Our kidneys work ceaselessly to filter out waste from the blood, producing urine. The urine then travels through the urinary tract—a group of organs that work together to drain urine from the body. These organs grow cells that help to process and transport the urine. But occasionally, something will go wrong. A change in the DNA (known as a mutation) can cause abnormal cells to grow along the urinary tract, forming a cancerous tumor.
Cancers of the urinary tract (or urologic cancers) may be linked to environmental, lifestyle, genetic and other factors. Over the years, methods for detecting and treating urologic cancers have improved, and patients are now offered a range of options to suit their goals and needs.
“Fortunately, the majority of urologic cancers that are detected are found at early stages, when they are still confined to the organ,” says Michael Leapman, MD, a Yale Medicine urologic oncologist, who is also part of Yale Cancer Center at Smilow Cancer Hospital at Yale New Haven. “Diagnosing and treating some cancers at an early stage has been essential to improving outcomes.”
What are the types of urologic cancers, and who’s at risk?
Some cancers of the urinary tract can occur in both men and women:
- Bladder cancer
- Kidney (renal) cancer
Others are specific to men:
Tobacco use is an important risk factor for all urologic cancers.
In the U.S., prostate cancer is the second most common cancer in men (after skin cancer). Prostate cancer is more likely to occur in men with a family history of the disease, who eat a high-fat diet and/or are older. More than 70 percent of prostate cancer cases are diagnosed in men older than 65.
By contrast, penile cancer is very rare, accounting for less than one percent of cancers in men. It’s also related to older age, as well as to human papillomavirus (HPV) infection, lack of circumcision and poor genital hygiene.
The rate of testicular cancer—which usually develops in younger men, between the ages 15 and 35—is on the rise. Although in most cases it’s not clear what causes testicular cancer, other medical conditions can be risk factors, such as polycystic kidney disease for kidney cancer and chronic inflammation for bladder cancer. A small percentage of these cancers are inherited.
What are the symptoms of urologic cancers?
Most of the time, symptoms don’t occur until the cancer has become more advanced. Then, they depend on the type of cancer. Blood in the urine (without pain) is a symptom of bladder, kidney and prostate cancer—at later stages, pelvic and back pain can also develop. Patients with prostate cancer may also have other changes in urination and sexual function. Those with testicular or penile cancer may notice a visible lesion on the skin, along with other skin changes or swelling. Any cancer patient can experience weight loss and fatigue.
More often, these cancers are detected during a routine physical exam of the abdomen or genitals.
How are urologic cancers diagnosed?
Once doctors have reason to suspect a urologic cancer, they may perform some of the following tests:
- Cystoscopy or ureteroscopy, using a tool with a tiny light or camera to check the ureter (the tube that carries urine), bladder and kidney for tumors.
- Lab tests to look for changes in the blood that could be signs of cancer.
- Imaging studies (MRI, X-ray, ultrasound, CT scan or angiogram) to check for abnormal tissue anywhere along the urinary tract.
- Biopsy to obtain a sample of abnormal tissue and analyze it for cancer cells.
How are urologic cancers treated?
Treatment for urologic cancer depends on several factors, such as the tumor’s grade and stage (indicating how advanced the cancer has become) and the patient’s preference. Common options include surgery, chemotherapy and radiation therapy. Patients can also receive immunotherapy, which boosts the immune system to fight disease.
If a significant portion of the bladder is removed, the surgeon may create a stoma (opening in the skin) as a new route to drain urine. Removal of one of the two kidneys doesn’t disrupt urologic function.
Since prostate cancer often occurs in older men, doctors may recommend a “watchful waiting” strategy (called active surveillance), in which they regularly monitor the patient and provide treatment only if the cancer progresses. This strategy helps to preserve quality of life.
For testicular and penile cancer, there’s an emphasis on maintaining organ function, but sexual dysfunction can result from treatment. After the tumor has been removed, the option to rebuild the organ (reconstruction surgery) is usually available.
What is unique about our approach to treating these cancers?
“Yale Medicine’s approach to treating urologic cancers is patient-driven,” says Dr. Leapman. “Not all cancers are the same, and the urologic oncologists at Yale are focused on using all available resources to understand the multiple forces that impact how an individual should be treated.”
“Our approach is team-driven,” he says, “allowing experts from multiple disciplines (urology, radiation oncology, pathology, radiology and medical oncology) to collaborate and offer world-class, personalized care.”