Uro-Oncology FAQ's
Uro-Oncology
Frequently Asked Questions
What is kidney?
Kidney is very important organ in human body. They act as filter and remove unnecessary waste product from body. There are two I number, one left and one right side of abdomen.
Where are they located?
Inside abdomen, on both sides in the flank region. Kidney located very deep in the posterior region and sometime more easily felt from back than front abdomen.
What is kidney cancer?
Any swelling or lump arising from kidney is known as kidney tumor/cancer. Tumor may be benign or malignant. Malignant tumor known as cancer.
What are symptoms of kidney tumor?
Surprisingly, small kidney tumor is completely asymptomatic or minimally symptomatic. Vague pain abdomen, fever, hematuria, unexplained loss of weight may be presenting symptoms in some patients.
How to diagnosed kidney cancer?
Usually, ultrasonography is the initial test for diagnosing kidney tumor. But USG scan cannot confirm nature of kidney tumor (benign or malignant), so for confirmation and staging purpose, contrast CT scan of abdomen is required for kidney tumor diagnosis.
Is kidney tumor biopsy needed for diagnosis?
Kidney tumor biopsy is not indicated for all patients. For clear cut diagnoses on CT/MRI scan, kidney tumor biopsy may not be needed and directly go for surgical removal of tumor as early as possible. On the other hand, if patient has single kidney, renal compromise patient or doubtful diagnoses on CT/MRI scan, then biopsy of tumor may be done to confirm diagnoses before surgical removal. Unnecessary biopsy may delay the definitive treatment for kidney tumor.
Is kidney biopsy being safe?
Yes, usually day care procedure and minimal problems on expert hand. However, renal failure patient and patient on anticoagulant (like ecosprine) may be challenging and difficult case for renal biopsy.
Who are more prone to develop kidney tumor?
Male, chronic smoker, obese patient and hypertensive patient are more prone for kidney tumor development.
What should I do if diagnosed with kidney tumor?
You should consult with your urologist immediately and they will guide you according to your disease status.
Is kidney cancer dangerous?
Yes, kidney is serious in nature if untreated or delayed and timely effective treatment help cure patients.
Is there any medicine treatment for kidney tumor?
No, don’t try unnecessary medicine for false belief to treat kidney tumor. They will delay proper treatment and make worse prognosis for patient.
Is surgery being mandatory for kidney tumor?
Yes. The only definitive or curative treatment of kidney cancer is surgical removal (Radical or partial nephrectomy). There is no medical treatment for cure of kidney tumor.
Is there alternative for surgical removal?
Practically no. However, in rare cases, small tumor or tumor in frail patient may be treated with non-surgical therapy like cryotherapy or radiofrequency ablation. But these are not standard treatment for kidney tumor and not easily available everywhere. They need tumor biopsy for all and long term follow up.
Is it necessary to remove kidney with tumor?
Early or small tumor can be removed without removing kidney, this is called partial nephrectomy. But it is not feasible in all cases. If tumor is large and located in the middle of kidney or along kidney vessels, then partial nephrectomy is not feasible, and whole kidney along with tumor has to be removed for complete cure of patient.
Can I survive after removal of one kidney?
Sure. One kidney is sufficient for survival and normal life. No need to panic after removal of one kidney if opposite kidney is normal.
Is partial nephrectomy safe?
Completely safe in expert hand. But complications are little more than radical nephrectomy. Partial nephrectomy patient had chance of tumor recurrence and high probability of urine leakage and post operative bleeding.
Is radical or partial nephrectomy done by laparoscopy?
Yes. Both partial and radical nephrectomy can be done by laparoscopically/minimally invasive technique.
Is chemotherapy or radiotherapy being available for kidney tumor?
Usually, No. Only late stage or advanced metastatic disease may be treated with limited CT/RT, immunotherapy with poor results. But they are not curative treatment.
Is follow up needed after surgery?
Yes, always there must be follow up visits. Visit frequency may be decided by your urologist depending on disease stage and biopsy reports.
Can kidney tumor affect children?
Yes. But they are usually different types from adult patients.
Is there any role for oncologist?
Usually, oncologist has no role for early-stage kidney tumor because medicine does not work for kidney tumor, they are treated by urologist. But for advanced disease, where surgery is not curative/possible, some immunotherapy may be provided for symptomatic treatment.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is prostate biopsy?
Prostate biopsy is taking few prostates chips/ tissue by needle puncture through perineum, usually done under ultrasound guidance. This is very common procedure to confirm prostate cancer in male
Is it necessary?
Till now, it is mandatory before any type of prostate cancer treatment. Despite having special MRI and PET scan of prostate, we still need prostate biopsy report to confirm prostate cancer before starting any treatment of prostate cancer. Discuss with your doctor for latest update and recommendation.
Who does this?
Urologist / Radiologist does prostate biopsy.
Is it painful?
Usually done under anaesthesia, sometimes local anaesthesia, so now a days pain is not there. However, if adequate anaesthesia is not given, there may little pain for the duration of the procedure.
How is it done?
Prostate biopsy is done under ultrasound guidance, so sometimes called TRUS (trans rectal ultrasound) guided prostate biopsy. It is done in lateral position with both legs flexed at knee level.
How much time needed?
10-15 min, depending on expertise of urologist.
What is the hospital stay?
Usually day care procedure. After procedure, 4-6 hrs. observation needed and then patient can go home with oral medications.
What are the complications/side effects?
Usually, minimal side effects in expert hand. These includes…
Mild pain
Bleeding per urethra/ with urine
Urinary tract infection
Fever
Others are very rare complications
What are tests/requirement for prostate biopsy?
Sterile urine, stop anti-coagulant (like ecosprine), avoid constipation. Details will be explained and written by the hospital day before procedure.
Does prostate biopsy spread cancer?
No.
How long it takes for biopsy report to come?
It depends on pathology lab. From private lab, usually 3-5 days later you will get biopsy report.
What are danger signs after biopsy?
Persistent fever or pain and swelling of testis (probably (UTI)
Persistent hematuria or red urine. Any of this problem, you have to consult with your doctor immediately.
Who will be affected by Prostate cancer?
Men, older age, usually, above 60-70 years. However, no age is safe for prostate cancer, now a days even younger age groups are also getting prostate cancer.
How to detect prostate cancer at early stage?
Urologist checkup and periodic PSA screening help detect early prostate cancer.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is PSA?
PSA is prostate specific antigen. It is produced and secreted from prostate gland. It is measured in blood.
What is the normal value?
<4 ng/ml. Different lab may take slight variance in normal refence range.
Why PSA increase?
When normal prostate become Prostate cancer. In prostate cancer, PSA is raised in variable range.
What are the other causes for raised PSA?
Other than prostate cancer, following are reasons for raised PSA.
Urinary tract infection (like Cystitis, prostatitis etc.)
Urinary retention
Post digital rectal examination
Recent sexual activity
Urinary tract surgery or intervention
Am I safe if PSA <4?
No. No PSA is safe for prostate cancer, even normal range PSA may be indicative of prostate cancer. However, PSA<4 usually have very lower chance of getting prostate cancer. There are rare variant of prostate cancer that may happen even with normal PSA level. These are neuroendocrine variety, small cell prostate cancer, prostatic sarcoma, squamous cell carcinoma prostate etc.
What will happen if my PSA is raised >4?
Don’t panic. Not all raised PSA will be prostate cancer. Your doctor will assess, examine and then advise some tests to further confirm your diagnosis.
What are the common tests for diagnosing prostate cancer?
PSA, MRI prostate (multiparametric MRI) with PIRADS scoring and PSMA PETCT scan may be advised if doubtful for prostate cancer.
How prostate cancer confirm?
For confirmation, always do prostate biopsy.
Can I avoid prostate biopsy even if suspected for prostate cancer?
No. It is mandatory before taking any treatment for prostate cancer. However, diagnosing prostate is not helpful for all patients.
Does all patient with raised PSA need prostate biopsy?
Not every patient needs prostate biopsy. Those who are vulnerable and debilitated for other severe problem (like severe hearts disease, last stage kidney disease, severe neurologic disease, very old age >85 years and poor health, and those who will not get benefited from treatment of prostate cancer) may not need prostate biopsy. On the other hand, healthy young or older people with good physical status usually get benefited by diagnosing prostate cancer. Ultimately, your treating doctor will determine what is appropriate for you.
What will u do after prostate cancer diagnosis?
You will be advised some imaging test (like MRI/PET SCAN/BONE SCAN) for accurate staging or spread of cancer. Before any treatment decision, staging is mandatory.
Do I need to visit urologist or oncologist?
You should visit urologist first. Early-stage cancer may be curable by doing surgery which will be done by urologist. Advanced stage disease may be deals by both urologist oncologist for appropriate treatment. Oncologist do medical treatment for cancer in advanced stage and not surgical removal of tumor.
What are the treatment options for prostate cancer?
Early-stage cancer-Surgical removal of prostate (Radical prostatectomy), advanced stage disease-surgery/radiotherapy, for metastatic disease-hormonal injection. However, types of treatment for your cancer will be guided by treating doctor and they may vary patient to patient.
Is prostate cancer being dangerous or serious?
Among all urological cancer, prostate cancer is most slowly growing cancer. But all depends on stage of disease at the time of diagnosis. Early or localized prostate cancer is slowly growing in some individual and they may survive for many years. But advanced or metastatic disease patient may deteriorate very early and rapidly. Over all, prostate cancer has very long natural course.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
Dose smoking causes urological cancer?
Yes. Smoking is responsible for almost all types of body cancer. Obviously, smoking is the most important risk factors for urological cancers risk i.e., kidney, urinary bladder, and penile cancer. Other than these, they are also risk factors for developing prostate and urethral cancer.
How smoking causes this cancer?
Smoking has many types of carcinogenic substances. These substances cause cancer.
What is passive smoking?
Those who smoke called as active smoker. If one smokes, surroundings person also inhales smoke because of the smoke spread in the air. This is called passive smoker. Some study says, passive smoker has higher risk of getting cancer than active smoker. If father smokes for many years, his wife and children are automatically becomes passive smoker. So not only father, but all family members will have higher risk for cancer development other than respiratory problem.
What is chronic smoker?
Those who smokes for long time, may be years called chronic smoker. Bad effects result from chronic smoker mainly. Sometime some people takes multiple packs of cigarettes or bidi, they are called chain smoker or heavy smoker. Chain smoker has higher risk of getting cancer.
I am old smoker. Do I have same risk for developing cancer?
If you quit smoking for >10-14 years, then your risk of developing cancer will get drastically decreased but still not equal to nonsmoker. After quitting >14 years, you have only 1.1 relative risk for cancer.
Many peoples smoke for long times but they did not develop cancer. Why this happen then?
It is very difficult to say all smoking patient will develop cancer, but it is certain that if someone smokes, they will get higher cancer risk than nonsmoker. This happen because, there are many other risk factors other than smoking. And most of the others risk factors like older age, genetic or hereditary factors can’t be modified while smoking can be stopped.
What will happen if kidney or bladder cancer developed and still smoking?
It is necessary to stop smoking immediately and then consult with urologist for best possible treatment. Smoking adversely affect treatment outcomes in cancer patient. Smoking is associated with bad types of tumors.
Dose tobacco/khaini chewing has same effects?
Yes. Smoking and tobacco chewing has same bad effects.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is testicular cancer?
Testis are two in number and situated inside scrotum. Testis are important for men’s sexual, fertility and general health. Any swelling inside testis is called testicular tumor. Testicular tumor may be benign or cancerous/malignant. This can be confirmed imaging like ultrasonography.
Are all swelling in the scrotum are cancerous?
No. There are different types of swelling may happen inside scrotum or testis, all are not cancerous. Infection, trauma, and some non-cancerous swelling may be present.
What is the common age for testicular tumor?
Young children or adult, 20-40 years are most affected. However, younger or older people may also get affected by testicular tumor.
How to diagnose testicular tumor?
Palpable by hand of any hard, painless or irregular swelling that is gradually increasing in size is commonly presented as testicular tumor. In doubtful cases, testicular ultrasound advised and confirmed the diagnosis. High resolution scrotal ultrasound and or CT scan can differentiate other swelling from tumor.
What are the blood tests advised for suspected testicular tumor?
Alpha feto-protein (AFP), beta HCG and Serum LDH are commonly elevated in varying degree. Your doctor may advise them along with high resolution scrotal ultrasound. These are testicular marker and they help in diagnosing testicular tumor and their types.
Dose testicular tumor need treatment?
Testicular tumors need urgent attention and prompt consultation with urologist. They must be evaluated and treated as soon as possible. Early treatment may decrease the complication and bad effects of tumor. Overall, early-stage tumor has very good chance of complete cure with effective treatment.
What is the best treatment for testicular tumor?
Surgery is the best treatment for testicular tumor. High inguinal orchidectomy surgery to be performed for best care. After surgery the tumor and affected testis sent for biopsy for tissue confirmation. CT scan abdomen and chest advised depending on tumor and if any spread of tumor confirmed, then further chemotherapy or radiotherapy may be advised.
Is it possible to save affected testis?
Usually, no. If opposite unaffected testis is normal, then affected testis usually have to be removed completely. But in some special situation like single testis or tumor is very small and doubtful, then partial testis along with tumor may be removed. This decision will be taken by treating doctor.
Is testicular cancer curable?
Yes. But it depends on stage of the disease, early-stage cancer patient will get complete cure with adequate treatment. Advanced or metastatic disease will get less chance for cure even after multiple treatment options.
What are other treatment options after surgery?
Chemotherapy and radiotherapy or both are required for tumor control. Both options are well establishing treatment for testicular cancer. Seminoma and non-seminoma are common variety for testicular tumor. Seminoma has very good response to chemotherapy and radiotherapy than non-seminoma tumor.
Is any other surgery needed after removal of affected testis?
For some patient, having large tumor spread to abdomen and non-response to chemotherapy /radiotherapy, abdominal surgery may be needed for cure. With effective chemo or radiotherapy, these are not required commonly.
Is there any chance of male infertility after treatment of testicular tumor?
Yes, there is possibility of infertility especially local radio or chemotherapy used for tumor control. Sperm banking can solve this problem in some patient. Your doctor may guide you in details regarding this.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.
What is urinary bladder cancer?
Urinary bladder cancer is very common in older people. This cancer is very serious is nature and usually recurs if not treated properly. Tumor occurs inside urinary bladder and cause urinary problems like hematuria dysuria etc.
Who are commonly affected?
Male and female >50-60 years age, chronic smoker with painless hematuria is commonly affected.
What are the risk factors for bladder cancer?
Chronic smoking, older age> (50 years), long term catheterization, urinary bladder stone, chemical industry workers are risk factors for bladder cancer.
What are problems for bladder cancer?
Painless bleeding with urine, passage of blood clots, urgency, dysuria, weight loss are common problem of bladder cancer. However, symptoms and signs depend on tumor stage and patient profile. Some patient may not have any problem and tumor detected on radiology imaging only.
What to do for hematuria or urethral bleeding?
You should consult with your urologist as soon as possible. Your doctor will examine you, advises ultrasonography and urine report. Most of the time, these reports detect causes of bleeding. If reports are normal, but hematuria persist, then contrast CT scan of kidney, ureter, bladder must be performed. Cystoscopy examination is needed in some patient.
What is cystoscopy?
Cystoscopy is looking inside urinary bladder. Special microscope/camera and light used to look inside urinary bladder for causes of bleeding. This is mandatory for anyone who are suspected to have bladder cancer or unknown cause of bleeding. It is usually done under local anathesia but sometime anathesia or sedation may be needed for few patients especially in male. Flexible cystoscopy can be performed in all patient under local anathesia as day care procedure. Bladder cancer can be detected in all cases by cystoscopy if present. In small tumor, CT scan or ultrasound may be misleading, so cystoscopy is most confirming test to detect bladder tumor.
What next if cystoscopy find bladder tumor?
Bladder tumor to be removed by microsurgery. There should be not any delay in starting surgery, otherwise tumor can spread rapidly.
What is TURBT?
This is initial or most commonly performed surgery for bladder cancer. This is microsurgery and there is no cut mark outside body. TURBT removed bladder tumor and then specimen sent for biopsy. It usually takes 2-3 days hospital admission.
Do I need any treatment after TURBT?
Yes. All treatment depends on biopsy report. Biopsy confirm bladder cancer, there characteristics, grade and muscle invasions.
What are the treatment options after TURBT?
For low grade, small tumor-TURBT is definitive treatment. For high grade or very large tumor, repeated TURBT or radical cystectomy may be appropriate. This will be determined by your treating urologist.
Is there any medical treatment other than surgery for bladder cancer?
No. TURBT is must for biopsy confirmation. After TURBT operation, there are many options available. Optimum treatment will be decided by treating urologist.
If surgery is not possible for poor general condition, what are the treatment option?
TURBT is must for all patient. It is microsurgery and safe for most patients including very old and with multiple comorbidities. However, after biopsy there are chemotherapy or radiotherapy are available for unfit patient (unfit for big surgery).
Is chemotherapy or radiotherapy safe?
Nothing is absolutely harmless. These are also toxic and causes multiple side effects. They are basically palliative and cure of disease is not possible like radical cystectomy.
What is radical cystectomy?
Removal of whole urinary bladder and surround organs to cure bladder cancer. This is one of the biggest surgeries in urology oncology.
How do I void after radical cystectomy surgery?
There will be one urine pouch made along abdominal wall and urine bag attached with it for life long. This is called ileal conduit.
Can I void through normal passage after surgery?
May be. Neobladder will help void through normal passage after surgery. But neobladder is not suitable for all patients and need expert urologist.
N.B: Information are for educational purpose only. For further queries and explanations, you can contact with your doctor/urologist.