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Uro Oncology Hospital in India

Asian institute of uro oncology and robotic surgery

Department of Uro oncology

What is cancer?
Cancer is an abnormal growth of cells which tend to proliferate in an uncontrolled way. Usually normal cells divide in an orderly way. They die when they are worn out or damaged, and new cells take their place. Cancer is when the cells start to proliferate exponentially and grow out of control. These cells eventually crowd out normal cells and form a mass of tissue, called a tumor. Cancer can affect any part of the body and can spread to other parts of the body. When cancer cells spread, it’s called metastasis.

What are the causes or risk factors of cancer development?
Causes or risk factors of cancer development can be broadly divided into the following groups: 1. Biological factors- such as age, gender, inherited genetic defects and family history of certain cancers. 2. Lifestyle-related factors- consumption of tobacco products and alcohol, Obesity and dietary factors. 3. Environmental exposure- UV radiation and carbon particles. 4. Occupational risk factors- many chemicals, radioactive materials and asbestos. 5. Infectious causes- Human Papilloma virus (HPV) 6. Carcinogens: The substances that cause cancer are called carcinogens.

What is oncology?
Oncology is a branch of medicine that deals with the prevention, diagnosis, and treatment of cancer.

What is Uro-oncology/ genito-urinary oncology
Uro-oncology/ genito-urinary oncology is a specialized field in oncology, focusing on cancers found in the urinary and the male reproductive organs. These include prostate cancer, kidney cancer, adrenal tumors, bladder cancer, testicular cancer and cancers of the penis. Urologist who specializes in the management of genito-urinary cancers is called Uro-oncologist.

How common are the Genito-urinary cancers?
Tumors of the genitourinary system are one of the most common tumors encountered in clinical practice, especially in Indian subcontinent. Increased screening programmes, improved cancer awareness in general population and with the advent of newer imaging modalities; the cancers of Genito-urinary system are being detected at early stages.

Is cancer curable?
Most of the cancers are curable if they are detected at initial stages or lower grades. Few can be treated even at relatively later stages with multiple treatment modalities. Cancers at very late stages are difficult to be cured; however quality of life can be improved with palliative and supportive care.

How to diagnose the cancer at early stage?
Early detection of cancer significantly increases the chances for successful treatment. Some signs of cancer include lumps/ swellings, sores that fail to heal, blood in the urine, unexplained loss of weight and loss of appetite. However for all practical purposes most of the cancers, genito-urinary cancers in particular, are silent in initial stages. These can only be detected with screening or regular health check. Kidney, adrenal, bladder and testicular cancers can be detected by scans, Prostate cancer can be detected by serum PSA (Prostate specific antigen) test and penile cancers can be diagnosed by clinical examination. Once suspicious lesions detected, confirmation can be done by tissue biopsy (Piece of tissue for microscopic assessment; i.e. needle biopsy of prostate, endoscopic biopsy for bladder and edge biopsy for penile cancers. At times entire tumor is removed and sent for microscopic examination ex: kidney cancers, bladder cancers and testicular cancers.

Is it possible to remove only the tumor without sacrificing the entire affected organ?
Yes. We at AINU strongly believe in preserving the affected organ as much as possible at the same time completely removing the tumor. In other words; our goal of treatment is not only to achieve good oncological outcome but also a fair functional out come. For example, we try to preserve as much kidney as possible for kidney cancers. This procedure is called partial nephrectomy. Similarly we routinely perform various organ preserving surgeries such as, endoscopic resection of bladder tumor and partial cystectomy for urinary bladder cancers; partial penectomy, glansectomy and local excision of penile cancers; rarely testis sparing surgery for small testicular tumors. However these procedures are considered in only special circumstances and as per the discretion of surgeon.

Is it possible to perform cancer surgeries by minimal invasive techniques, avoiding big incisions?
Yes. Our institute has got experienced and distinguished surgeons, reputed for laparoscopic as well as robotic surgeries. Most of the cancer procedures at our hospital are being done by minimal invasive techniques, which can limit the size of incisions needed and so less blood loss, lessen wound healing time, associated pain and risk of infection. Eventually this helps in early and comfortable post-operative recovery.

What are the treatment facilities available for genitourinary cancers at AINU?
Asian Institute of Nephrology and Urology is renowned for minimally invasive surgeries (laparoscopic as well as robotic procedures) for cancer treatment. It served many genito-urinary cancer patients not only from this region but also from several parts of the country. AINU is also one of the most sought after hospitals for medical tourism.

We Specialize In

kidney cancer

Kidney Cancer

Treatment Options

Causes: Smoking or chewing tobacco, longstanding uncontrolled blood pressure, obesity and familial syndromes
Symptoms: Blood in the urine, loin pain, loin mass and unexplained weight loss
Treatment: Robotic Partial Nephrectomy: Removal of small to moderately large tumors without harming the healthy part of the kidney. Intra-operative ultrasound is helpful in detecting the tumor-kidney parenchyma transition. It ensures clear surgical margins and at the same time reduces damage of rest of the kidney. Surgical robot has added advantage of freedom of instruments movement and 3-D vision which allows Urologist to perform surgery with high precision and reduces blood loss and collateral damage.

Laparoscopic Radical Nephrectomy: Removal of cancer affected kidney for very large, infiltrative tumors

Advanced kidney cancer (Metastatic) - to be treated by combination of immunotherapy and Targeted therapy, which has relatively fewer side effects and good survival outcomes

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Bladder Cancer

Treatment Options

Causes and Risk factors: Smoking causes about half of all bladder cancers.Certain industrial chemicals, eg:aromatic amines used in dye, rubber, leather and textiles.Lynch syndrome is a familial syndrome linked mainly to bladder,colon and endometrial cancer.

Symptoms:Blood in the urine without much pain (called painless hematuria) is usually the first sign. Sometimes bladder cancer can cause irritative urinary symptoms. In advanced stage patient looses weight & appetite and can have bony pains.

Treatment:Depending on the depth of bladder wall invasion bladder cancer can be categorized as superficial (Non-muscle invasive) and deep (muscle invasive).

Endoscopic resection of bladder tumors or laser fulguration of tiny lesions (TURBT) is usually sufficient for superficial tumors. To reduce the recurrence few patients may need additional intravesical therapies i.e instillation of drugs into the bladder.

Radical cystectony is the treatment of choice in muscle invasive cancers. This surgery involves removal cancerous bladder and surrounding lymph nodes. Urine diversion is done by ileal conduit (urine tubes or ureters are attached to a segment of small intestine and this is brought out through the tummy wall as stoma to which a urine bag is applied). In selected patients neobladder can be created where intestinal segment is used to create a reservoir similar urinary bladder, facilitating urine passage naturally.

We at AINU perform these surgeries completely by Robot, called Robotic Radical cystectomy with intracorporeal ileal conuit/neobladder. Advantages are less blood loss, less postoperative pain and early recovery.

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Prostate Cancer

Treatment Options

Risk factors: Prostate cancer is primarily a disease of the elderly. Men with a family history have 2 to 3-fold increased risk
Symptoms: Difficulty in passing urine, Urinary frequency and blood in the urine. In early stages patients might not have any symptoms at all. Bony pains, loss of weight and appetite- in advanced stage

Prostate cancer investigations:

  • Serum PSA test (Prostate Specific Antigen)- For screening
  • Trans Rectal Ultrasound (TRUS) guided biopsy: AINU is equipped with advanced BK Biplanarultrasound, helps in targeting the suspicious lesion precisely and to confirm diagnosis.
  • MRI Prostate- for local staging (To assess operability)
  • Bone scan or PSMA (prostate-specific membrane antigen) PET scan are used to know whether cancer has spread to the other parts of the body

PSA screening of Prostate cancer: (American Cancer Society recommendation)

  • All men ≥ 50 years or45 yearsif there is a family history of prostate cancer
  • Opportunistic screening: all men with good life expectancy between 50-75 years comes to hospital with urinary symptoms.

Treatment of localized prostate cancer:

  • Robotic assisted Radical prostatectomy: Surgical removal of cancerous prostate by using surgical Robot. AINU has davinci X Robotic surgical system (advanced version) featuring a high-definition, magnified (12 times) 3-D view and freedom of instruments movement(more flexible than the human hand), allows surgeon perform surgery with high precision, to achieve cancer clearance and also to preserve nerves which are responsible for urine control (less urine leak) and potency.
  • Radiotherapy is usually preferred in patients who are not fit for the surgical procedure or in case of locally advanced disease.
  • Advanced prostate cancer can also be effectively controlled by using Hormonal therapy, which is the backbone management. Other add-on therapies are Docetaxel chemotherapy, newer immunotherapy, PARP inhibitors and Radio nucleotide therapy.
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Penile Cancer

Treatment Options

Penectomy : Surgical removal of entire cancerous penis is called Total penectomy. However partial penectomy is more commonly done procedure, in which only a part of penis is removed enabling the patient to urinate in standing position. We also frequently perform various penile sparing procedures such as glansectomy (removal of glans penis only) and excision of cancerous lesion alone in case of very small tumors.

Groin node dissections (Complete ilioinguinal or modified inguinal node dissection) : Penile cancer usually spreads to groin nodes followed by pelvic lymph nodes. These nodes are surgically removed depending on the extent of nodal involvement.

Risk Factors

  • HPV Infection
  • Smoking
  • Age
  • Smegma
  • Phimosis
  • Psoriasis Treatment

Symptoms

  • Growth or sore on the penis, especially on the glans or foreskin, but cancer also occurs on the shaft
  • Changes in the color of the penis
  • Thickening of the skin on the penis
  • Persistent discharge with a foul odor beneath the foreskin
  • Blood coming from the tip of the penis or from under the foreskin
  • Unexplained pain in the shaft or tip of the penis
  • Irregular or growing bluish-brown flat lesions or marks beneath the foreskin or on the penis
  • Reddish, velvety rash beneath the foreskin
  • Small, crusty bumps beneath the foreskin
  • Swollen lymph nodes in the groin

Diagnosis

  • Biopsy
  • Inguinal (groin) lymph node dissection
  • X-ray
  • CT Scan
  • MRI Scan

Treatment Options

  • Laser therapy
  • Cryosurgery
  • Circumcision
  • Excision
  • Mohs surgery
  • Penectomy
  • Lymph node dissection
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Testicular Cancer

Treatment Options

Risk Factors:
Age: It is most common cancer affecting young adults.
Undescended testis: Development of testis occurs inside the adomen of fetus, later descend into the scrotum by birth. If the descent is hampered, then it is called Undescended testis, which increases the risk of testicular cancer.
Personal history: Having testicular cancer in one testicle increases the likelihood of developing a cancer in the other testicle.

  • family history of testis cancer in father or sibling
  • Infertility increases the risk of testis cancer

Clinical features:

  • Testicular enlargement or swelling without much pain
  • In advanced stage- lump in the abdomen or neck swelling

Investigations:

  • Ultrasound of testis- to diagnose tumor in the testis
  • Testicular tumor markers: Serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG or beta-HCG) and lactate dehydrogenase (LDH).
  • Contrast CT abdomen and Chest- To look for cancer spread

Treatment:

  • High Orchiectomy: Surgical removal of cancer affected testis via groin incision and microscopic examination to confirm the cancer type (Seminoma vs Nonseminoma). In early stages this procedure itself is curative.
  • Chemotherapy: With the advent of chemotherapy drugs such as Bleomycin, Etoposide and Platin drugs (BEP regimen)- probability of cure improved. It is recommended to preserve the semen before chemo, if family is not completed.
  • Retroperitoneal Lymph node dissection (RPLND): Usually testis cancer spreads to lymph nodes in the abdomen. Sometimes lymph nodal mass persists in spite of chemotherapy. Removal of such post chemo residual lymph nodes (especially Nonseminomas) is called RPLND. This procedure is technically challenging and being performed at highly specialized hospitals.
  • Radiotherapy: rarely used for post chemo residual lymph nodes in seminoma.

Patient Testimonials