Urothelial Cancer Keyhole Surgery Treatments
You have just been diagnosed with Urothelial cancer. This is a cancer that affects anywhere along the lining cells of the kidney and ureter (this is the tube that comes out of the kidney and drains urine into the bladder). This is a rare cancer.
Most commonly patients with this cancer present with blood in their urine. Most times they have a history of smoking. Sometimes none of these are present.
The cancer has a broad range or how it presents, and as such the treatment varies according to this.
The cancer is often detected on a scan. Following this, we often look in with a camera to visualise the tumour and take samples of tissue from it to confirm the diagnosis (this is called a biopsy). You will need CT scan of your chest and abdomen as part of the work up for this cancer. The CT is to tell us if cancer has spread to other parts of the body. Sometimes you might need additional scans.
When the biopsy confirms urothelial cancer, we discuss different treatment options with you.
The cancer can either be:
• Deep into the muscle
• Metastatic (spread to other parts of the body)
For superficial cancer, often we can manage this with laser treatment to the area to burn the cancer away, and this works well – as long as it is not too bulky and is low grade (low grade means it is not aggressive). This operation is done by endoscopy – a camera that is passed up through the water passage.
For cancer that is deep into the muscle – this means it has invaded through some of the lining of the kidney or ureter, I often advise chemotherapy before surgery to try kill any cancer cells that may have escaped in the bloodstream. See a below attachment for more information on this.
Surgery involves taking the kidney, the ureter and a cuff of the bladder. This operation is called a Nephroureterectomy and is done by keyhole surgery – laparoscopic or robotic.
If the urothelial cancer has spread to other parts of the body you will be referred to an oncologist for consideration of chemotherapy.
I have attached links to information on this cancer, which I hope is of help to you.
What are the Signs of Having Urothelial Cancer?
Urolthelial cancer doesn’t have many signs or symptoms and can be hard to detect. Blood in your urine is probably the only sign you will experience that could indicate urothelial cancer. There is a strong link between smoking and urothelial cancer, and this is a major risk factor in developing it. Therefore, if you have blood in your urine, a smoker and between the ages of 50-70 it would be highly suspicious for this cancer. It doesn’t always occur in this type of patient profile, however – sometimes completely healthy non-smoking patients develop this cancer for no apparent reason. Blood in the urine is not always visible, and during a health screening check you may get a urine test that detects microscopic levels of blood, and this would prompt a referral to a urologist usually to get investigated for this. Occasionally a patient might experience pain on one side of their abdomen, and this could be because the tumor grows within the ureter (the tube that comes out of the kidney and drains urine into the bladder), and this causes obstruction which gives the pain.
Urothelial Cancer Treatment – What is the Recovery Post Surgery?
Surgery for urothelial can be performed in many ways – endoscopically (for very simple cases), Robotic assisted surgery or laparoscopic surgery, a combination of laparoscopic surgery and open surgery, or completely open surgery. I generally only do this operation by pure robotic-assisted or laparoscopic surgery.
This is where an instrument is passed up inside the body either via the male penis or the female urethra and is the quickest to recover from. Usually, this can be performed as a day case operation. Unfortunately, this only applies to certain types of urothelial cancers – there needs to be only a small amount of the cancer present and of a low-grade nature (non-aggressive). The cancer can be treated by laser surgery in this instance – this is where a laser is applied to the cancer via the scope that has been passed into the body, and the laser burns away the cancer. This is obviously the most attractive option, and I will always strive to apply this method, but unfortunately, these types don’t come along that often.
Robotic and Laparoscopic Surgery
The operation for urothelial cancer is officially called ‘Nephroureterectomy’. This operation involves removal of the kidney, the ureter and an incision to open the bladder and remove the area where the ureter inserts into the bladder (a cuff of the bladder is taken). This operation is often considered by urologists as a double operation in one sitting (first removal of the kidney and second removal of the bladder component). Robotic or laparoscopic surgery is pretty much the exact same thing, therefore the recovery is the same. The incisions are small, and the kidney etc is removed through a small incision through the abdomen (this can vary – can be hidden under the underwear line or a little incision under the belly button).
Usually, patients will say they feel they have recovered within about two weeks after this surgery, but this varies a lot. It can be anything up to four weeks for some people. Walking and light activity can occur two weeks after surgery if you are feeling well enough, but common sense needs to be applied. Between 4-6 weeks resumption of most activity can occur, but nothing seriously strenuous for 3 months. And all activity should be gradually resumed, never go back into things where you left off before surgery. The main thing to worry about is developing a hernia, or injuring the delicate surgery area which could bleed again if too much too soon is applied!