Urological cancers


  • Bladder cancer

    Types of bladder cancer

    Bladder cancers can be non-muscle invasive or muscle invasive.

    Cancer Research UK has detailed information on the different types of bladder cancer.

    Investigations and diagnosis

    You may be sent for a number of investigations at Belfast City Hospital or the Mater Hospital.

    Cancer Research UK has detailed information on the different tests to diagnose bladder cancer.

    If you are diagnosed with bladder cancer, you will be able to discuss the diagnosis with your consultant. Your results will also be discussed by the urological cancer multi-disciplinary team.

    Treatment

    Macmillan has a range of information on treatment for bladder cancer.

    Pre-assessment clinic

    You may be asked to attend an appointment with a member of the anaesthetic team for a pre-assessment before surgery. This is to ensure you are fit to undergo the treatment.

    Surgery

    For many patients with bladder cancer, surgery may be the most appropriate treatment. Your stay in hospital is likely to be 10 to 12 days.

    Surgery for bladder cancer is a major operation and it can take a number of weeks to recover.

    Types of surgery:

    Chemotherapy

    Macmillan has comprehensive information on chemotherapy for bladder cancer.

    Radiotherapy

    Macmillan has comprehensive information on radiotherapy for bladder cancer.

    Symptom control

    Following treatment, you will be encouraged to self-manage as soon as you can, with guidance from the stoma nurse and ward nursing staff.

    At first, the stoma will be slightly swollen and it can take several weeks for it to settle down to its normal size.

    The nursing staff will help you look after the urostomy if one has been formed and will encourage emptying and changing of the bag as often as necessary.

    When changing the bag, you should allow yourself plenty of time and privacy.

    Before you leave hospital, the nurse will make sure you have a good supply of urostomy bags. You can get further supplies from a chemist. It may be a good idea to order in advance. The stoma nurse can also organise delivery to your home.

    Follow-up

    After your treatment is complete, you will be asked to return to the hospital for follow-up appointments.

    These review appointments allow us to check the progress of your recovery. They are also an opportunity for you to discuss any concerns you may have.

    If you have any problems or notice any new symptoms in between review appointments, contact your urology clinical nurse specialist, consultant or GP. You may need additional treatment or rehabilitation services.

    Useful links

  • Penile cancer

    Types

    Penile cancer is known as carcinoma of the penis.

    Like many cancers, penile cancer is graded on its severity. The grade will determine the treatment options available.

    Treatment

    Macmillan has a range of information on treatment for penile cancer.

    There are several surgical procedures used to treat penile cancer:

    • wide local excision – removes the tumour and some of the healthy tissue surrounding the tumour
    • microsurgery – removes the tumour and as little of the surrounding healthy tissue as possible
    • laser surgery – uses a laser light to burn or cut away cancerous cells
    • circumcision – removes a cancerous foreskin
    • penectomy – total removal of the penis (and lymph nodes if the cancer has spread)

     

    Penile cancer may also be treated with radiotherapy or chemotherapy.

    Useful links

  • Prostate cancer

    Types of prostate cancer

    There are several types of prostate cancer:

    Investigations and diagnosis

    There are several investigations that can diagnose prostate cancer:

     

    When your investigations have been completed, your results will be discussed at the multi-disciplinary team meeting. You will then be referred to see a consultant urologist.

    Treatment

    Macmillan has a range of information on treatment for prostate cancer.

    There are a number of treatment options for prostate cancer:

    Pre-surgery

    Prostate cancer surgery is provided at Belfast City Hospital by specialist surgeons.

    You will be asked to attend a pre-operative assessment to ensure you are fit for surgery. This will take place in the Outpatients Department or as part of an overnight stay.

    Your surgeon will let you know when you can expect your surgery to take place. Most patients stay in hospital for two to four days and go home with a urinary catheter in place for approximately 10 to 14 days.

    After that, you will return to the hospital to have the catheter removed. This may require an overnight stay.

    At this time, you will have the opportunity to see a specialist physiotherapist regarding pelvic floor exercises to help regain continence as soon as possible.

    Side effects of treatment

    There are a number of side effects to all treatment options for prostate cancer. The most common side effects include:

    Follow-up

    After your treatment is complete, you will be asked to return to the hospital for follow-up appointments. Your GP will need to check a PSA blood test before each follow-up appointment.

    These review appointments allow us to check the progress of your recovery. They are also an opportunity for you to discuss any concerns you may have.

    If you have any problems or notice any new symptoms in between review appointments, contact your urology clinical nurse specialist, consultant or GP. You may need additional treatment or rehabilitation services.

    Useful links

  • Renal / kidney cancer

    Types of Kidney Cancer

    The majority of kidney cancers are renal cell cancers (RCC). These are sometimes called renal adenocarcinoma. The most common subtype is clear cell renal adenocarcinoma.

    Other less common types of renal cancer include:

    • Papillary (or chromophilic)
    • Chromophobic
    • Oncocytic
    • Collecting Duct
    • Sarcomatoid

    A rarer type of kidney cancer is transitional cell cancer (TCC) of the urethra.

    More information on types of kidney cancer

    Investigations and Diagnosis

    If a patient is suspected of having kidney cancer, they will be referred to Belfast City Hospital by their GP. The referral will usually be based on the results of blood and urine tests conducted by the GP.

    If blood is found in a urine sample (haematuria), the patient will be referred to a ‘one stop’ haematuria clinic. At this kind of clinic, all the tests needed to make a diagnosis can often be carried out at the same time and it is possible to go home the same day. Eating or drinking may be prohibited for up to eight hours before the appointment.

    There are a number of diagnostic investigations that patients with suspected kidney cancer may have. These can usually be done at a one stop haematuria clinic.

    Diagnostic investigations:

    • Flexible Cystocopy
    • Ultrasound Scan
    • CT (Computerised Tomography Scan)
    • MRI Scan
    • Intravenous Urogram
    • Imaged guided biopsy
    • Chest X-ray

    Treatment

    Pre-assessment clinic

    When coming to Belfast City Hospital for surgery, patients may be asked to come up to meet one of the surgical team for a pre-assessment appointment to ensure the patient is fit and safe for surgery. In some cases patients may have an anaesthetic assessment and if this is required then the patient may be admitted overnight.

    Patients are informed of approximate date of their surgery or the expected waiting time by their surgeon and will be kept up to date by the Urology Scheduling office. When a patient comes to the hospital for surgery, they will most probably be admitted to Level 3 of Belfast City Hospital Tower. This is a specialised urology ward.

    Surgery

    For many patients with kidney cancer, surgery may be the most appropriate treatment. Surgery to remove the cancer is a major operation and it will take a number of weeks to recover. Surgery is performed at Belfast City Hospital.

    There are 3 main types of surgery to treat kidney cancer:

    • Partial Nephrectomy: This procedure involves the surgical removal of part of the kidney in which a small tumour is located.
    • Radical Nephrectomy: This procedure involves the surgical removal of all of the kidney to prevent a serious side effect or chronic kidney disease.
    • Laparoscopic Nephrectomy: This procedure involves the removal of some or the entire kidney via keyhole surgery. This type of surgery makes a small opening in the kidney and a laparscope is used to see/examine and work inside the abdomen.

    If the urology surgeon decides that a patient is not suitable for surgery then they may send them for an embolisation procedure. This procedure may also be performed if the cancer tumour is too large to remove. It involves blocking off the blood supply to the tumour. A thin plastic tube known as a catheter is placed into the blood vessel in the groin. A substance is then injected through the catheter which passes into the kidney.This substance blocks off the blood supply i.e. oxygen and nutrients to the tumour in the kidney.

    Chemotherapy

    Patients may require chemotherapy as part of their treatment for kidney cancer.

    Radiotherapy

    Patients who require radiotherapy as part of their treatment for kidney cancer will be treated in the Radiotherapy Department in the Cancer Centre.

    Follow Up

    As part of follow up after treatment, patients will be asked to attend review appointments with a member of the uro-oncology cancer team. The frequency of these review appointments will differ for each patient. The review appointments allow the team to assess patient progress following treatment. The appointments are also a good opportunity for patients to discuss any problems or worries they may have.

    Follow up appointments will take place in Belfast City Hospital or the Mater Hospital.

    If patients notice any new symptoms or have any worries between follow up appointments, they should contact their GP, Urology Clinical Nurse Specialist or Consultant.

    Useful Links

    For more information on kidney cancer and kidney cancer charities and support groups, please follow the links below:

  • Testicular cancer

    Types of Testicular Cancer

    There are two main types of testicular cancer:

    • Seminoma: These usually occur in men between 25 and 55 years of age.
    • Non-seminomatous germ cell tumours (NSGCTs): These tumours used to be called teratomas. This group of tumours usually affects younger men – from about 15 to 35 years old. It includes different types of tumours such as teratoma and embryonal tumours. Many are a mixture of these types and other tumours, including seminoma.

    Rare types of testicular cancer include:

    • Non-Hodgkin lymphoma
    • Leydig Cell
    • Sertoli cell tumours

    Sometimes cancer cells from the testicle can spread to nearby lymph nodes (also known as glands). Doctors will discuss this with patients diagnosed with testicular cancer, so it can be helpful to understand a bit more about it. Cancer cells can be picked up by the lymph fluid and carried to lymph nodes in other parts of the body. Lymph vessels in the testicles carry fluid to a collection of lymph nodes at the back of the stomach (abdomen).

    Investigations and Diagnosis

    As part of the pathway for diagnosis and management of testicular cancer, patients may be sent for a number of investigations in Belfast City Hospital.

    Blood tests: Some testicular cancers produce chemicals, which are released into the bloodstream. The two main chemicals, called tumour markers, are alpha-fetoprotein (AFP) and beta human chorionic gonadotrophin (BHCG). If they are present in the blood, they can be used to measure the effect of treatment on the cancer or detect recurrence of the cancer.

    • Ultrasound Scan
    • Chest X-Ray
    • CT Scan
    • PET Scan
    • Lymph Node Biopsy

    Types of Treatment

    Surgery

    For most patients with testicular cancer, surgery may be the most appropriate treatment.

    • Orchidectomy: The standard treatment for localised disease is an orchidectomy (surgical removal of the testicle), which usually takes place within a few weeks of diagnosis. The procedure is via an incision (cut) in the groin and not through the scrotal sac. An artificial testicle (prosthesis) can be inserted into the scrotum to restore a normal appearance. The removed testicle is sent to the laboratory and examined further to find out which type of testicular cancer it is. Patients can usually go home the same or next day.
    • Lymph Node Dissection: If the cancer has spread to the lymph nodes then patients may have a lymph node dissection at a later date.

    Urology cancer surgery for Northern Ireland is provided at Belfast City Hospital by specialist uro-oncology surgeons.

    Patients are informed of the approximate date of surgery or waiting time by their surgeon. When they come to the hospital for surgery they will be admitted to Level 3 of the Belfast City Hospital Tower; this is a urology specialist ward. Staff on the ward will be on hand to answer any questions and they can refer patients to a urology clinical nurse specialist if required.

    Chemotherapy

    There are two main types of chemotherapy used to treat testicular cancer:

    • BEP Chemotherapy – patients receive this treatment as an inpatient in the Cancer Centre
    • Carboplatin Chemotherapy – patients receive this as an outpatient in the Bridgewater Suite of the Belfast City Hospital.
    Radiotherapy

    Patients diagnosed with testicular cancer may sometimes receive radiotherapy.

    Follow Up

    After treatment is completed, patients will have regular check-ups with blood tests, scans and x-rays. The frequency of these review appointments will differ for each patient. These appointments allow the team to assess patient progress following treatment. The check-ups are also a good opportunity to discuss any problems or worries patients may have with their doctor.

    Follow up appointments will take place in the Teratoma Clinic in Bridgewater Suite, Belfast City Hospital Tower.

    If patients notice any new symptoms, or have any worries, they should contact the Teratoma Clinic, to discuss the symptoms as they may need additional treatment or rehabilitation services such as a dietician or physiotherapy services.

    It is vital that patients who have been diagnosed with testicular cancer attend regular follow up appointments.

    Useful Links

  • Referral

    If a GP suspects a patient may have a urological cancer, they will be referred to a consultant urology doctor in Belfast City Hospital for further tests and specialist advice.

    Patients will be contacted regarding an appointment.

    ‘One-stop’ Haematuria Clinic

    If blood is found in a patients urine (haematuria), they may be referred to a ‘one-stop’ haematuria clinic at Belfast City Hospital or Mater Hospital. At this kind of clinic, all the tests needed to make a diagnosis can often be carried out on the same day. Patients may be given instructions not to eat or drink anything for up to 8 hours before their appointment.

  • Multi-disciplinary team

    To ensure that patients get the best care and treatments availiable, every new patient with urology cancer is discussed by the Urological Cancer Multi-disciplinary team. The team located in the Belfast Health and Social Care Trust is a specialist team. This means that the team discuss patients from all over Northern Ireland and includes clinicians from every health and social care trust.

    The Urological Cancer Multi-disciplinary Team (MDT) meets every Thursday afternoon in Belfast City Hospital. Detailed discussions between the relevant specialists take place, looking at all the available results for each patient to ensure that the best treatment plan for every patient is agreed.

    The team has a range of specialists including:

    • Consultant Oncologists
    • Consultant Surgeons
    • Consultant Pathologists
    • Consultant Radiologists
    • Clinical Nurse Specialists
    • Allied Health Professionals