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Oncology – The care of patients with urologic cancers

Urology includes the care of patients with a large number of different types of cancers including those of the bladder, prostate, kidney, testis, and the adrenal gland. Prostate cancer ranks 2nd amongst cancers in US men, bladder 5th, and kidney 9th so urologists must be experts in managing 3 of the 10 most prevalent cancers in the country today. We here at the Urology Center of Westchester have fellowship trained oncologic urologists who focus on the diagnosis, treatment, and long term follow up of these cancers. We also offer participation in clinical trials for those patients who seek additional therapy and support beyond that provided by standard of care medicine and or surgery. Urologic Oncology is unique in the wide range of minimally invasive surgical options from non-surgical ablation of kidney tumors, to natural orifice surgery for bladder tumors, and Da Vinci robotic prostate surgery for prostate cancers. For patients with new diagnoses or questions about cancers, we will make every effort to ensure you are seen by one of our oncology specialists within 24 hours of your first call to our office. Please click below to learn more about what we at the Urology Center of Westchester can offer to patient with the following conditions:
  • Bladder Cancer Bladder cancer is a malignancy of the lining of the bladder, or the urothelium.  The cells that make up the urothelium go through a transition from very flat when the bladder is full, to piled up in column shapes when the bladder is empty and collapsed. For this reason, they are transitional cells of the bladder; bladder cancer is, therefore, called transitional cell carcinoma or TCC.Bladder cancer is the 8th most common solid organ malignancy.  It occurs in men 3 times as common as in women; it most often occurs in the 5th and 6th decades of life.
    Causes The most common cause of bladder cancer is smoking although the following risk factors for bladder cancer:
    •  Cigarette smokers are two to three times more likely than nonsmokers to get bladder cancer. Pipe and cigar smokers are also at increased risk.
    • Occupation in the rubber, chemical, and leather industries are at risk. So are hairdressers, machinists, metal workers, printers, painters, textile workers, and truck drivers.
    Diagnosis Bladder cancer is diagnosed with a biopsy, usually in an outpatient procedure called a cystoscopy.  The most effective method is a trans-urethral resection of the bladder, or TURBT, which provides enought tissue to determine the type of cancer as well as its depth of invasion.  Once the diagnosis of cancer is made, a 'clinical staging' where the physician determines whether the cancer has spread.  A clinical staging requires the following
    • Bimanual examination:  a type of extend pelvic or rectal exam to determine if the bladder is normal
    • CAT scan or MRI scan: creates pictures of the body to ensure normal organs, lymph nodes, and vessels.
    • Bone scan: helps assess the status of the skeleton
    • PET Scan: some oncologists use this test to determine the activity of cancer areas
    Stages of Bladder Cancer
    • Infections. Being infected with certain parasites increases the risk of bladder cancer. These parasites are common in tropical areas but not in the United States.
    • Treatment with cyclophosphamide or arsenic. These drugs are used to treat cancer and some other conditions. They raise the risk of bladder cancer.
    • Race. Whites get bladder cancer twice as often as African Americans and Hispanics. The lowest rates are among Asians.
    • Family history. People with family members who have bladder cancer are more likely to get the disease.
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    Treatment Bladder cancer is often caught early enough that the bladder can be saved.  However, treatment depends on the aggressiveness of the tumor, its risk of recurrence, and whether it has failed prior treatments.  Treatments are often based on whether the tumor is superficial or invasive.
    Superficial Bladder Cancer: The "simple polyp" or Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP).  These tumors tend to grow slowly but can recur frequently, some with troublesome bleeding.  Small tumors can be treated in the office; larger ones require a TURBT in the operating room.
    • Cystoscopic removal
    • Close surveillance every 6 months
    • Decrease risk factors (e.g. stop smoking)
    • 15% can progress to invasive disease
    • Periodic kidney evaluation
    Superficial Bladder Cancer: CISCarcinoma in situ or CIS.  These cells are more aggressive but not invasive.  They are fragile and can spread to other parts of the bladder easily.  The bladder appears irritated but may not have large tumors growing.  These tumors are often related to the appearance of more invasive tumors.
    • BCG therapy:  Induction dose: Weekly x 6 weeks; Maintenance dose: Weekly x 3 weeks annually.
    • Close surveillance every 6 months
    • Decrease risk factors (e.g. stop smoking)
    • 25% can progress to invasive disease
    • Periodic kidney and urethra evaluation
    Superficial Bladder Cancer: T1. T1 tumors have invaded into the superficial layers of the bladder but not into the deep layers.  These require aggressive treatment to eradicate but many can be permanently cured.  Some patients benefit from BCG; some from additional agents.  Recurrences risk invasive cancers 30-50% of the time.
    • BCG therapy:  Induction dose: Weekly x 6 weeks; Maintenance dose: Weekly x 3 weeks annually.
    • Close surveillance every 6 months
    • Decrease risk factors (e.g. stop smoking)
    • 50% can progress to invasive disease
    • Periodic kidney and urethra evaluation
    Invasive Bladder Cancer: T2. T2 tumors have invaded through the superficial layers of the bladder and into the deep layers.  These tumors can be life-threatening but still curable.  Some patients benefit from chemotherapy prior to surgery but removal of the bladder, or radical cystectomy, is the mainstay of therapy.
    T3 and T4 tumors.  Many patients who are clinically staged as having T3 or T4 tumors may still be helped with surgery; often the results of surgery are improved by chemotherapy and/or radiation.  As T3 and T4 disease represents high-risk stages, a combined approach with a urologist, a medical oncologist, and a radiation therapist may yield the most benefit.
    BCG therapy: BCG is such an important treatment in bladder cancer that it requires its own section.  BCG stands for bacillus Calmetter-Guerin after two early 20th century French bacteriologists who originally developed cultures of microorganisms they thought would work as a vaccine against tuberculosis.   BCG was used throughout the world for this purpose.  In the 1980s, BCG was noted to be powerful against certain forms of bladder cancer.  BCG was a kind of 'immuno-potentiator': it stimulates the body's immune system to identify and then kill cancer cells.  The two most common stages of cancer BCG is used for are Stage CISand some forms of stage T1.
    BCG vaccine.  The BCG powder (right) contains attenuated (non-infectious) mycobacteria.
    Types of BCG Therapy BCG is given for newly diagnosed patients with bladder cancer, for those with certain forms of recurrences, and also to given to prevent recurrences in the future.  BCG given shortly after cancer has been diagnosed is known as induction therapy.  BCG used to prevent recurrences is often termed 'maintenance' BCG.
  • Cancer of the testicle is a highly curable disease, especially when the tumor is only in the testicle. The testicle contains cells which develop sperm called germ cells. It is thought that mutations occur in a germ cell which leads to a germ cell tumor. The mutation may occur even before we are born and the tumor may take 20 years to be felt. The most common germ cell tumor is called a seminoma and it is so common than all the other types of tumors are referred to as non-seminoma. This is important becuase the treatments for seminomas may be quite different than for non-seminomas.