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Urological Cancers

Kidney Cancer Prostate Cancer Testicular Cancer Bladder Cancer Adrenal Gland Cancer KIDNEY CANCER Kidney cancers are generally seen between the ages of 40-70. 3% of all cancer patients are kidney cancer.

In our country, approximately 5000 people are diagnosed and treated with kidney cancer annually. There are some risk factors for the formation of kidney cancer. These; smoking, obesity, high blood pressure, chemical exposure and genetic causes. Kidney Cancer Symptoms Kidney cancer is usually asymptomatic. It is detected incidentally during radiological imaging methods for another ailment. Classic symptoms such as flank pain, bleeding in the urine and palpable mass are seen only in 10-15% of patients.

Due to spread to other organs in advanced disease; cough, jaundice, bone pain, weight loss complaints. Since it provides 85% survival with early diagnosis, it is important that those who have risk factors for kidney cancer or have a family history of kidney cancer should not miss their annual routine check-ups. Diagnostic Methods; Physical examination History Blood biochemistry Urinalysis Ultrasound Tomography MR PET/CT Treatment of Kidney Cancer Treatment of kidney tumors depends on the stage. In the early stages, partial nephrectomy, in which only the tumor is removed, can be performed in small tumors, and radical nephrectomy, in which the entire kidney is removed, in tumors that surround the kidney more. These surgeries can be performed with laparoscopic or robotic methods in suitable patients.

Radiofrequency ablation, cryotherapy and microwave thermal ablation methods can be used in patients who cannot receive anesthesia or have very small tumors. In suitable patients with tumor spread to other organs, targeted therapy and immunotherapy drugs that strengthen the immune system can be applied surgically or alone. PROSTATE CANCER It is a tumoral formation that occurs as a result of uncontrolled and abnormal growth of prostate gland cells.

What are the Symptoms of Prostate Cancer?

Prostate cancer usually does not show any symptoms while in its early stages. It gives symptoms only in advanced stages. At this stage, patients generally lose their chance to recover from the disease. For this reason, even if there are no complaints after the age of 50, annual routine control is recommended especially for people with a family history of prostate cancer. How Common Is Prostate Cancer? Prostate cancer is the second most common type of cancer in men. It constitutes 15% of all cancer types. It is seen with a similar frequency in our country. Despite being so common, the mortality rate due to prostate cancer is very low. The reason for this is that the chance of recovery is high when diagnosed in the early period and when the right treatment is applied. How is Prostate Cancer Determined? First step evaluation is performed with PSA measurement and examination.

If prostate cancer is suspected as a result of this evaluation, the diagnosis is made by prostate biopsy, if necessary, after multiparametric prostate MRI. What is Prostate Biopsy? In classical biopsy, tissue sampling is performed under ultrasound guidance from 10-12 focal points of the prostate. The classical method diagnoses 70%-75% of prostate cancer patients. An important part is skipped. In recent years, this rate has increased to 98% with the MRI Fusion Biopsy (smart biopsy) method. Prostate Cancer Treatment In determining the treatment in prostate cancer; The pathological features (stage, aggressiveness, etc.) obtained as a result of the biopsy should be determined by considering the general health status, age, and treatment expectations of the patient. Considering the above-mentioned features of the treatment; Active monitoring, surgical treatment (Open or robotic radical prostatectomy), radiation therapy (radiotherapy), focal treatments (HIFU), Hormone Therapy, Drug therapy (chemotherapy) should be chosen by the patient, their relatives and the doctor as a result of a joint decision.
 Surgical Treatment (Radical Prostatectomy open or robotic) Radical prostatectomy surgery is the removal of the entire prostate in patients with tumors confined to the prostate and, if necessary, the removal of the lymph nodes where the prostate is drained. The 10-year survival rate of patients who have undergone radical prostatectomy operation is over 90%. Prostate tissue is very close to the nerves that provide sexual functions and the muscles that provide urine retention. The most important goals during this surgery are the control of the tumor, the protection of the muscles that provide urine retention and the protection of the nerves that provide sexual functions. The most important advantage of the surgery performed with robotic surgery over open surgery is better protection of the nerves that provide sexual functions and structures that provide urine retention. Other advantages are smaller incisions, less blood loss, and faster discharge. HIFU (High Intensity Focused Ultrasound) HIFU is the destruction of cancer cells in the prostate with the help of high-intensity focused sound waves.

Under general anesthesia, the targeted points with the MR images taken beforehand in the prostate tissue with an ultrasound source inserted through the anus are destroyed by the high heat energy created by HIFU. The most important advantages of the HIFU method are that patients do not have the risk of urinary incontinence or sexual dysfunction in surgery or radiotherapy. It is used as an alternative to surgery or radiation therapy in suitable patients. Testicular cancer Role of the testicles: The facilities are responsible for the production of sperm in men and the secretion of the male hormone testosterone. Testicular cancer is the most common type of solid cancer in men aged 18-35 years. It constitutes 1% of all cancers seen in men. What are the symptoms? The most common finding is a palpable, painless testicular mass. Sometimes it can cause pain. When distant organ spread, complaints such as back pain, bone pain, cough, change in consciousness, and sometimes enlargement and pain in the breasts due to hormone release may occur. What are the Risk Factors? History of undescended testis Family or history of testicular tumors Genetic diseases (klinefelter syndrome, down syndrome) Cannabis use How is Caucasian Diagnosis Made? • If a mass is detected on ultrasound, tumor markers AFP, BHCG, LDH •Tomography for staging, bone scintigraphy, Pet/ct How to Treat Testicular Cancer? When the diagnosis of testicular tumor is made, an operation should be performed quickly. Under general or spinal anesthesia, the testis and its cord are removed with an incision made in the inguinal region. According to the pathology and staging results, a second operation, lymph node removal (RPLND), chemotherapy or radiotherapy treatment can be applied. BLADDER CANCER What is Bladder Cancer? It is a tumoral formation that starts from the inner layer of the bladder and can then hold the deeper layers. Bladder cancer is the 11th most common type of cancer worldwide. Although it is more common in men than women, it is more aggressive in women. Its frequency increases in direct proportion to age. Although 75% of bladder tumors are detected at an early stage, the follow-up in the first 5 years after diagnosis is very important to prevent tumor recurrence and staging. What Are Bladder Cancer Risk Factors? Cigarettes and other tobacco products Exposure to chemical agents (especially those working in professions related to paint, textile, leather and petroleum products) Chronic irritation (bladder stone, infection, prolonged exposure to catheters, etc.) Some parasites (schistosome) Having received radiotherapy Bladder Cancer Symptoms In the urine painless bleeding (may be clotted) Difficulty urinating, burning during urination, pain, frequent urination, Weight loss in advanced tumors, loss of urine and defecation control, bone pain, cough, confusion What are the Diagnostic Methods? Cystoscopy: It is the visualization of the external urinary tract under local anesthesia by entering the camera. Biopsy: If a bladder tumor is suspected during cystoscopy, a piece can be taken during the procedure and pathological evaluation can be made. When the biopsy procedure is performed as a TUR procedure, it can be both diagnostic and therapeutic.

Urine Cytology: It is the evaluation of the urine sample taken under the microscope to evaluate the presence of a smaller tumor in case the tumor is not seen during cystoscopy but the suspicion continues. Imaging Methods:  What are the Pet/CT Treatment Methods if Ultrasound Tomography MRI is required? The main determinants in the treatment of bladder cancer are; the type, pathological stage and aggressiveness of the tumor are the general health status and age of the patient. Stage 1 tumors involve only the epithelial layer, the innermost layer of the bladder. At this stage, chemotherapy or BCG drugs administered into the bladder after the procedure are usually sufficient in cases where TUR is required. The aim of these treatments is to stop tumor recurrence and progression. Nevertheless, periodic cystoscopy controls are necessary for these patients. Stage 2 tumors involve deeper muscle layer. The gold standard treatment method in these patients is radical cystectomy, in which the lymphatic tissues are removed along with the bladder. After the bladder is removed, a new bladder is made from the intestines of the patient with various tests. Although it can be performed with open surgery in general, radical cystectomy can be performed with less risk with laparoscopic and robotic methods.

In Stage 3 tumors, in cases where the outer layer of the bladder (serosa) is occupied by the tumor, and in Stage 4 tumors, in cases where cancer spread to other organs is detected, Systemic Chemotherapy is applied first, and radiotherapy or surgery (radical cystectomy) options can be applied depending on the response. Adrenal Gland Tumor Adrenal glands (adrenal or adrenal gland) It is two glandular organs located just above the kidneys, responsible for hormone production. The incidence of adrenal gland tumors increases with aging, especially when detected incidentally, which does not require benign surgery. What are the Symptoms? If it causes hormone release; High blood pressure, palpitation, sweating, Weight gain, increased hair growth, increased fat on the face and abdomen, Headache, irritability, acne, Sexual dysfunctions If the mass has grown too much, compression symptoms (constipation, abdominal pain, etc.) If the mass has metastasized, related symptoms Diagnosis How is it put? In a patient with a mass in the adrenal gland, blood tests to determine hormone secretion and computerized tomography or MRI are used to differentiate benign/malignant in the first place. Imaging methods have over 90% accuracy. When Is Surgery Recommended? Masses smaller than 4 cm in the adrenal gland that do not cause hormone production should be followed up for 6 months or annually. Surgery is recommended for masses that are suspected of being malignant, those that produce active hormones, those that are larger than 4 cm, and those that grow faster than 10 mm per year. When the operation decision is taken, robotic laparoscopic or open surgery can be performed. Robotic and laparoscopic surgery is recommended with rapid recovery, small incisions, less bleeding and less hospital stay. If the decision for surgery has been taken, the operation can be performed by laparoscopic, robotic or open methods. Laparoscopic and robotic surgery is the gold standard in experienced hands and provides many advantages. It saves a large incision cosmetically and provides a comfortable and fast healing process.


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