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Treatment Planning for cancer with Urological Oncology or Uro-oncology

At American Oncology Institute (AOI), our team of one of the best urologic oncologists or uro-oncologists in India, along with other cancer specialists, together discuss, analyse and decide a treatment plan personalized for each patient. Factors such as cancer type, its size, location, stage, spread and patient-related factors such as health, age, pre-existing medical conditions, etc determine the individual treatment plan. Depending on the clinical condition, a patient may be indicated cancer surgery in combination with other treatment modalities such as chemotherapy and/or radiation therapy. Some types of cancers may require closed and less invasive techniques such as laparoscopy or robotic surgery while others may require open surgeries, which are more invasive and have larger incisions.

At American Oncology Institute (AOI), one of the top urological oncology hospitals in India, we offer a standard and multi-disciplinary approach when treating urologic cancers, with our high-end technology and commitment to provide the best urinary or urologic cancer treatment including robotic surgeries for urological cancers in Hyderabad. Our team of medical experts including one among the best urologic oncologists assess the patient’s condition and develop a comprehensive and personalized treatment plan depending on the type, stage and location of the cancer and the patient’s overall health. Usually, the low-grade tumors are better manageable and treatable compared to the advanced and high-grade cancers which may also spread more easily.

Laparoscopic/Robotic urologic surgeries at American Oncology Institute (AOI)

The principle and procedure in laparoscopic and robotic assisted-urologic surgeries are similar to that in the open surgery or larger cut surgeries with added benefits such as:

Smaller incisions
High degree of precision with less chances of damage to surrounding critical structures.
Less/minimal scarring of the skin post-surgery
Minimally invasive techniques
Relatively less blood loss
Lesser risk of infections
Relatively faster healing and recovery after surgery
Shorter hospital stays thus more convenient for the patients

What happens in laparoscopy or laparoscopic surgery?

Laparoscopic surgery or laparoscopy is done by using fine compact miniaturized instruments which are inserted through trocars, traversing keyhole size incision made in the abdominal wall. Then carbon dioxide gas is filled in the abdominal cavity to make the area more accessible by the surgeon. A high definition, digital camera is attached to a telescope lens in one of the trocar sites, provides view of the internal structures.

What are the advantages of da Vinci robotic surgical system over conventional laparoscopy?

Robotic surgery is the recent advancement introduced into the field of uro-oncology which has gradually superseded many of the laparoscopic procedures due to its several advantages such as better visualization, user-friendly systems and instrumentation.

Recently, robotic surgery using the da Vinci Surgical Robotic System is also available which offers more advantages over the conventional laparoscopic surgery. Robotic surgery can be said as an advanced form of minimally invasive or laparoscopic surgery with a computer-controlled robotic system to assist the surgeons in surgical procedures. Robotics offer multiple advantages and has revolutionized the surgical approach in many complex oncological procedures.
The uro-oncologists including other surgeons are benefitted in many ways:

High-definition magnified view with added three-dimensional depth and perception of the internal structures while performing robotic surgeries contrast to the two-dimensional view in laparoscopy.
Greater agility due to multi-jointed robotic instruments and a better freedom of movements similar to that of performing with hands.
Reduced tremors and more precision in fine surgical procedures like dissection provided by high scaling technology.

We, at AOI, offer the world’s most advanced robotic surgeries, including the revolutionary da Vinci – X surgical system for performing robotic surgeries for cancer treatment including various robotic surgeries for urologic cancers. At AOI, one among the few and best hospitals for minimally invasive surgery, we perform various robotic surgical procedures for urologic cancers including Radical Nephrectomy, robotic partial nephrectomy, robotic radical prostatectomy, etc., using robotic technology.

What is the treatment process involved in urologic oncology or uro-oncology?

At AOI, our team of one of the best uro-oncologists in India, use several minimally invasive surgical techniques for urological cancers which provides benefits of easy approach to tumors for surgeons with more precision, safety and agility.

Urologic oncology treatment options basically comprise of:

Surgery for urologic cancers
- Some of the Urologic Cancer surgical treatment options include:
  - Nephrectomy – minimally invasive or traditional removal of a kidney tumor
    - Robotic radical nephrectomy for renal cancer
    - Laparoscopic radical nephrectomy for renal cancer
  - Urinary bladder cancer surgical treatment
    - Laparoscopic radical cystectomy
    - Bladder reconstruction surgery
  - Inguinal lymph node dissection
  - Minimal Invasive inguinal dissection
  - Prostatectomy — removal of the prostate.
    - Robotic-assisted laparoscopic radical prostatectomy
    - Laparoscopic prostatectomy for prostate cancer
    - Salvage prostatectomy
  - Nerve-sparing lymph node dissection
  - Penectomy — removal of some or all of the penis
    Laparoscopic surgery for penile cancer
  - Orchiectomy — removal of one or both testicles.
Chemotherapy for urologic cancers
Radiation therapy for urologic cancers
Immunotherapy for urologic cancers
Active surveillance or watchful waiting (for example, in case of prostate cancer)

At AOI, we always prefer fertility-preserving options whichever case it is possible, and personalise every treatment plan with newer agents & fewer side effects. American Oncology Institute (AOI) strives to provide the top-notch and best urologic cancer treatment in India and is also one among the best hospitals for treating urologic cancers in India.

What is the kidney (renal) cancer treatment options?

Surgery for renal cancer/ kidney cancer surgical treatment

Surgery for renal tumors is usually the only treatment required in cases where the tumor has not spread beyond the kidneys. It involves removing the tumor part or all of the kidney, as well as nearby tissue and lymph nodes to ensure the complete removal of the tumor cells from the body and to prevent any recurrence later.

Renal cell carcinoma (RCC) surgical treatment options –
- Robotic / laparoscopic Radical nephrectomy
- Robotic / laparoscopic Partial nephrectomy
Transitional cell carcinoma (TCC) surgical treatment options –
- Robotic / laparoscopic Nephrectomy

Regular follow up is required in case of TCC due to its high risk of recurrences mostly to urinary bladder.

Robotic / laparoscopic Radical nephrectomy – It is the removal of the whole kidney along with surrounding fatty tissue and adrenal gland. This procedure is usually performed only when the kidney cannot be left even after a partial nephrectomy. Especially indicated in kidney cancer cases which have spread to surrounding tissue but not yet spread; stage I tumors where nephrectomy is not an option.
- Advantages of laparoscopic radical nephrectomy – relatively safe and minimally invasive technique, less pain & blood loss, shorter hospital stay, faster healing compared to conventional open surgery.
Robotic / laparoscopic Partial nephrectomy – This type of nephrectomy intends to preserve kidney function and to lower any risk of chronic kidney disease post-surgery. Newer techniques with small incisions are now-a-days considered to have better treatment outcomes compared to the conventional ones.
- Advantages of laparoscopic partial nephrectomy – preserves the kidney by only removing the tumor, significantly lower risk of kidney failure.
- In few patients with larger tumors, partial nephrectomy may not be a good option hence radical (i.e., complete) nephrectomy may be required.

Non-surgical treatment options

chemotherapy for renal cancer, targeted therapy for renal cancer, radiation therapy for renal cancer.

Chemotherapy for renal or kidney cancer –
- Chemotherapy uses the systemic agents administered through various ways like oral, intravenous, etc. To destroy the cancer cells and prevent them from further growing and spreading to other distant parts within the body.
- There are usually chemotherapy sessions or chemo cycles decided by your uro-oncologist personalised to the cancer type, stage and spread as well as your health conditions. You will be asked to visit hospital/clinic for specific duration at regular intervals for receiving your chemotherapy.
- Most cases of renal/kidney cancer do not respond well to chemotherapy whereas transitional cell carcinoma, also called urothelial carcinoma, and Wilms tumor are much more likely to be successfully treated with chemotherapy.
Targeted therapy for renal cancer –
- Targeted therapy as the name is suggestive, it ‘targets’ or aims to a specific protein molecule, gene or a receptor in the tumor cell and inhibits its further growth preventing its spread in the body.
- Usually indicated in cases of advanced or metastatic renal cancers.
Radiation therapy for renal cancer –
- Radiotherapy employs high energy rays to destroy cancerous cells.
- It is not alone the treatment of kidney cancer but is indicated in combination with other treatment modalities.
- When indicated for kidney cancer treatment it helps slow down the tumor spread within the body as well as has palliative (symptom relieving) action.
- Indicated in metastatic or advanced renal cancer cases that has spread to other parts of the body, such as bones or brain.

What are the urinary bladder cancer surgery treatment options?

Most of the times, surgery, alone or with other treatments, is used to treat most bladder cancers. Early-stage bladder cancers can be surgically treated but there are high risks of its recurrence in the bladder itself. Hence, radical cystectomy i.e., removal of the entire bladder could be an option. In cases, when the entire bladder is not removed, other treatment options could also be a choice to reduce the risk of new cancers. It is always advised to maintain a strict follow-up to watch for signs of any recurrence or new cancers in the bladder.

The common surgical approaches for bladder cancer treatment include:

Endoscopic TURBT – Trans urethral resection of bladder tumour (TURBT) is one among the first choice of the uro-oncologist especially in case of early bladder cancer treatment.
- In TURBT the uro-oncologist or onco-surgeon removes the tumor tissue from the urinary bladder through the urethra. Sometimes, a more extensive TURBT could be done to ensure complete removal of the tumor.
- It is an “incision-less” surgery performed usually as an outpatient procedure.
Robotic/Laparoscopic cystectomy – This bladder cancer surgical procedure is employed to i.e., remove either the entire bladder or a part of it. Both robotic as well as laparoscopic surgeries are can be used to do the cystectomy.Cystectomies can be done in two different ways depending on the case:
- Robotic/Laparoscopic Partial cystectomy: in cases where the tumor has affected only muscle layer sparing the other regions is confined to one region of the bladder, it may be possible to treat the cancer by removing only part of the bladder. With this procedure, the portion of the bladder affected by cancer is removed, and the hole in the bladder wall is then closed.
- Robotic/Laparoscopic Radical cystectomy: when the bladder cancer has advanced and metastasised or spread to distant sites in the body, then radical cystectomy is the surgical treatment of choice. With a radical cystectomy, nearby lymph nodes along with the prostate (in men), and, the ovaries, fallopian tubes, uterus and a small part of the vagina (in women) needs to be removed as well. Though it is an extensive surgery but offers advantage of reduced risk of recurrence.
Intravesical chemotherapy/immunotherapy – Intravesical chemotherapy is indicated in cases when radical cystectomy is not an acceptable or feasible option. In this procedure, the chemotherapy medication or agent is directly injected into the urinary bladder. The advantage is that only the bladder is exposed to the medication sparing the other organs from unnecessary exposure to the chemo medication. This prevents any systemic side effects though local irritation could be a side effect at the site.Based on the therapy/ medications administered, intravesical therapy is of two types – intravesical chemotherapy and intravesical immunotherapy.
The goals of intravesical treatment are to:
- Reduce any chances of implantation of tumour cells after TURBT
- Eliminate any residual cancer
- Prevent recurrence and further progression of the tumor
New bladder reconstruction or Neobladder reconstruction – Reconstructing a new bladder for urine or creating a diversion of urinary flow. In this procedure, the surgeon uses a piece of intestine to create a new bladder. Advantage offered doing this is that the patient now after surgical removal of bladder can voluntarily urinate and maintain continence.

What are the prostate cancer treatment options?

Prostate cancer, being one of the common cancers in males is a concern in elder males and American Oncology Institute (AOI) is one of the best hospitals for the treatment of prostate cancer in India. Treatments for prostate cancer can be single or a combination of two or more treatment modalities.

Active surveillance or watchful waiting – Close monitoring the prostate cancer by regular tests such as prostate specific antigen (PSA) and digital rectal exam (DRE) tests including prostate biopsies, and treat it only if it grows further or causes symptoms.
Radiotherapy or radiation therapy for prostate cancer – Radiotherapy employs high-energy rays or particles to destroy cancer cells and control their further growth. Radiation therapy for prostate cancer is given depending on the stage and other clinical factors; especially given in low grade and initial stages of prostate cancer confined just within the prostate gland itself.
Surgery or Surgical treatment options for prostate cancer includes:
- Robotic radical prostatectomy or Robotic-assisted laparoscopic radical prostatectomy or robotic prostatectomy – It is the main treatment for prostate cancer where the surgeon removes prostate gland including surrounding tissue as well as the seminal vesicles.In this procedure, laparoscopic surgery is done with a robot-assisted system. The surgeon operates through a control panel in the operating room and uses the robotic arms for making the incisions on the patient’s abdominal wall.It offers advantages such as less pain and blood loss with a shorter recovery time contrast to the conventional the open approach. This procedure should be performed by a highly-skilled, experienced and proficient uro-oncologist or onco-surgeon which determines the success of either type of these surgeries.
- Laparoscopic radical prostatectomy – This is a minimally invasive uro-oncologic surgery done to remove a patient’s cancerous prostate. In this procedure, the surgeon makes small incisions with the use of specialized surgical tools. Contrast to the traditional open surgery, laparoscopic surgery differs in the number of incisions (five small incisions) unlike one large incision in open surgery. It could be either manual by the surgeon or robotic-assisted system operated by the surgeon.
- Salvage prostatectomy – Some of the males, even after receiving the initial radiotherapy for prostate cancer, return to the uro-oncologist with recurrence of the prostate cancer. An elevated PSA level and a positive prostate biopsy post-radiation therapy is suggestive of cancer recurrence or incomplete elimination of previous cancer. Such patients are eligible candidates of salvage prostatectomy. This procedure has shown fair success rates in cases where the cancer is confined to the prostate or in tissues in its proximity, and has been shown to eliminate prostate cancer for almost ten years or more. There are higher incidences of complications following radiotherapy for prostate cancer. Radiotherapy may cause scarring which makes it more difficult to perform salvage prostatectomy compared to the traditional methods, hence it needs to be performed under a skilled uro-oncologist surgeon.At AOI, our experienced and one of the best uro-oncologists in India, are highly skilled and expert in performing salvage radical prostatectomy following radiation therapy.
Other treatment options are – chemotherapy, immunotherapy, hormone therapy.

What are the penile cancer surgery treatment options?

Penile cancer, or cancer of the penis usually affects the covering skin, especially the foreskin and may later spread to the other parts. If detected early, it can be treated well. It is observed that the Human papillomavirus (HPV) and Human immunodeficiency virus (HIV) infection may increase the risk of developing penile cancer.

Surgery is the most common treatment for all stages of penile cancer. Surgical treatment options for Penile cancer include:

Organ conserving surgery or Mohs surgery – In this procedure, the tumor is cut from the skin in thin layers. The edges and layers of the tumor are viewed through a microscope to check for cancer cells while removing them. Layers are removed until no more cancer cells are seen. Advantage offered with this technique is that less normal tissue is removed and only cancerous cells are removed; this preserves the organ as much as in its natural way.
Minimal Invasive inguinal dissection (VEIL) – this is a minimally invasive approach for radical inguinal lymph node dissection with an intention to reduce skin related morbidity contrast with open radical inguinal lymphadenectomy. This technique can be performed in low volume palpable inguinal nodes. Advantages offered are reduced skin related complications.
Robotic-assisted laparoscopic VEIL – The robotic-assisted system has also been adapted for this approach and it has been observed that it is associated with significant improvements in morbidity.

What are the vesicular or seminal vesicle cancer treatment options?

Seminal vesicles or vesicular cancer is one of the rare cancers. Usually, seminal vesicular cancer occurs due to involvement or invasion of another malignant cancer, typically prostate cancer. The close location of these vesicles with the prostate gland makes this invasion possible. Treatment for seminal vesicle cancer is usually surgery, combination therapy with radiation and/or hormone deprivation therapy depending on the case.

What is the testicle cancer or testicular cancer treatment option?

The testes are the primary male reproductive organ in males and contribute majorly to testosterone and sperm production. Testicular cancer is one of the common cancers in males and if diagnosed timely or early, it can be treated easily. Its symptoms could be testicular swelling, scrotal pain and/or groin, back or lower side of abdomen, lump/mass or any non-healing ulcer in the loin area, lower abdomen or testicles, changes in size or texture of testicles, fluid build-up. Exact cause is still unknown where genetic mutation could be a cause.

Testicular cancer treatment options include:

Surgery – Main treatment where the entire testicle is removed along with affected nearby lymph nodes.
- Radical inguinal orchiectomy – It is the primary treatment for almost all stages and types of testicular cancer. An incision is made in the groin area and the entire testicle is removed through the opening in the abdomen.
- Robotic/Laparoscopic Retroperitoneal lymph node dissection (RPLND) – especially indicated in advanced stage and in early stage or low stage (stage I and stage II) with curative intention. It is both diagnostic (staging) and therapeutic (stop the spread of cancer) in the body. RPLND is a major surgical procedure, performed under general anaesthesia. During the surgery, the doctor removes lymph nodes in retroperitoneum.At American Oncology Institute (AOI), our highly proficient and one of the best uro-oncologists in India, perform several uro-oncologic surgeries in a routine manner including Robotic and Laparoscopic Retroperitoneal lymph node dissection (RPLND).
Other treatments –
- Radiotherapy for testicular cancer- Radiation therapy is usually indicated in case of people who have the seminoma type of testicular cancer. Radiation therapy may be recommended after surgery to remove your testicle.
- Chemotherapy for testicular cancer – Chemotherapy may be recommended before or after lymph node removal surgery.

Sperm preservation or Sperm freezing is a modern facility for preserving sperm especially useful for patients undergoing cancer therapy. It also plays a vital role in treating couples with infertility.

What are the ureteric cancer treatment options?

Ureter cancer most often originates in transitional cells of the lining of urinary bladder.

Treatment options for Ureteric cancer include:

Surgery for ureter cancer –

It is the most commonly recommended option for treating ureter cancer. Based on the stage of the ureteric cancer:
- Initial/early-stage ureteral cancer may need removal of only a portion of the ureter.
- Advanced ureteral cancer may require removal of the affected ureter, its associated kidney (nephroureterectomy) and sometimes a portion of the bladder.
In case of very early stage, or if cancer cells are only on surface of the ureter:
- Robotic or laparoscopic Laser – A ureteroscope (tube with a lens on one end) is inserted through the bladder into the ureter. The beam of high-intensity laser traverses this tube and destroys the tumor tissue when it reaches.
- Robotic or laparoscopic electrosurgery – electrosurgery uses electric current which burns the tumor as well as the adjacent tissues.

Other treatments –

Chemotherapy & radiotherapy are usually recommended post-surgery to ensure complete elimination of any cancer cells from the body and prevent any recurrences.

Regular follow-ups are necessary to keep a check on any recurrence and ensure proper recovery including clinical examination, blood tests and cystoscopies of ureter.

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