Barts Cancer Centre

Barts Cancer Centre | Cancer types | Uro-genital (Urological) cancer

Uro-genital (Urological) cancer

Our service
Type of treatments available
For patients
For clinicians
Research and clinical trials
Sources for further information
Meet the team

Our service

Advice for patients with prostate cancer

Consultant Medical Oncologist, Dr Tom Powles, explains the treatments currently available for patients diagnosed with prostate cancer. He talks about the novel therapies available at Barts Cancer Centre, as well as how to be referred here.

At Barts Cancer Centre, our urological cancer specialists have access to the most advanced treatments and facilities to treat and support patients with cancers affecting the urinary organs, namely the bladder, kidney, prostate, testicles or penis. Our multi-disciplinary team includes a range of specialists that are experts in their field who work together to manage patients at all stages of diagnosis and treatment of their cancer.

Advice to patients diagnosed with kidney cancer

Consultant Medical Oncologist, Dr Tom Powles, explains the treatments available for patients diagnosed with kidney cancer. He talks about the novel therapies available at Barts Cancer Centre, as well as how to be referred here.

Type of treatments available

The treatments and equipment used at our centre are at the forefront of modern healthcare. As with all of our services at Barts Cancer Centre, treatments offered will be individualised dependent on the stage of cancer. This will be discussed in detail with every patient by one of our medical team once a diagnosis has been made.

Barts Cancer Centre offers patients the full range of cancer treatments for all tumour types including minimally invasive surgery (key hole), brachytherapy (prostate implant) Intensity Modulated Radiotherapy (IMRT) Image Guided Radiotherapy (IGRT) and cryotherapy for prostate cancer and radiofrequency ablation for certain types of renal tumours.

To find out more about these treatments, please read on and refer to the individual cancer types detailed below.

For patients

Our aim is to provide efficient and effective treatment for all urinary cancers. We care for patients who are referred both from our local area and from different areas of the country. Our team of cancer specialists looks into every case individually to work out the best possible treatment for your condition. If you are a patient who has been referred to us, you will be seen within two weeks of us receiving your referral letter.

We have dedicated clinical nurse specialists who will discuss all aspects of their cancer treatment and answer any queries they may have. We advise and encourage our patients to bring along friends or relatives to their appointments and it is sometimes helpful for patients to write down their queries before coming into hospital to remind them of any specific questions they have.

Most patients requiring surgery (urological surgery) for their condition have their treatment carried out at Barts Cancer Centre. Our urology unit works closely with the urology unit at Whipps Cross Hospital for bladder and prostate cancer surgery and therefore major procedures for these cancers are also carried out at Whipps Cross Hospital.

Urological cancer types

For detailed information about specific urological cancers that we treat at Barts Cancer Centre, please read on:

Bladder cancer
Kidney (renal) cancer
Prostate cancer
Testicular cancer

Bladder cancer

The bladder is essentially a muscular storage organ for urine. The lining of the bladder is special and extends into the inner part of the kidneys and the tubes connecting kidneys and bladder. It is called the transitional cell epithelium.

Bladder cancer (also called transitional cell cancer) is the fifth most common cancer in men and the eighth in women. The common age of presentation is 70 years. It is an occupational-related cancer and also caused by cigarette smoking. The most common presenting feature of bladder cancer is blood in the urine (haematuria). Our urology unit runs a one-stop clinic for the prompt diagnosis of bladder cancer in patients who come with blood in the urine.

Bladder cancer is diagnosed by imaging with an ultrasound scan and contrast x-rays/CT scan and a visual inspection of the bladder with a telescope (cystoscopy) and biopsy of the tumour, if present. The cystoscopy may be given to the patient under a local anaesthetic or general anaesthetic depending on the details given by earlier investigations.

Early bladder cancer (cancer confined to the superficial part of the bladder wall) is usually treated by the telescope-assisted surgical removal of the tumour (without cuts in the abdomen), followed by the placement of cytotoxic drugs (intravesical chemotherapy) into the bladder. With this type of chemotherapy, patients are unlikely to get side effects that are often associated with chemotherapy such as nausea or hair loss.

Another treatment offered for certain types of bladder cancer is the Bacille-Calmette-Guerin (BCG) vaccine (normally used to prevent tuberculosis), which is also inserted directly into the bladder. This vaccine works by its effects on the local immune system (immunotherapy).

There are a variety of other treatments for the superficial type of bladder cancer including other forms of immunotherapy and chemotherapy, which are only used when the intial treatment does not work. Once the tumour is controlled we continue to observe the patient’s progress using cystoscopy at certain intervals.

When tumours are more advanced, it may be necessary to deliver chemotherapy to shrink the cancer and then remove the bladder (cystectomy) or give radiotherapy treatment with the aim of achieving long-term control of the disease.

All the treatment options are considered on an individual basis and are discussed in detail with the patient.

Kidney (renal) cancer

There are generally two kidneys at the back of the body, one on each side underneath the ribcage. They filter the blood to remove waste products in urine. Urine is carried from each kidney, through a tube called a ureter to the bladder.

Kidney cancer is the 11th most common cancer in the UK. Nearly 2 out 3 people diagnosed with this type of cancer are over 65 years old. Kidney cancer is rare in people under 50
(ref: Cancer Research UK). There are certain risk factors for kidney cancer, namely:

Smoking - the risk could be double that of a non smoker
Chemicals at work - people working in some industries have a higher risk
Genetic - some people inherit a tendency to develop kidney cancer. This is called hereditary or familial kidney cancer. Certain inherited conditions also increase the risk
Obesity
Having kidney failure that needs dialysis

In early kidney cancers there are often no obvious symptoms. More recently, kidney cancers are being picked up on ultrasound scans that are being done for other reasons, so they are being found at an earlier stage. Once the cancer begins to grow, the symptoms can become more obvious. The most common symptom is blood in the urine (haematuria). Sometimes the blood cannot be seen by the naked eye but can be picked up by a simple urine test (microscopic haematuria or invisible haematuria).

Most people who have blood in the urine do not have kidney cancer. In most cases it is caused by an infection, enlargement of the prostate or kidney stones. Other symptoms include tiredness, loss of appetite, weight loss, fever with heavy sweating, pain in the loin that won’t go away, a general feeling of poor health.

At Barts Cancer Centre, once we receive a referral for a suspected kidney tumour, our specialists will make an assessment of the kidneys using examinations and tests, including an ultrasound scan, a test called an intravenous urogram (IVU) or a computerised tomogram (CT) urogram. For completion of all the tests, the bladder may also be examined by cystoscopy. Once all the test results are available, a management plan is developed by the specialists involved in our multi-disciplinary team.

There are three likely presentations of kidney tumours:

1. Newly diagnosed but localised

Treatment for this type of kidney cancer may involve a partial nephrectomy (removing the tumour and only leaving behind the kidney) or by radical nephrectomy (removing the whole kidney with surrounding fat). The decision to do these operations depends on size of the tumour and its position in the kidney. The removal is either by key-hole or an open procedure. Some tumours would be suitable for radiofrequency ablation (killing the cancer cells with heat).

2. Newly diagnosed but advanced

In this type of presentation, the tumour has spread to the vein or beyond the tissues around the kidney or to other parts of the body. Where the cancer has spread locally, surgery to remove the kidney (and where it has spread) may be an option. This type of treatment may not suitable for everyone.

3. Recurrence of the kidney cancer

For patients whose kidney cancer has returned following initial treatment, the cancer cells may have spread to different parts of the body. In this case, surgical treatment is unfortunately not an option. The only way the cancer cells can be attacked is by killing them with drugs or biological substances that can reach the vicinity of the cells through blood vessels. At Barts Cancer Centre we are at the forefront of managing patients with ‘targeted therapy’. This treatment works by targeting the new blood vessels in the cancer and stopping them from growing and spreading.

Patients undergoing targeted therapy are monitored using the latest scanning equipment called a PET (Positron Emission Tomography) scanner, a £2m state-state-of-the-art piece of equipment and one of only a few in the UK.

Our PET scanner scans use a special radioactive marker that is taken up preferentially in the cancer cells inside the kidney indicting they are more active than the surrounding cells. This allows our team to accurately monitor changes occurring due to treatment and assess whether the drug is working.

Sometimes these drugs are administered prior to removal of the kidney to shrink the tumour which may help improve the chances of success. Surgery may involve removing some or all of the kidney.

Prostate cancer

The prostate gland is found only in men and its main function is to make the seminal fluid (fluid the sperm are transported in). It is located below the bladder surrounding the tube that carries urine from the bladder to the penis (urethra). Prostate cancer cells are usually require the presence of male sex hormone (testosterone) to grow, therefore some of the treatments for prostate cancer work by reducing the levels of testosterone.

Prostate cancer is the most common cancer in men. In the UK, 35,000 men are diagnosed with prostate cancer every year and it mainly affects men over the age of 50.

Patients with early prostate cancer may not notice any symptoms. Due to its location, it can produce urinary symptoms usually due to enlargement of the prostate or restriction of urine flow. It is important to note that symptoms of prostate cancer and non-cancerous enlargement of the prostate are the same and both occur in the same age group.

Symptoms include having to rush to the toilet to pass urine (urgency), frequency, difficulty in passing urine, pain on passing urine, blood in the urine or sperm.

Prostate cancer is usually suspected after a raised prostate specific antigen (PSA) in blood. The prostate gland is accessible for examination through the back passage and if prostate cancer is suspected, a biopsy of the prostate is done through the rectum by using a special ultrasound probe.

The biopsy tissues are then analysed for cancer cells and the cancer is assessed for Gleason grading - the Gleason grade describes how closely the malignant glandular patterns resemble normal ones, with a lower number being closer to normal and describing a tumour with less potential to spread. The Gleason score is the sum of the two Gleason patterns, which in the opinion of the pathologist best characterise the tumour. Thus a score of 3 + 4 = 7 means that the pathologist sees predominantly pattern 3 and a secondary pattern of 4.

Once a diagnosis of prostate cancer is made, our specialists determine the stage of the cancer using magnetic resonance imaging (MRI) and bone scan in some cases. Early cancers are localised to the prostate gland. Advanced cancers have spread out of the prostate through the capsule and into surrounding tissues. After this, the cancer could spread anywhere in the body but its preference is for bones in the centre of the body. When the cancer spreads to bones, the symptoms include pain in the back, hips, pelvis and other bony areas.

Various factors are taken into account while deciding the most appropriate type of treatment for prostate cancer. These include the age of the patient, Gleason grading, life expectancy, presenting PSA level, associated medical conditions and stage of the disease.

For localised disease (cancer confined to the prostate), patients may be offered observation, surgical removal, radiotherapy or some treatments that are being investigated (high intensity focused ultrasound- HIFU). For advanced prostate cancer, radiotherapy is the choice.

Patients may also be suitable for brachytherapy (where radioactive seeds are implanted into the prostate). Approximately 20 cases are performed each year at Barts Cancer Centre, and these include referrals both from the local area and Essex. Treatment is delivered under general anaesthetic with the majority of patients going home on the same day.

Barts Cancer Centre has led the field in the delivery of Intensity Modulated Radiotherapy (IMRT) for prostate cancer having started treating patients with this technique in 2003. In addition, Image Guided Radiotherapy (IGRT) has been introduced, which allows the movement of the prostate to be accurately monitored during the treatment process.

Hormone therapy is another widely used treatment for locally advanced and metastatic prostate cancer. It is also employed prior to radiotherapy. The male sex hormone testosterone is known to help prostate cancer cells grow and hormone therapy works by stopping testosterone from stimulating the cancer cells or by halting the production of testosterone in the body altogether. Our team is currently investigating the best combinations of these treatments. For example, we may decide to prescribe hormone therapy before chemotherapy.

Our doctors are investigating a new generation of chemotherapy drugs which are usually given through a drip. These are more aggressive forms of chemotherapy are tested on suitable patients to see if they can improve their outcome.

Testicular cancer

The testicles are two oval shaped organs situated below the penis one on either side in a pouch of skin called the 'scrotum'. They are part of the male reproductive system. From the age of puberty the testicles produce sperm. They also produce the male sex hormone 'testosterone'.

Patients with testicular cancer generally present with a lump or swelling of different sizes, but not all testicular lumps are cancers. Sometimes there may be a feeling of heaviness. Testicular cancers are usually painless, but sudden pain or heaviness is not uncommon. Testicular cancer cells can spread into lymph glands at the back of the abdomen, which can cause backache. They can also spread to the lymph nodes in the centre of chest (mediastinum) between the lungs. This could cause a cough or difficulty in breathing or swallowing. If testicular cancer has spread, there may be lumps in other parts of the body. Testicular cancer can also spread to other organs in the body like the lungs and brain.

Patients with suspected testicular cancer undergo a number of tests at Barts Cancer Centre including ultrasound examination of the testes and blood examination for specific tumour markers of testicular cancer, followed by a CT scan for staging. Depending on the outcome of these tests, patients may undergo an operation to remove the affected testis. This operation is done as a day case, meaning that patients do not have to stay in hospital overnight. Once the results of CT scan and microscopic examination of the tumour are available, further assessment is made by our cancer experts for chemotherapy.

Some chemotherapies for testicular cancer have an associated risk of causing damage to the kidney. At Barts Cancer Centre we are developing a treatment which seems to be free of that problem. It uses a combination of chemotherapy; using an alternative drug called oxaliplatin in combination with two other chemotherapy drugs. The combination of the three drugs has led to very encouraging results in a group of patients where previously people have had experienced kidney damage. The results also show higher success rates in terms of patients recovering from the cancer.

We also offer stem cell transplants for resistant cases of testicular cancer. Through this, we’re using new combinations of chemotherapy with stem cell transplants for testicular cancer and this is giving us encouraging results.

For some patients, we also offer treatments that have the option of sparing fertility. These options are all discussed in detail with individual patients at the stage of diagnosis.

For clinicians

We consistently achieve national access targets for patients with suspected cancer and for treatment following diagnosis.

All patients with suspected cancer are seen within two weeks of referral from their general practitioners. Within 1-2 weeks of seeing the patients in the clinic, efforts are made to reach a definite diagnosis either by biopsy or by various tests like ultrasound, dye x-rays or CT scan within 7-10 days. All patients should receive the copies of their letters of communication outlining the progress of the treatment sent to their general practitioners (unless patients specifically request not receive them).

Referral criteria and forms are all available on our website, please click here for referral forms please click here for referral forms.

Research and clinical trials

Barts has been at the forefront of medical discovery since it was founded nearly 900 years ago and today, our research continues to be recognised for its originality, significance and rigour. The results of the work we do here means we are constantly improving the treatments and care we can offer patients.