Urological Cancers


  • Bladder Cancer

    Types of Bladder Cancer

    There are three common types of bladder cancer:

    • Transitional Cell Bladder Cancer (TCC) is the most common type of bladder cancer. Nearly all cancers of the bladder start in the layer of cells (transitional cells) which form the lining of the bladder (transitional epithelium). These cancers are called transitional cell or urothelial cell cancers.
    • Invasive Bladder Cancer may appear as a tumour which has grown into the muscle wall of the bladder. This is known as invasive bladder cancer. Bladder cancer may also begin as a small growth only on the inner lining of the bladder (called papillary cancers). Sometimes these early cancers can start to grow into the muscle of the bladder and become invasive bladder cancer.
    • Carcinoma In Situ (CIS) is a type of early bladder cancer which appears as a red, ulcerated area in the bladder. In CIS the cells are very abnormal or high-grade, so it can grow quickly. If it’s not treated effectively, there’s a high risk that CIS will become an invasive cancer.
    • Rarer types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancers start from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus. Both of these types are usually invasive.

    Investigations and diagnosis

    As part of the pathway for diagnosis and management of Bladder Cancer, patients may be sent for a number of investigations at Belfast City Hospital or Mater Hospital. Please follow the links below for information on investigations for bladder cancer:

    • Cystoscopy
    • Ultrasound

    Patients who are diagnosed with bladder cancer will discuss the results of their investigations with their consultant and will be discussed by the urological cancer multi-disciplinary team.

    Treatment

    Pre-assessment Clinic

    Patients who are coming to Belfast City Hospital for surgery may be asked to attend an appointment with a member of the anaesthetic team for a pre-assessment prior to surgery to ensure they are fit and safe to undergo the treatment.

    Patients will be informed of approximate date of surgery or waiting time by their surgeon and will be kept up to date by the Urology Scheduling office staff.

    Surgery

    Patients who have surgery to treat their bladder cancer will be admitted to level 3, Belfast City Hospital tower. For many patients with urology cancer, this may be the most appropriate treatment. The approximate length of a hospital stay will be 10 – 12 days. Surgically removing the cancer is a major operation and it can take a number of weeks to recover.

    Types of Surgery:

    • Transurethral resection of bladder tumour (TURBT): This type of surgery involves the removal of any unusual growths or tumours on the bladder wall. Patients will have this surgery under general anaesthetic. Any abnormal areas within the bladder are carefully assessed by the surgeon and all visible tumour is then resected with a hot loop (diathermy). Tumour samples are sent to the histopathology laboratory. Patients will be reviewed at a results clinic within 3 – 4 weeks.
    • Partial Cystectomy: This procedure involves the surgical removal of part of the bladder in which a small tumour is located.
    • Radical Cystectomy: This procedure involves the surgical removal of all of the bladder to prevent the spread of the cancer. It is the main treatment for muscle invasive bladder cancer and is occasionally followed by radiotherapy. Patients who have this procedure will have a new area created by the surgeon for storing urine following this procedure. This may be done by:
      • Urostomy: The urethers are connected to a stoma which is connected to a urostomy bag that sits outside the body.
      • Bladder Reconstruction
      • Continent Urinary Diversion: A section of the bowel is used to make a pouch in the abdomen to store urine. This is a closed system to create a ‘new’ bladder.

    Symptom control

    Post operatively, patients will be encouraged to self manage as soon as they are able with guidance of the stoma nurse and ward nursing staff with the aim of independent management as soon as possible. At first the stoma will be slightly swollen and it can take several weeks before it settles down to its normal size. The nursing staff will help the patient look after the urostomy if one has been formed and will encourage emptying and changing of the bag as often as is necessary. When changing the bag, patients should allow themselves plenty of time and privacy so that they can do things at their own pace and without interruptions.

    The size and position of the stoma will be the most important factor in how noticeable the bag or appliance is through clothing. The stoma position is not a choice. The stoma nurse will mark the site pre-operatively with the aim of optimum positioning but this may need to be relocated during surgery.

    Before patients leave hospital, the nurse will make sure they have a good supply of urostomy bags. When at home, patients can get all their supplies from their chemist. As some chemists don’t have a very large stock, it’s often a good idea to give them an order well in advance or the stoma nurse can organise delivery to the patient’s home.

    Once at home, patients will still be able to phone their stoma care nurse for advice and may have contact with a community stoma nurse. The staff at Belfast City Hospital can arrange for a district nurse to visit a patient when they first leave hospital and are recovering. The nurse can help to sort out any problems patients have with a urostomy.

    Chemotherapy

    Patients who are to receive chemotherapy to treat their bladder cancer, will discuss the specifics of this treatment with their consultant oncologist.

    Radiotherapy

    Patients who are to receive radiotherapy to treat their bladder cancer, will discuss the specifics of this treatment with their consultant oncologist.

    Follow Up

    As part of a patient review following cancer treatment, patients will be asked to return to the hospital to see one of the uro-oncology 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 check-ups are also a good opportunity for patients to discuss any problems or worries they may have.

    Follow up appointments will take place in one of two hospitals of the Belfast Health and Social Care Trust; Belfast City Hospital or the Mater Hospital.

    If patients notice any new symptoms or have any worries they should contact the urology clinical nurse specialist, consultant or their local GP to discuss the symptoms as they may need additional treatment or rehabilitation services such as a dietician or physiotherapy services.

    Useful Links

    • www.macmillan.org.uk/Cancerinformation/Cancertypes/Bladder/Bladdercancer.aspx
    • www.actiononbladdercancer.org
    • www.ucanhelp.org.uk/
    • www.bladderandbowelfoundation.org/
  • Penile Cancer

    Types

    Penile cancer is known as carcinoma of the penis though there are varying degrees of severity. Like many cancers, penile cancer is ‘graded’ to determine its severity. There are several grades and these determine what the next steps are in treating penile cancer. Please follow the link for more information on the grading of penile cancers.

    Treatment

    There are several surgical procedures used to treat penile cancer:

    • Wide local excision – This procedure aims to remove the tumour and some of the healthy tissue surrounding the tumour.
    • Microsurgery – This surgery is performed with a microscope. It aims to remove the tumor and as little of the surrounding healthy tissue as possible.
    • Laser surgery – This procedure involves the use of a laser light which burns or cut aways cancerous cells
    • Circumcision – This procedure is used to remove a cancerous foreskin.
    • Penectomy – A penectomy is the total removal of the penis. Lymph nodes may also be removed if the cancer has spread.

    Penile cancer may also be treated with radiotherapy or chemotherapy. Please follow the link for more information on the treatments used to treat penile cancer.

    Useful Links

    Below are links to useful web resources on penile cancer and charities who raise awareness of urological cancers as a whole:

  • Prostate Cancer

    Types of Prostate Cancer

    There are several types of prostate cancer:

    • Localised Prostate Cancer: Prostate cancer that is contained within the prostate gland.
    • Locally Advanced Prostate Cancer: Prostate cancer that has spread to the area just outside the prostate gland.
    • Advanced Prostate Cancer: Prostate cancer that has spread outside of the prostate gland to other parts of the body.

    Investigations and Diagnosis

    There are several investigations which a patient may undergo to diagnose prostate cancer:

    • Prostate Specific Antigen (PSA) Test: PSA is a protein made by the prostate gland which naturally leaks out into the blood. The PSA is a blood test which measures the level of PSA in your blood. It can take up to two weeks to get the result of a PSA test. Please note: a raised PSA does not always mean a patient has prostate cancer. For more information on the PSA test please click here
    • Digital Rectal Examination (DRE): A common way of diagnosing a prostate problem is for the doctor to feel the prostate gland through the wall of the back passage (rectum), using a gloved, lubricated finger. The doctor is feeling for any hard or irregular areas that may be a sign of cancer. The DRE may be carried out by a GP and will be repeated by the hospital specialist.
    • Trans-Rectal Ultrasound Guided Biopsy (TRUS): Patients will usually be recommended to have a TRUS biopsy. The aim of a prostate biopsy is to detect the presence of prostate cancer. The prostate needle biopsy involves taking a number of small pieces of prostate tissue to be looked at more closely under the microscope. This procedure will be carried out in Urology Day Care Level 3 Belfast City Hospital Tower. The biopsy is carried out under local anaesthetic, usually as a day case.
    • MRI Scan: MRI (Magnetic Resonance Imaging) uses magnets rather than X-rays to create a detailed picture of the prostate and surrounding tissues. This may be carried out as part of routine investigations.
    • Bone Scan: A bone scan may show whether any cancer cells have spread from the prostate to bone. The scan involves an injection of a safe radioactive dye into a vein in the arm. The bone scan is done in the Nuclear Medicine Department on the Lower Ground Floor of the Cancer Centre.

    Once all the investigations are completed the patient will be discussed at the multi-disciplinary team meeting. Patients will then be referred to see a Consultant Urologist to discuss the results of their biopsy and any other investigations they may have had.

    Types of Treatment

    Active surveillance

    Prostate cancer is often very slow growing and for many men with prostate cancer, the disease may never progress or cause any symptoms. Not all prostate cancers need treatment. Active surveillance involves monitoring prostate cancer to begin with, rather than treating it straight away. Typically, monitoring includes PSA testing, regular Digital Rectal Examinations and repeat prostate biopsies every two or three years, or MRI scans.

    Surgery
    Pre-surgery

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

    When coming to Belfast City Hospital for surgery, patients will be asked to attend for a pre-operative assessment to ensure they are fit and safe for surgery. This assessment will take place in the Outpatient department or as part of an overnight stay.

    Patients are informed of the approximate date of surgery or waiting time by their surgeon.

    When patients come to the hospital for surgery they will be admitted to Level 3 of Belfast City Hospital Tower, this is a urology specialist ward. Staff on the ward will be on hand to answer any questions and can refer patients to a nurse specialist if required.

    Most patients will stay in hospital for 2-4 days and will go home with a urinary catheter in situ for approximately 10-14 days. Patients will then return to hospital, generally for an overnight stay to have the catheter removed. At this time patients will have the opportunity to see a specialist physiotherapist regarding pelvic floor exercises to help regain continence as soon as possible.

    Types of Surgery

    For many patients with prostate cancer, surgery may be the most appropriate treatment. The main type of surgery that patients with prostate cancer will have is known as a radical prostatectomy.

    Radical prostatectomy is a treatment option for fit, healthy men with cancer that is thought to be contained within the prostate gland (localised prostate cancer). It may not be suitable for patients to have surgery if they have other health problems such as significant heart disease, as these increase the risks of surgery. Surgery to remove prostate cancer is a major operation and it will take some time to recover from the operation

    There are several ways of removing the prostate gland via surgery:

    • Open Retropubic Prostatectomy: This is the most common method and is done through an opening in the lower abdomen.
    • Laparscopic Retropubic Prostatectomy: This is also known as keyhole prostatectomy. This involves accessing the prostate gland through five or six openings, rather than one large one. A tube with a light and eye piece is used to look inside the body. Gas is injected into the abdomen and the area is examined with a camera. The surgeon can then cut away the cancerous gland.
    • TURBT/Transurethral Resection : A TURBT is a common operation for men who have an enlarged prostate gland. An enlarged prostate gland causes men to have difficulty passing urine from the bladder as the gland will be swollen and causing obstruction. TURBT surgery removes a section of the prostate gland to reduce the pressure on the bladder.

    Radiotherapy

    Radiotherapy is the use of exact, carefully measured doses of radiation to destroy cancer cells in the body. This treatment is painless; there is no sensation of heat or pain while treatment is being given. It is rather like having an x-ray picture taken but lasts slightly longer. The type of radiotherapy used to treat prostate cancer is known as external beam radiotherapy

    Radiotherapy is a suitable treatment for men of any age and is as effective as surgery (radical prostatectomy) at treating localised prostate cancer. Radiotherapy may also be suitable for a small number of men whose cancer has spread outside the prostate gland (locally advanced).

    Most patients are given hormone therapy as part of their cancer treatment, before starting radiotherapy to reduce the size of the prostate. Patients may also have hormone therapy during their course of radiotherapy, and sometimes for a period of time afterwards.

    For general information on radiotherapy in the Belfast Health and Social Care Trust, please follow this link

    Brachytherapy

    Brachytherapy is a treatment for cancer that is contained within the prostate gland (localised prostate cancer). Studies show that brachytherapy is as effective at treating prostate cancer as radical prostatectomy or external beam radiotherapy in men who are suitable for treatment.

    Brachytherapy treats prostate cancer by implanting tiny radioactive seeds directly into the prostate gland using thin needles. This is carried out under general anaesthetic. At Belfast City Hospital brachytherapy is given as a two-stage procedure and the treatment involves two hospital visits. The first stage is the pre-implant planning session. Two to four weeks later patients come back to the hospital for the second stage when the seeds are implanted.

    For general information on the use of brachytherapy in the Belfast Health and Social Care Trust, please follow this link.

    Hormone Therapy

    Hormone therapy is an effective drug treatment which works by changing the hormone balance in the body which stops the male hormone testosterone from reaching the prostate cancer cells. This may be given as a combination of tablets and injections, or injections or tablets alone.

    Hormone therapy is used in different ways depending on the stage of a prostate cancer and will be discussed with patients by their consultant.

    Chemotherapy

    Chemotherapy uses anti-cancer drugs to kill cancer cells. It is a very common treatment for many types of cancer. In the past chemotherapy was not shown to be a very effective treatment for prostate cancer. However, newer chemotherapy drugs are available which are sometimes useful if the cancer has spread outside the prostate gland and is no longer responding to hormone therapy.

    For general information on chemotherapy in the Belfast Health and Social Care Trust, please follow this link.

    Side Effects of Treatment

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

    • Erectile dysfunction (ED): or the ability to have or maintain a natural erection.
    • Loss of sex drive: All types of hormone therapy are likely to cause patients to lose desire for sex (libido)
    • Urinary incontinence: Ranging from drips of urine to leaking larger amounts.
    • Bowel problems: Radiotherapy may cause the lining of the bowel to become inflamed which leads to various symptoms such as loose, watery stools, which can sometimes be blood stained; increasing wind and more frequent bowel movements.
    • Infertility: The prostate gland and seminal vesicles which produce and store some of the fluid in semen are affected during treatment. Patients planning to have children may be able to store their sperm before treatment starts for use in IVF (In Vitro Fertilisation).
    • Hot flushes: Most men taking hormone therapy will get hot flushes due to the lowering of the male hormones in the body.

    Follow Up

    As part of review following cancer treatment patients will be asked to return to the hospital to see one of the Surgical or Oncology 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 check-ups are also a good opportunity for patients to discuss with a doctor or specialist nurse any problems or worries they may have.

    A PSA blood test will need to be checked by a patients’ GP prior to each follow up appointment.

    If patients notice any new symptoms, or have any worries, they should contact their GP, nurse specialist, or consultant to discuss these symptoms.

    Useful Links

    Please click on the links below for more information on prostate cancer:

  • 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