What are genitourinary cancers?

Cancers start when a change occurs in the DNA in a cell in our body. DNA, simply stated, is our body's own unique “instruction book.” Changes in our instruction book can cause a normal cell in our body to grow in an uncontrolled way. This abnormal growth can result in the cancerous cells invading the surrounding tissues in the body and even invading blood or lymphatic vessels in the body, which results in the spread of the disease to other sites in our body (also known as metastases).

These behaviors are what constitutes a cancerous condition. The causes of cancer are quite varied. It can result from being born with a predisposition (being born with abnormal DNA) to develop a specific cancer or by being exposed to DNA-damaging chemicals in our environment, such as cigarette smoke. For many cancers, we do not know why a person develops the DNA changes.

The genitourinary tract traditionally includes the kidneys, the bladder, the tubes that collect and drain urine from the kidneys and drain it into the bladder (the ureters), the tube that drains urine from the bladder to the outside (the urethra), and specifically in men, the testicles and the prostate. The prostate is an accessory sex gland necessary for reproduction.

Also classified as genitourinary cancers are cancers that develop on the penis or in the adrenal glands. The adrenal glands are small hormone-producing glands, which are located on the top of each kidney. In women, cancers that develop in the ovaries, the uterus, the cervix, or the vagina are in a separate category of cancers called gynecologic cancers.

What follows is a brief description of each of the major types of genitourinary cancer.

Prostate cancer

The prostate gland is located in a man’s pelvis underneath the bladder, where it supports the reproductive process. The prostate cells that can become cancerous are cells that produce many of the components of a man’s ejaculate or semen.

Beginning at about age 50, a man’s risk for developing significant prostate cancer begins to rise. More than 200,000 men will be diagnosed with prostate cancer in the United States in 2012. Prostate cancer behavior is highly variable and not all men need to be treated. However, in 2012, prostate cancer will be the second-leading cause of cancer-related deaths in men in the U.S., resulting in the early death of more than 30,000 men.

If prostate cancer is found before it has spread (metastasized), potentially curative treatments can be considered either with a surgical procedure to remove the prostate or with a number of different types of radiotherapy (exposing the cancer to charged particles).

Because of its highly variable behavior, most men found with the disease must be carefully assessed for exactly how aggressive the cancer is. This assessment can best be accomplished in a multidisciplinary clinic staffed by urologists, pathologists, radiation oncologists and medical oncologists who can provide the best possible estimate as to how aggressive his cancer is and what all of his management options are.

For about 1/3 of men with newly diagnosed prostate cancer which has not spread (metastasized), simply watching the disease carefully (surveillance) is a reasonable treatment option.

Kidney cancer

Most humans are born with two kidneys, one on the left side of the body and one on the right side. The kidneys help remove waste products from the body and also help control blood formation and fluid balances in the body.

Most cancers of the kidney develop in the cells that line the filtration apparatus in the kidney that produces urine. Kidney cancer is quite rare before age 50, but the incidence increases with age.

Kidney cancer is much more predictable in its behavior than is prostate cancer. Unless someone is likely to be in the last few years of his or her life because of age or other health problems, a kidney containing a cancer should be completely removed. The part of the kidney that contains the cancer be removed unless the cancer has already metastasized.

There have been a number of advances in the treatment of kidney cancer in the last five years. At the University of Arizona Cancer Center, a multidisciplinary approach can provide someone afflicted with this cancer the information and evaluation that he or she needs to receive the best treatment possible.

Testicular cancer

Testicles have two functions in men. One is to produce sperm, permitting reproduction, and the other is to make male hormone. The cells that can become cancerous are the cells that make sperm. All men who develop testicular cancer are born with an abnormality on their 12th chromosome.

Testicular cancer is very rare before puberty and after the age of 65. There are five different subtypes of testicular cancer and treatments almost always involve removing the impacted testicle surgically.

Additional treatments with chemotherapy or sometimes radiotherapy can have the potential to cure even advanced cases that have spread in the body. For this disease, a multidisciplinary approach is very important to achieve the highest chance of success.

Bladder (urothelial) cancer

The cells that line the tube that collects urine produced by the kidney and drain the urine into the bladder (ureters), plus lining the bladder itself, are called urothelial cells.

These cells can have their DNA damaged by waste chemicals that are in the urine and can become cancerous anywhere from the kidneys to the bladder. Most cancers are found in the bladder, where the urine has the longest contact with the lining urothelial cells. Most of these cancers can result in bleeding into the urine. A majority of bladder cancers are found early before they invade deeply or metastasize.

When a superficial bladder cancer is found, it can frequently be treated by simply "scraping it off" the surface. These cancers can commonly recur, so continued procedures to look at the lining of the bladder to check for recurrences needs to be done.

If a cancer grows deeper into the wall of the bladder, consideration has to be given to surgically removing the entire bladder, with the surgery sometimes preceded by chemotherapy. If the cancers cannot be cured with surgery, treatments with chemotherapy or radiation need to be considered to help control the disease.