Cancer

This section focuses on the issues associated with various urological cancers.

Bladder Cancer

What is bladder cancer?

Bladder cancer is a type of cancer that begins in the bladder, usually in the cells that line the inside of this organ.

Who gets bladder cancer?

Anyone can get bladder cancer but it is more common among certain populations.  It is more likely to occur in men (#4 cancer) than in women (#8 cancer).  Additionally, it is more likely to occur in people over the age of 50.  Caucasians are at a higher risk of developing this cancer.

Other risk factors:

  • SMOKING is one of the strongest risk factors for bladder cancer.
  • Chemotherapy / Radiation
  • Industrial chemical exposure
  • Analgesic abuse
  • Chronic infections and Chronic inwelling catheter
  • And many others

How is bladder cancer diagnosed?

The most common symptom of bladder cancer is blood in the urine (hematuria).  Hematuria can also be caused by other conditions, so you must be evaluated by a urologist.  A urologist can perform a cystoscopy, which is the most important test used to diagnose bladder cancer.  A cystoscopy is an internal examination of the bladder and urethra using a cystoscope.

If your urologist suspects bladder cancer after performing the cystoscopy, further testing is done including taking a biopsy (tissue sample) and imaging using a CT scan or ultrasound.

How is serious is bladder cancer?

The severity of bladder cancer can vary widely.  Most bladder cancer is caught in its early stages when it is very treatable, but you must remember that all bladder cancer is likely to recur.  In general, there are 3 categories of severity:

  • Premalignant tumour (Carcinoma insitu) – This can progress very rapidly to invasive cancer and must be followed closely. It is treated with medication placed into the bladder.
  • Superficial Invasive (Ta, T1)– the least severe, this category can be managed with minor surgery or medication placed in the bladder. Some tumors can progress to a very serious stage and therefore can require strict, sometime lifelong, observation.
  • Muscle invasive but localized (T2, T3) – this is a serious category but still curable. Treatment calls for removal of the bladder or the use of chemotherapy and radiation combined.
  • Advanced Systemic/metastatic – this third and most serious category of bladder cancer occurs when tumors have spread beyond the bladder and entered the lymph nodes or other areas of the body. This stage is usually incurable and fatal.

How is bladder cancer treated?

Not all bladder cancer is the same, and so it follows that not all treatments for it are the same.  Treatment will depend on the individual and the type and aggressiveness of their tumors.  All bladder cancer should be treated, as it is often fatal if left untreated. Overall though, there are three types of treatment which roughly correspond to the three categories of bladder cancer:

  • Superficial treatment – This is for tumors mainly found in the mucosa or near the surface and which are more nuisance than necessarily life threatening. These are often curable with major surgery. The treatment includes resecting the tumor followed by close surveillance with cystoscopy and urine tests.
  • Muscle invasive but localized treatment – This calls for a removal of the bladder and surrounding organs, as well as the pelvic lymph nodes and reconstruction of the urinary tract. Additionally, 3-4 months of chemotherapy is often used.
  • Advanced Systemic/metastatic treatment – At this most serious stage, bladder cancer cannot be cured.  Treatment is palliative, meaning it focuses on relief of pain and suffering.  This palliative care is achieved through chemotherapy, surgery or radiation.

Kidney Cancer

Understanding Kidney Cancer

WHAT TO EXPECT WHEN HAVING A: Laparoscopic Nephrectomy

THE OPERATION:

You will be given a general anesthetic, so you will be asleep for the surgery. A small incision is made on the side of your abdomen and gas (carbon dioxide) is put into your abdomen to make space for the laparoscope. Then the laparoscope goes through the incision. Small incisions (3 to 5 of them), 5 to 10 mm in size, are made for the passage of the laparoscope. One of them will be larger to allow for removal of the kidney. Most patients will have dissolvable stitches and dressing tapes (steri strips) over their incisions. There is a small chance during your surgery that your surgeon may have to make a larger incision to complete the operation (open nephrectomy). This will only be done if it is considered safer or more effective in your situation.

After the operation you will be in the post-operative recovery area for 12hrs then you will be taken upstairs to the 3 West surgical ward.

In order to avoid complications (listed below), I will want you to move around as soon as possible after surgery. On the day of surgery when you are on the ward I have the Nurse assist you to stand at the bedside. On the day after surgery I will want you to walk around the ward. You will find that moving from lying down to sitting can be painful without assistance at first but once you are standing the discomfort is much better.

Also by walking your bowels with start to function sooner and relive the bloating that is common after surgery. Once you are passing flatus you will be allowed to go home to complete your recovery.

You will be discharged home on the second day after surgery if you are passing flatus, and your pain is controlled with oral pain medications. It is better to be at home for the remainder of your recovery as there are fewer chances for contracting an infection at home.

WHAT TO EXPECT AT HOME:

May experience pain or discomfort around incision sites especially with coughing or sitting up. You may feel tired and need to nap during the day.

REASONS TO SEE A DOCTOR:

• Redness, foul-smelling drainage or separation of incision site
• Fever over 38.5 C.
• Severe pain unrelieved by medication.
• Leg pain or swelling.
• Nausea or vomiting which persists.

DIET

Advance your diet slowly at home. Stick to foods that are simple and easy to digest. Try to drink 6-8 glasses of water per day.

ACTIVITY

Get up and about as soon as possible after surgery. Walk as tolerated. Avoid lifting more than 20 lbs for 6 wks. Avoid pressure on your incisions. You may start showering 24-36 hrs after surgery. Avoid water stream directly on incisions by applying clear plastic wrap over them when showering. You may sponge bathe. Do not submerge in a tub bath for 3-4 weeks.

MEDICATIONS

Use prescription pain medication as needed. Do not apply ointments or creams to incisions until the steristrips have been removed. You may then apply polysporin or other antibiotic ointment 2-3 times per day until healed.

Take a stool softener (obtain over the counter at local pharmacy) starting the night of your surgery. Stop taking stool softeners once having soft bowel movements. Do not take stool softeners if diarrhea occurs. If you have not had a bowel movement by the 3rd day after your surgery, take a laxative (obtain at your local pharmacy over the counter).

You may begin your regular medications when you leave the hospital unless instructed otherwise. If you take blood thinners (ASA, plavix, warfarin), I will advise when you can start them again.

POSSIBLE COMPLICATIONS:

Adapted from Campbell-Walsh Urology Tenth Edition

Prostate Cancer

Understanding the Prostate and PSA

Understanding Prostate Cancer

Localized Prostate Cancer: Making a treatment decision

Hormone therapy for Prostate Cancer

Radical Prostatectomy- Understanding the procedure

Radical Prostatectomy- Understanding the Risks

External beam Radiation Therapy for Prostate Cancer