modalities are employed to treat these cancers, often in a multi-disciplinary team approach with the integration of expertise by medical oncology and/or radiation oncology.
• In advanced/metastatic stage urological cancers, systemic therapy approach comprising chemotherapy, hormonal therapy, targeted therapy and immunotherapy, alone or in combinations is employed to achieve maximum patient benefit.

Surgical Uro-Oncology & Robotics

• We regularly perform Robotic/laparoscopic and open partial nephrectomy, Robotic/Laparoscopic/Open radical nephrectomy, Robotic/Open radical nephrectomy with inferior vena cava thrombectomy for advanced kidney cancer, Robotic radical prostatectomy and Robotic/Open radical cystectomy with intracorporeal/open urinary diversions amongst others.
• Endourological procedures and other less-invasive treatment alternatives (where appropriate) for urologic cancers such as active surveillance are offered for select candidates.
• Our team have been at the forefront of pioneering complex surgeries in a minimal invasive manner such as Robotic radical nephrectomy with IVC thrombectomy and Robotic radical cystectomy with intracorporeal neobladder/ileal conduit formation. These procedures are currently being performed in only a handful of centres around the world.
• The complication rates are no more than that of at best centers around the world. The average length of stay after surgery for all robotic cases (except radical cystectomy) has been less than 48-72 hours keeping in sync with our motto of eager to get you home!! The clinical activities of the Center are supported by world-class clinical experts in pathology, radiology, and anesthesia team.

Intraop – IVC and renal vein dissection during robotic radical nephrectomy with IVC thrombectomy

Radiation Oncology

• Radiation Oncology for urogenital tumors takes pride of treating about 16% patients with rare or special tumors like pediatric RMS, Small cell carcinomas and double Cancer that requires a dedicated-integrated Multi-specialty Team for best outcome. Radiation Oncology department at Adei Medical Complex, is equipped with ‘State of Art’ facility of IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy) SBRT (Stereotactic Body Radiation Therapy) which allow very focused precise treatment.
• We are amongst leading institution that regularly does short course radiation therapy for prostate cancer. Whole treatment is done in 5 weeks instead of 8 weeks that leads to better compliance, as mostly these patients are elderly. We pay equal importance to cure as well as quality of life and offer ‘Organ Conservative Radiation Therapy’ in suitable patients with Urinary bladder Cancer.

Uro-Medical oncology

• Uro-Medical oncology takes care of judicious use of chemotherapy, targeted therapy, hormonal therapy and immunotherapy in the treatment of Urological Cancers.
• The intent of treatment is cure in cases where the disease is localized. In those cases where disease is widespread and cure is not possible, we aim to control the disease, improve of maintain quality of life, prevent/delay cancer complications and increase the survival.
• Uro-Medical Oncology is one of the most dynamic and rapidly developing fields in Oncology. Over last decade more than 20 new targeted therapies, hormonal agents and immunotherapy agents have shown improvement in survival outcomes of patients with urological cancers.
• During treatment, updated standard practice guidelines are followed strictly. The new concept of chemo-hormonal therapy in metastatic prostate cancer is routinely practiced and the survival data is remarkable. Metastatic kidney cancer is a unique entity in which there is little role of chemotherapy. Such cancers are successfully treated with oral targeted therapy.

Thorough evaluation is done in a systematic manner for making a particular diagnosis. Patient’s symptoms, personal and family medical history, physical exam and screening tests can help identify a patient’s urologic cancer type. Urologic cancer symptoms vary depending on the specific cancer type, and may include:

• Abdominal pain

• Blood in urine

• Elevated hormone levels

• Enlarged prostate

The diagnostic tests recommended will depend on specific symptoms and may include:

• Biopsy

• Blood tests to evaluate hormone levels

• Bone scan

• CT scan (computed tomography)

• Digital rectal exam

• Liver function test

• MRI scan (magnetic resonance imaging)

• PET CT scan

• Pelvic exam

• Renal arteriography

• Ultrasound

• Urine test

Urologic oncology care at Max Institute of Cancer Care is a multidisciplinary team approach that includes the Uro-Oncologist, medical oncologist, radiation oncologist and many cancer care associates.

It is holistic at its core – healing the body, mind and spirit -- so that patients are back doing the activities they love.

Patient health and well-being are top priorities and every effort is made to compassionately guide our patients and their families through the treatment process—from the first hospital visit to the postoperative appointment.

Taking Patient Care to the Next Level

• Our team collaborates on each patient’s case, tailoring a precise treatment plan that is best suited to the patient’s physical, mental and emotional needs.

• Every case is discussed in tumor board and a wide array of treatment options are offered ranging from conventional care to leading-edge alternatives.

Patients facing a urological cancer diagnosis can be confident that they will receive the most advanced and effective disease treatment.