CANCER OF KIDNEYS, URINARY BLADDER, PROSTATE GLAND AND TESTICLE

In general tumor of urino-genital organs comprises

approximately 33%ооо that constitutes about 10% from all
magnitude neoplasms.
Kidney cancer (KC), urinary bladder cancer (UBC), prostate
gland cancer (PGC) and testicle cancer (TC) constitutes
more than 95% from all oncologic-urological diseases.
The actuality of the problem is in the fact that the growth
of cancer rate of the above-mentioned organs on 25% is
observed every 5-th year in region and in Ukraine.
Each year the number of patients who appeal for medical
help on the stage of local spread of tumor process is
increasing.
Treatment of this patient category could be only with the
application of surgical methods followed by recurrences
and development of remote metastases. Most operated
patients die during first three years.
KIDNEY CANCER
 INDICES OF URINO-GENITAL ORGANS CANCER MORBIDITY

Localization Ukraine Ivano- Maximum morbidity Minimum morbidity

Frankivs indices in the world indices in the world
k region
Kidney cancer 10 9 15 (Holland) 2 (China, Cuba)

Urinary bladder 11 9 26 (Denmark, USA) 3 (China)

cancer
Prostate gland 28 28 165 (USA) 2 (China)
cancer
Renal cell carcinoma develops from embryonal germ of kidney
urethras.
Morphologically: it is more frequently clear cell
adenocarcinoma of the high, idle and low differentiation.
Macroscopic: the tumor is situated in the kidney depth in the
form of clearly circumscribed node of soft-elastic consistency.
On the section it has versicoloured structure – interchange of
areas of yellow colour with light-grey, brown and red necrosis
nidus.
Renal cell carcinoma is characterized by primary-hematogenic,
rarer lymphatic cancer spread. In the first place there are
affected lungs, bones, liver and brain.
Classification of kidney cancer
1 stage – tumor is up to 7 cm , limited by kidney
without N and M.
2 stage – tumor is more than 7 cm, doesn’t extend to
capsule, without N and M.
3 stage – tumor is within fascia Gerot (Герота),
extends to main veins or there are regional metastases
(N)
4 stage - any Т and N when there is М
 Kidney cancer can be declared by such local signs
(symptoms) as:
- hematuria,
- pain
- tumor, which is palpated.
Hematuria is met in 80% of patients with kidney cancer, moreover in 50%
it is the first sign (symptom) of the disease. Hematuria appears as a result
of tumor extension to calyx. The appearance of hematuria is more likely
when there is a tumor of big sizes. If during hematuria there isn’t any
formation of blood clots, then it goes indolent – total indolent hematuria.
Such hematuria usually lasts several hours, sometimes days and it
suddenly stops. It appears rather rare, in a few days or months and
sometimes in a few years. The characteristic feature for hematuria of kidney
origin is the presence of clots in urine in the form of casts of ureter lumen –
worm-like clots.
 Tumor detection on the basis of the fact that tumor is
palpated in the abdomino-transversal area isn’t an early
symptom. This sign could be used only for the solution of
tumor operability. If during palpation the kidney with tumor
moves than it shows the possibility of its operability. The
possibility to operate big unmovable during palpation
tumors is rather doubtful.
During kidney cancer the pain is met in 60% cases.
Colicky pain, owing to ureter lumen obstruction by blood
clots during hematuria, could be the early but not the first
symptom.
Usually the pain appears as a result of tumor extension
to capsule and adjacent anatomic structures as well as the
result of capsule stretching by the growing tumor and
presence of necrosis nidi in it.
KIDNEY CANCER – renal cell carcinoma constitutes 90%
of kidney parenchyma.
Such tumors as adenoma, lipoma, fibroma , leiomyoma,
hemangioma and dermoid tumors are considered as
relatively benign due to their high ability to malignization.
 Peculiarities of kidney cancer morbidity in Ukraine and
region.
By the state of 2006 the morbidity in Ukraine and region constitutes
10%ооо. Men have this disease more often than women. The morbidity
peak goes to the patients who are older 50. The lesion frequency of
right and left kidneys is the same. Synchronous cancer of both kidneys
is met rather rare.
 During kidney cancer the general symptoms are also
observed such as:
-ТIncrease of body temperature from low grade fever to the long-term
fever;
- Anaemia or sometimes erythrocytosis as a result of production of the
excessive number of erythropoietin by tumor, common ailment and weight
loss;
Presence of all general symptoms is the result of intensive tumor growth,
intoxication and sometimes metastasizing.
To the late symptoms there can be referred varicocele found in men,
which appears as a result of squeezing of testicle vein by tumor or
presence of tumor thrombus in the postcava.
Timely diagnostics is possible when there is a complex
examination of all people who consult a doctor with the
following complaints:
1/ blood in urine, including the cases when this symptom
has been found anamnestically,
2/ loin pain / including colics /,
3/ tumors found in the kidney projection,
4/ increase body temperature which is not connected with
suppurative processes in respiratory tracts .
Sequence and compounds of this examination process are
the following:
1. Complete blood count / anaemia or erythrocytosis, heightened
erythrocyte coagulability rate/;
2. Common urine analysis;
3. Roentgenography of chest organs;
4. Ultrasonic scanning of kidneys, liver, urinary bladder;
5. Cystoscopy during hematoria helps to determine by blood
discharge or blood clots from ureter on which side there are
lesions;
6. Excretory urogram permits to find deformation of мисково-
мисничкового complex, lengthening of its segments,
displacement depending on whether the tumor grows close or far
in the kidney.
7. Computerized tomography is an obligatory and most exact
method of kidney cancer diagnostics. This methods permit to
determine the exact tumor sizes, their extension and relation to the
main vessels as well as the state of regional lymph nodes. Reliability
and specificity of computerized tomography in kidney cancer
diagnostics approach 100%.
 Treatment of patients with kidney cancer

The radical treatment method of patients with kidney cancer is the

operation – nephrectomy.
It provides 5-year survival or full recovery if the tumor isn’t situated
near kidney porta and its size doesn’t exceed 2cm.
Removal of kidney with tumor during operation is accomplished by its
detachment together with Gerot’s fascia, which will inevitably lead to
the traumatism and as a result there is a high probability of the
provoked hematogenic and lymphogenic metastasizing.
Abdominal approach and preliminary kidney vessels
ligation conducted before nephrectomy permits to avoid
hematogenic spread of tumor cells during the operation.
 Urinary bladder cancer
11 cases of this cancer on 100 thousand of population that
is a morbidity index of urinary bladder cancer in Ukraine and
accordingly 7%ооо is in our region. In 90% of cases men
older than 55 have urinary bladder cancer.
 Etiology.
Among possible reasons of urinary bladder cancer appearance the most
evident is the role of some chemical substances. They get into the
human organism owing to the production and usage of synthetic
colouring agents especially such as: alpha and beta naphthalene,
benzidine, nitrosocompounds and products of amino acid exchange:
tryptophan with the formation of 3-hydrox of anthranilic acid. The latter
are also carcinogens, which play a considerable role in the formation of
urinary bladder cancer. Usually they get into the human organism with
food, through skin, respiratory tracts or they are developed
endogenously /tryptophan metabolism/, and are excreted with urine in
the form of ethers of sulfuric and D-glucuronic acids. It has been
determined that human organism, epithelial cells in particular, reacts to
carcinogens influence by the heightened induction and increased
activity of the beta-glucuronidase enzyme. Carcinogen metabolites in
the complex with glucuronic acid, in the form of beta-D glucuronids, in
the urinary bladder are rather easily hydrolyzed by beta-glucuronidase
releasing carcinogen metabolite. When there is a prostate adenoma,
long-term carcinogen in the urinary bladder will create favourable
conditions for carcinogenesis.
Protection from naphthalene influence, opportune
treatment of prostate adenoma, giving up smoking and
excessive coffee drinking may decrease the morbidity on
urinary bladder cancer. The inhibitor of beta-glucuronidase
– D – saccharic acid , 1,4 lactone in particular has been
studied as a prophylactic drug, as it has the ability to
decrease beta-glucuronidase activity to 90%. /N.N.Vlasov,
G.B.Plyss, 1990 /.
 According to the international morphologic classification of ВООЗ
(World Health Organization, WHO) 1997 the following malignant
tumors of urinary bladder have been differentiated:
1/ transitional cell cancer
2/ variants of transitional cell cancer with squamous and glandular
metaplasia
3/ squmous cell cancer – rare form
4/ adenocarcinoma - very rare cancer form
 Classification according to the stages:

1stage – extension of tumor to subepithelial layer without

N and М
2 stage – extension of tumor to muscle without N and М
3 stage – extension of tumor to parabladder fat without N
and М
4 stage – tumor adjacent organ extension or presence of
regional and remote metastases
 Clinical picture of the urinary bladder cancer
Hematuria and dysuria are the predominant and main symptoms which
accompany urinary bladder cancer from the very beginning. These
symptoms become more evident with the growth of tumor.
The dominating tumor localization in ostiums of ureter zone – vesical
triangle zone predetermines further symptoms such as kidney dysfunction
from cystopyelitis to the kidney block with the development of
hydronephrosis and when there is metastases invasion or squeezing of
both ureters by expanded lymph nodes to the uremia development.
Immediate appeal of patient to the doctor for medical aid after the first
blood signs in urine will solve the task of early and timely diagnostics and
as a result – effective treatment.
 Diagnostics of urinary bladder cancer
Hematuria and different kinds of ureter disorders are the signs to conduct complex
diagnostic methods. Their enumeration and sequence are the following:
- complete blood count – when there is a long-term hematuria it can show anemia;
- common urine analysis and examination of daily urine sediments – shows new
erythrocytes and in some cases complexes of cancer cells;
- cystoscopy - has a leading role in forming diagnosis and gives the possibility to
determine: a/ urinary bladder capacity
b/ tumor and its sizes,
c/ take biopsy for cytological and morphological diagnostics,
d/ determine the state of ureter ostiums and kidney function;
- rectum digital investigation to determine the state of prostate or infiltrate in
retropubic space;
- ultrasonic scanning of urinary bladder and kidneys –
- excretory urography gives the opportunity to determine:
а/ kidneys functions, state of ureters – their dilatation when there is tumor
localization near ostiums,
б/ for 30 minutes there is a possibility to examine urinary bladder filled by contrast
and watch corresponding filling defects.
- sedimentary pneumocystography in combination with pneumocystography gives
the information concerning capacity and tumor relation to the urinary
bladder wall;
- roentgen toponometry finishes examination having the aim to plan radiation
therapy.
 Treatment of urinary bladder cancer
Treatment results of invasive forms of urinary bladder cancer are still
left deplorable. Expectations to solve the problem of urinary bladder
cancer by cystectomy operation cannot help to avoid the appearance of
relapses and remote “М” in these patients. In all the cases it causes
disability and deterioration of life quality.
Recommended standard of urinary bladder cancer treatment
I stage – TUR – transurethral resection + 45 gray of remote gamma
therapy
II-III stages - presurgical chemical-radiation therapy, then a break, then
surgery - TVRUBW (transvesical resection of urinary bladder
wall)
When the urinary bladder capacity is less than 200 ml - cystectomy
 MINISTRY OF EDUCATION
AND SCIENCE OF UKRAINE
STATE DEPARTMENT OF
INTELLECTUAL PROPERTY
DECLARATION PATENT
ON THE INVENTION
It is issued according to the Law of Ukraine “About protection of rights for inventions
and useful models”
Head of the State Department (personal signature) M. Paladiy
of intellectual property
Official seal: Ministry of Education and
Science of Ukraine
State
Department of Intellectual Property

(21) 2003021738
(22) 27.02.2003
(24) 17.05.2004
(46) 17.05.2004 Bulletin №5
(72) Kostinskyy Ipolit Yulijovych, Zakala Igor Stepanovych, Val’chyshyn Mykola
Petrovych
(73) Kostinskyy Ipolit Yulijovych, Zakala Igor Stepanovych, Val’chyshyn Mykola
Petrovych
(54) METHOD TO CURE PATIENTS WITH FOCALLY LOCALIZED CANCER OF
URINARY BLADDER
 Prostate Cancer
It is the most frequent malignant neoplasm of urogenital system that
is found in 29 cases per 100 thousands of men population in Ukraine
and 24%ооо in our region.
In men oncologic disease structure it occupies the 4th place and in
general morbidity structure it occupies the 6th place.
The appearance of prostate cancer depends on the undue influence of
androgens. In other words this tumor is a hormone-dependent one. The
mechanism of hormone carcinogenesis during prostate cancer has
been clarified completely yet.
Considerable regional differences of falling ill with cancer – for
example, high percentage in the USA (165) and low in China and Japan
(2)– have been tried to explain by differences in nourishment (Western
and Eastern types) as well as by sexual peculiarities.
Pathologic anatomy. Prostate cancer is characterized by
multicentral growth and has the appearance of nodes
located in the peripheral parts, more often in the back
part of a gland. Histologically, it is usually
adenocarcinomas (in 70% of all cases) of different
structure. Among them mucinous and cribrose
carcinomas are prognostically unfavourable due to early
metastasizing and resistance to hormonotherapy.
In 16% of cases there can be met undifferentiated cancer.
 Classification of prostate cancer according to the stages
I stage – the tumor is not palpated through rectum and can be found only
during histologic study (autopsy, after prostatectomy)
II stage – the tumor is palpated through rectum, limited by gland, movable,
regional and remote metastases are absent
III stage – limitedly movable tumor that spread out of capsule boundaries or
to urinary bladder neck, when there are no regional and remote
metastases
IV stage – the tumor of any size with regional or remote metastases.
 Clinical picture of prostate cancer
During the I stage symptoms are absent and its diagnostics as a purposeful
measure nowadays is impossible.
During the II stage there should be palpation of a dense node in one of the
parts of prostate gland.
During III stage we can observe the tumor spread out of capsule followed by
the appearance of symptoms similar to those, characteristic for prostate
adenoma:
- frequent vesical tenesmus
- pains,
the feeling of incomplete bladder emptying up to the full urinary retention
long-term urination disorder will lead to the development of cystitis and
pyelonephritis. And in the late stages due to the squeezing of ureters by
tumor or enlarged glands it will lead to the increasing renal insufficiency.
 Diagnostics of prostate cancer
Detection of prostate cancer at the early stages of its development as a purposeful
measure is impossible. Determination of PSA is rather specific for big tumors and its
level is especially high when there are metastases “М”. (>10nmol/L)
Prostate cancer could be diagnosed in time and this diagnostics is very simple and
available in all medical establishments – it is rectum digital investigation of all the men
older than 45. Exactly, digital palpation of cone-shaped dense node in the
posterolateral parts of prostate gland is considered as the first clinical sign of prostate
cancer.
The patient is given an appointment card for the consultation in regional oncology
dispensary.
- In regional oncology dispensary oncourologist fulfills trocar biopsy of the detected
node in prostate with the help of ultrasonic scanning.
- When there is cytological confirmation of carcinoma and in all cases of high
numbers of PSA the patient is hospitalized where he/she undergoes:
- excretory urography and cystoscopy.
- on the roentgenograms we can observe changes in bones of spine, pelvis, hip
joints as zone frequently met metastases“М”.
Ultrasonic scanning of prostate with the filled urinary bladder sometimes helps to
detect heterogeneous mass in prostate gland, as a sign of its tumorous lesion.
 Treatment of prostate cancer
I and II stages – Radical prostatectomy has rather limited application due to the
advanced age and concomitant serious pathology of these patients.
( 95% of patients with prostate cancer are revealed and ask for medical help only on
the 3d and 4th stages)
Treatment of local-spread prostate cancer forms causes considerable medial and
social problems.
As a standard for prostate cancer treatment it is usually applied
maximum androgenic block, which includes:
1. Surgical castration
2. Prescription of antiandrogens (steroid ones – androkur (Cyproterone) and
nonsteroid ones - Flutamide)
In most countries of Europe and America instead of surgical castration it is
recommended to apply “chemical castration” by introduction of analogs of relysine –
hormones (Zoladex, Decapeptyl, Casodex).
None of the methods of medication castration exceeds by effectiveness a surgical
castration.
 Testicle cancer
Malignant tumors of testicle are mostly germinogenic tumors:
1. Of one histological type: 1) seminoma
2) embryonal carcinoma
3) gallbladder cancer
4) chorionepithelioma
5) teratoma
11. more than one histological type – embryonal carcinoma and
teratoma - teratocarcinoma
111. secondary germinogenic testicle tumor – for extragonadal
tissue of retroperitoneal space.
In practical respect from the point of view of treatment
all malignant testicle tumors are divided into:
Seminomas and
Nonseminomas
In general testicle cancer isn’t frequently met and
comprises one case per 100 thousand. Usually, men at the
age of 20-45 are fallen ill.
Cryptorchism, injury, hypoplasia and inflammatory
processes often precede malignant transformation of
testicle.
In 75% at the moment of diagnosis formation
germinogenic testicle tumors have oligospermia or
azoospermia. Atrophic processes in testicles are
stimulated by hypophysis production of gonadotrophin as
an attempt to compensate insufficient androgen secretion.
Gonadotrophin plays the role of simulator of proliferation
of testicular tubule cells, which can further transform into
malignant tumors.
 Clinical picture
The main and single symptom of germinogenic testicle tumor is the
testicle enlargement. The exception is retroperitoneal germinogenic
tumors (extragonadal) that become evident by "М" into lungs and by
squeezing syndrome.
Induration or gradual increase of a testicle, which is followed by
temperature rise (locally and general) is the reason to suspect testicle
tumor.
Having determined the testicle enlargement there should be taken
general blood and urine test, and blood is taken to determine the
markers of nonseminoma tumors.By the markers of germinogenic
testicle tumor we consider the determination of chorionic gonadotropin
and human alpha-fetoprotein (HAFP).
In 70% of embryonal cancer and always at chorionepithelioma their
level in blood exceeds N in ten and hundred times.
During the clinical stage, the diagnostics starts with the
ultrasonic scanning of testicle with deliberate puncture for
the cytological confirmation of malignant process.
After positive cytology results, excretory urography should
be done (here we can observe the dislocation of ureters at
increased lymph nodes).
Presence on indirect signs of increased lymph nodes is the
reason for making computer tomography, where we can
determine the size of lymph nodes.
The latter will considerably influence on the selection of
therapy approach.
 Treatment
At all testicle tumors the treatment is started from orchofuniculoctomy.
Further treatment depends on histological data, whether it is seminoma
or nonseminoma tumor.
Seminoma, I stage – prophylactic radiation of inguino-retroperitoneal nodes – 30
gram or control
II stage – when there is evidence of invasion of albuminous tunic and
absence of N –radiation of regional lymph nodes
III stage – 1) retroperitoneal lymph nodes up to 5 cm in size – radiation
therapy – 40 gram
2) retroperitoneal lymph nodes are more than 5 cm in size – chemical
radiation therapy according to the РVВ scheme (cisplatin, vinblastine,
bleomycin).
Nonseminoma,
I stage – control or first course of chemical radiation therapy accoding to the
РVB scheme
II stage – course of chemical radiation therapy accoding to the РVB scheme
with further lymphadenectomy (Chevassu).
III stage – several courses of chemical radiation therapy with further Chevassu
operation.