{"id":17688,"date":"2020-04-15T15:57:11","date_gmt":"2020-04-15T15:57:11","guid":{"rendered":"https:\/\/urosassociats.com\/tratamientos\/oncology\/"},"modified":"2023-01-16T14:57:20","modified_gmt":"2023-01-16T14:57:20","slug":"oncology","status":"publish","type":"project","link":"https:\/\/urosassociats.com\/en\/treatments\/oncology\/","title":{"rendered":"Oncology"},"content":{"rendered":"<div id=\"cmsmasters_row_gh0ouuv8jj\" class=\"cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed\">\n<div class=\"cmsmasters_row_outer_parent\">\n<div class=\"cmsmasters_row_outer\">\n<div class=\"cmsmasters_row_inner\">\n<div class=\"cmsmasters_row_margin\">\n<div id=\"cmsmasters_column_xlabzu7bx\" class=\"cmsmasters_column one_first\">\n<div class=\"cmsmasters_column_inner\"><div class=\"cmsmasters_tabs tabs_mode_tour tabs_pos_left\">\n<ul class=\"cmsmasters_tabs_list\">\n<li id=\"cmsmasters_tabs_list_item_nhlqhxnx7i\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-27\">\n<span>PATHOLOGY \/ SYMPTOMS:<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_54bcx6ro8n\" class=\"cmsmasters_tabs_list_item current_tab\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Urethral cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_n8kt1a2yi\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Penile cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_bphgrcqect\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Testicular cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_qi7k8rnlh\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Bladder cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_02d7z11z81\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Prostate cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_awgifh40x\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Kidney cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_hg57fwv5mo\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Upper urinary tract cancer<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_7mgp4stnpk\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Benign tumors of the adrenal gland<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_sbcvvln64t\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Malignant tumor of the adrenal gland<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_o5dv2iwrqi\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-arrow-right\">\n<span>Pathology of the urachus<\/span>\n<\/a>\n<\/li><li id=\"cmsmasters_tabs_list_item_fnxw5g1t4h\" class=\"cmsmasters_tabs_list_item\">\n<a href=\"#\" class=\"cmsmasters-icon-custom-8\">\n<span>TREATMENTS:<\/span>\n<\/a>\n<\/li><\/ul>\n<div class=\"cmsmasters_tabs_wrap\">\n<div id=\"cmsmasters_tab_nhlqhxnx7i\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<ul style=\"user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">URETHRAL CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PENILE CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">TESTICULAR CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> BLADDER CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PROSTATE CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">KIDNEY CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">UPPER URINARY TRACT CANCER.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">BENIGN TUMORS OF THE ADRENAL GLANDS.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">MALIGNANT TUMOR OF THE ADRENAL GLANDS (ADRENAL CARCINOMA).<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PATHOLOGY OF URACHUS.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_54bcx6ro8n\" class=\"cmsmasters_tab active_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><strong style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">Urethral cancer<\/span><\/strong><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Urethral cancer is a disease that involves the formation of cancerous or malignant cells in the tissues that comprise the urethra, the tube that carries urine from the bladder to the outside of the body. The size of this varies according to sex, in men it has a larger size than in women.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">This type of cancer is rare in the population and there are more cases in men. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Aetiology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The causes of urethral cancer are unclear. There are people who have more risk factors for this disease, although this does not mean that you will get it. Factors that can increase the chances are:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Have <\/span><b style=\"user-select: auto;\">a family history<\/b><span style=\"font-weight: 400; user-select: auto;\"> with this pathology.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Having a condition that affects the urethra, causing chronic inflammation. The most important are: sexually transmitted infections, such as <\/span><b style=\"user-select: auto;\">human papillomavirus (HPV)<\/b><span style=\"font-weight: 400; user-select: auto;\"> and<\/span><b style=\"user-select: auto;\"> recurrent urinary tract infections<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Having a history <\/span> of <b style=\"user-select: auto;\">bladder cancer<\/b><span style=\"font-weight: 400; user-select: auto;\">, since implants may appear in the urethra during the evolution of this disease.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptoms<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The signs of this disease are not usually shown in the early stages. Among the most frequent we find:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Difficulty urinating.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Frequent urination, especially at night.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Weak or interrupted urination flow, often coupled with difficulty emptying the bladder completely.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/enfermedades\/urologicas\/incontinencia-urinaria.html\"><span style=\"font-weight: 400; user-select: auto;\">Incontinence<\/span><br style=\"user-select: auto;\" \/><\/a><span style=\"font-weight: 400; user-select: auto;\"> or inability to control urine in the bladder.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Discharge from the urethra.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Presence of blood in the urine.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Thickening of the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/cuidateplus.marca.com\/sexualidad\/diccionario\/pene.html\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a> in men or the presence of a lump in women.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Subtypes<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Variants of urethral cancer depend on the tissues lining this duct and the types of cells that make it up. The pathology can spread and metastasize to nearby tissues or lymph nodes. Known subtypes of urethral cancer are:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46595&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Squamous cell carcinoma<\/b><\/a><\/span><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"> is the most common type of urethral cancer. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Transitional <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46629&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">cell carcinoma<\/b><\/a>\u00a0<\/span><\/span>forms in the <span style=\"font-weight: 400; user-select: auto;\"> area near the urethral opening in women and in the part of the urethra that passes through the prostate in men.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"> <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46216&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Adenocarcinoma<\/b><\/a> <\/span><\/span>forms in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46386&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">glands<\/span><\/a> surrounding the urethra in men and women.<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on the location of the tumor, we can differentiate between:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Distal urethral cancer:<\/b><span style=\"font-weight: 400; user-select: auto;\"> in the area closest to the outside of the body.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Proximal urethral cancer:<\/b><span style=\"font-weight: 400; user-select: auto;\"> located in the part closest to the bladder.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the diagnosis of urethral cancer, multiple tools are used, since it must be determined not only the presence of tumor implants in the organ, but also the possibility that it has spread to other parts of the body. In the diagnosis, information is collected through:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270871&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Physical<\/b><\/a> <\/span><\/span>exam <span style=\"font-weight: 400; user-select: auto;\"> and <\/span> health <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=798522&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">history<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> An exam of the body to check overall health and identify any signs of disease, such as lumps or anything else that seems abnormal. Data on health habits, history of illnesses, and previous treatments are also taken.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=322873&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Pelvic exam<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\">: <\/b><span style=\"font-weight: 400; user-select: auto;\">Examination of the vagina<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46133&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cervix<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46645&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">uterus<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45687&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">fallopian tubes<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46687&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">ovaries<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46555&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">rectum<\/span><\/a>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">Digital rectal exam<b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> rectal exam<\/span> <b style=\"user-select: auto;\"> <\/b><\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270872&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Urine cytology<\/b><\/a><b style=\"user-select: auto;\">:\u00a0<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46590&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">A laboratory test<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">in which urine is viewed under a <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">microscope<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">to look for abnormal cells.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46641&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Urinalysis<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> A test to analyze the color of urine and its contents.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=304685&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Blood tests:<\/b><\/a> <span style=\"font-weight: 400; user-select: auto;\">Tests in which a blood sample is examined to measure the amount of certain substances released into the blood by organs and tissues in the body. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=354470&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Urethroscopy<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> A procedure to look inside the\u00a0<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethra<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">and check for abnormal areas. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45164&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Biopsy<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> removal of cells or tissue samples from the urethra. <\/span> <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The process used to find out if <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> has spread within <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46640&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethra<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> or to other parts of the body is called <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46597&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">staging<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">. The information obtained in the staging process determines <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45885&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> of the disease. It is important to know what stage the disease is at in order to plan your treatment.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The following procedures are used during the staging process:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=304687&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Chest x-ray<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\">:<\/b> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45944&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">X-ray<\/span><\/a> of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257523&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">organs<\/span><\/a> and bones inside the chest.<\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44236&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Computed<\/b><\/a> <\/span><\/span>tomography <b style=\"user-select: auto;\">(CT)<\/b> scan of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46246&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">pelvis<\/b><\/a> <b style=\"user-select: auto;\">and<\/b> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45070&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">abdomen<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> A procedure that makes a series of detailed pictures of the inside of <\/span> <b style=\"user-select: auto;\"> the body from different angles.<\/b><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45997&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Magnetic resonance imaging<\/b> <\/a><\/span><\/span><b style=\"user-select: auto;\">(MRI)<\/b><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Urethrogram:<\/b> <span style=\"font-weight: 400; user-select: auto;\">A series of x-rays of the urethra. Contrast is injected through the urethra into the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46501&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">bladder<\/span><\/a><\/span><\/span>.<\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatments<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">There are different types of treatment available for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446540&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethral cancer <\/span><\/a><\/span>patients<span style=\"font-weight: 400; user-select: auto;\">. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatments:<\/b><\/span><\/p>\n<p style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Surgery <\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">to remove the cancer is the most common treatment for urethral cancer<\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446540&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">. Sometimes one of the following types of surgery is done.<\/span><\/a><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=641952&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Open resection<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> removal of the cancer by surgery.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Transurethral resection<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">(TUR):<\/b><span style=\"font-weight: 400; user-select: auto;\">\u00a0Surgery to remove the cancer using a special tool inserted into the urethra.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Electroresection with <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46393&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">fulguration<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove cancer using an electric current. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=322858&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Laser surgery<\/b><\/a><\/span><\/span>: A surgical procedure in which a laser beam is used<a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45748&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\"> like a scalpel to make bleeding-free cuts in the <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a> or <span style=\"font-weight: 400; user-select: auto;\"> to remove or destroy tissue.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44435&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Lymph node dissection<\/b><\/a><\/span><\/span>: Sometimes lymph <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes <\/span><\/a>in <span style=\"font-weight: 400; user-select: auto;\"> the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46246&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pelvis<\/span><\/a> and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a> are removed<span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446217&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Cystouretrectomy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove the <\/span><\/span><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46501&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">bladder<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">and urethra.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446218&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Cysthoprostatectomy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove the bladder and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46539&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">prostate<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446220&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Anterior pelvic exenteration<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove the urethra, bladder, and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46646&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">vagina<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Partial penectomy<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove the part of <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a> <\/b><b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">that surrounds the urethra to where the cancer has spread.<\/span><\/b><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radical penectomy<\/b><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove the entire penis. <\/span> <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">If the urethra is removed, the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44306&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">surgeon<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> will open a new avenue for urine to<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46642&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">leave the body. This procedure is called <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446222&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urine shunting<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. The surgeon sometimes uses a part of the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46582&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">small intestine<\/b><\/a> to <span style=\"font-weight: 400; user-select: auto;\"> make a tube for urine to pass through an opening (<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45104&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">stoma<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">). This is called <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46251&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">an ostomy<\/b><\/a><b style=\"user-select: auto;\"> or <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46644&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">urostomy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Once the doctor removes all of the cancer visible at the time of surgery, some patients may receive <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemotherapy<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44295&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation therapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> after surgery to kill any <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\"> remaining cancer cells. Treatment given after surgery to decrease the risk of the cancer coming back is called <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45587&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">adjuvant therapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/p>\n<p style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Radiation therapy is a cancer treatment that uses <\/span><span style=\"font-weight: 400; user-select: auto;\"> high-energy x-rays or other types of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45072&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> to kill cancer cells or stop them from growing. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are two types of radiation therapy:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46686&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">External<\/b><\/a> <\/span><\/span>radiation therapy<b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> A type of radiation therapy that uses a machine that sends radiation to the area with cancer from outside the body.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Internal<\/b><\/a> <\/span><\/span>radiation therapy<b style=\"user-select: auto;\">: <\/b><span style=\"font-weight: 400; user-select: auto;\">A type of radiation therapy that uses a <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46550&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radioactive<\/span><\/a> substance <span style=\"font-weight: 400; user-select: auto;\"> sealed in needles<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257219&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">seeds<\/span><\/a>, wires, or catheters that are placed directly into or near the cancer. Internal radiation therapy is also called brachytherapy.<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The way radiation therapy is given depends on the type of cancer and where in the urethra the cancer formed. External and internal radiation therapy are used to treat urethral cancer.<\/span><\/p>\n<p style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Chemotherapy is a cancer treatment that uses<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">drugs<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> to stop cancer cells from growing, either by killing them or by stopping them from dividing. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on the location of the cancer, certain treatments may be used and others may not.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">For distal urethral cancer&#8230;<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=747977&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">of distal urethral cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> is different for men and women.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For women, treatment may include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove the tumor (transurethral resection), electroresection and fulguration, or laser surgery<\/b><span style=\"font-weight: 400; user-select: auto;\"> for tumors that have not spread deep into the<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45151&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Brachytherapy <\/b><\/a><\/span><\/span><b style=\"user-select: auto;\">(<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">internal radiation therapy<\/b><\/a><b style=\"user-select: auto;\">) or <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46686&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">external radiation therapy<\/b><\/a> for tumors that have not spread deep into the tissue.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove the tumor (<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446220&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">anterior pelvic exenteration<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\">)<\/b><span style=\"font-weight: 400; user-select: auto;\"> for tumors that have spread deep into the tissue. Nearby <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a> are also sometimes removed <span style=\"font-weight: 400; user-select: auto;\"> (<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44435&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph node dissection<\/span><\/a>). Radiation therapy is sometimes given <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">before surgery.<\/span><\/a><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For men, treatment may include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove the tumor (transurethral resection) electroresection and fulguration, or laser surgery <\/b><span style=\"font-weight: 400; user-select: auto;\">for tumors that have not spread deeply into the tissue.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove part <\/b> of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">penis<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">(<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">partial penectomy<\/b><\/a><b style=\"user-select: auto;\">)<\/b><span style=\"font-weight: 400; user-select: auto;\"> for tumors that are near the tip of the penis. Nearby lymph nodes are also sometimes removed (lymph node dissection).<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove part<\/b> of the urethra <span style=\"font-weight: 400; user-select: auto;\"> for tumors that are in <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=749437&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">distal urethra<\/span><\/a> <\/span><\/span>but are not at the tip of the penis or spread deep into the tissue. Nearby lymph nodes are also sometimes removed (lymph node dissection).<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery to remove the penis (radical penectomy)<\/b><span style=\"font-weight: 400; user-select: auto;\"> for tumors that have spread deep into the tissue. Nearby lymph nodes are also sometimes removed (lymph node dissection).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radiation therapy<\/b><span style=\"font-weight: 400; user-select: auto;\">, with <\/span><span style=\"font-weight: 400; user-select: auto;\"> or without<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemotherapy<\/span><\/a><\/span><\/span>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Chemotherapy<\/b><span style=\"font-weight: 400; user-select: auto;\"> given along with radiation therapy.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">For proximal urethral cancer&#8230;<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment <\/span> for proximal urethral cancer <span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446540&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethral cancer<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> that affects the entire <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46640&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethra<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> is different for men and women.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For women, treatment may include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44295&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Radiation therapy<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">or <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">surgery<\/b><\/a> <b style=\"user-select: auto;\">(<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=641952&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">open resection<\/b><\/a><b style=\"user-select: auto;\">, <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">transurethral resection<\/b><\/a><b style=\"user-select: auto;\">) <\/b><span style=\"font-weight: 400; user-select: auto;\">for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tumors<\/span><\/a> that are 3\/4 inch or smaller.<\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radiation therapy followed by surgery (<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446220&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">anterior pelvic exenteration <\/b><\/a><b style=\"user-select: auto;\">with <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44435&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">lymph node dissection<\/b><\/a> <b style=\"user-select: auto;\">and <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446222&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">urine diversion<\/b><\/a><b style=\"user-select: auto;\">).<\/b><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For men, treatment includes the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radiation therapy or radiation therapy <\/b> and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">chemotherapy<\/b><\/a><\/span><\/span>, <b style=\"user-select: auto;\">followed by surgery (<\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446218&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">cystoprostatectomy<\/b><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">penectomy<\/b><\/a>, <b style=\"user-select: auto;\">lymph node dissection, and urine diversion).<\/b><\/li>\n<\/ul>\n<h3 style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">For urethral cancer resulting from bladder cancer<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446540&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">of urethral<\/span><\/a> <\/span>cancer <span style=\"font-weight: 400; user-select: auto;\"> that forms at the same time as <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45741&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">invasive<\/span><\/a>\u00a0<a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444968&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">bladder<\/span><\/a>\u00a0cancer <span style=\"font-weight: 400; user-select: auto;\"> may include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Surgery<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">(<\/b>cystoretrectomy for <b style=\"user-select: auto;\"> women or urethrectomy and <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446218&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">cystoprostatectomy<\/b><\/a> <b style=\"user-select: auto;\">for men).<\/b><br style=\"user-select: auto;\" \/>\n<p style=\"user-select: auto;\">\n<\/li>\n<\/ul>\n<h3 style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">For metastatic urethral cancer&#8230;<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446540&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">for urethral cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> that <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46283&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">metastasized<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">(spread to other parts of the body) is usually <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">chemotherapy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">Treatment of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45862&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">recurrent<\/b><\/a>\u00a0<\/span><b style=\"user-select: auto;\">urethral cancer <\/b><span style=\"font-weight: 400; user-select: auto;\"> may include one or more of the following:<\/span><\/p>\n<ul style=\"user-select: auto;\">\n<li style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Surgery<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">to remove the <\/b><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">tumor<\/b><\/a><b style=\"user-select: auto;\">.<\/b> Nearby <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a> are also sometimes removed <span style=\"font-weight: 400; user-select: auto;\"> (<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44435&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph node dissection<\/span><\/a>).<\/li>\n<li style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Radiation therapy<\/b><\/a><b style=\"user-select: auto;\">.<\/b><\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_n8kt1a2yi\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Penile cancer<\/b><\/span><\/h2>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Risk factors<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Human <\/span><b style=\"user-select: auto;\">papillomavirus<\/b><span style=\"font-weight: 400; user-select: auto;\"> (HPV) infection is the risk factor most associated with penile cancer. There are more than 100 serotypes, but only some increase the possibility of cancer in the genital organs. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Other factors involved are:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Age over 60 years.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Phimosis (<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=651193&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">condition<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">in which the foreskin of the penis cannot move backwards over the glans).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"> Inadequate personal<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=430486&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">hygiene<\/span><\/a><\/span><\/span>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Consumption of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=439432&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tobacco<\/span><\/a> <\/span><\/span>products<span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptoms<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Signs and symptoms that suggest penile cancer include:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Redness, irritation, or a sore on the penis.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Ulcers that do not heal.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A mass on the penis.<\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The following is done:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270871&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Physical exam<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=689078&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">history<\/b><\/a><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> Examination of the body to check general health and identify any signs of penile disease, such as lumps or anything else that seems abnormal. Data on health habits, history of illnesses, and previous treatments are also taken.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45164&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Biopsy<\/b><\/a><\/span><\/span>: The removal of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cells<\/span><\/a> or tissues for a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46244&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pathologist<\/span><\/a> to look at under a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">microscope<\/span><\/a> and check for signs of cancer. The tissue sample is removed using one of the following procedures.<\/li>\n<\/ul>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46698&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Incisional biopsy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: The removal of a part of a mass or sample of tissue that does not look normal.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46411&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Excisional biopsy<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: The complete removal of a mass or area of tissue that does not look normal.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In diagnosis it is important to determine if penile cancer is localized or has spread to other regions of the body. Several complementary tests are used to place the case within a specific clinical stage: 0, I, II, III or IV. It is important to know the stage to plan treatment.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stages of Penile Cancer<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The different stages are:<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage 0<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Stage <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=482355&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">0<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> is divided into stages <\/span><b style=\"user-select: auto;\">0is<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">0a<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In stage <\/span><b style=\"user-select: auto;\">0is<\/b>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44636&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">abnormal <\/span><\/a><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cells<\/span><\/a> are found <span style=\"font-weight: 400; user-select: auto;\"> on the surface of the skin of the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a>. These abnormal cells form lumps that sometimes become <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancerous<\/span><\/a> and spread to<br style=\"user-select: auto;\" \/>\n<p style=\"user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\"> nearby normal tissue. Stage 0is is also called <\/span><b style=\"user-select: auto;\">carcinoma in situ<\/b><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><b style=\"user-select: auto;\">intraepithelial neoplasia of the penis<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/a><\/p>\n<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><b style=\"user-select: auto;\">stage 0a<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46595&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">squamous cell cancer <\/span><\/a><\/span><\/span>that does not spread is found on the surface of the skin of the penis <span style=\"font-weight: 400; user-select: auto;\"> or on the inner surface <\/span> of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446203&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">foreskin<\/span><\/a> of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a>. Stage 0a is also called <b style=\"user-select: auto;\">localized noninvasive squamous cell carcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446206&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage I<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\">, <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> has formed and spread to<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">tissue <span style=\"font-weight: 400; user-select: auto;\"> just under the skin of the <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. Cancer has not spread to the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=269463&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymphatic<\/span><\/a> vessels, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45020&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">blood vessels<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">, <\/span><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373935&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nerves<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. Cancer <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"> cells <span style=\"font-weight: 400; user-select: auto;\"> look like normal cells when viewed under a <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">microscope<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446208&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Stage II<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> is divided into stages <\/span><b style=\"user-select: auto;\">IIA<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">IIB<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><b style=\"user-select: auto;\">stage IIA<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a> has spread as follows:<\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">to <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a> <\/span><\/span>just under the skin of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a>. Cancer has spread to <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=269463&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymphatic<\/span><\/a> vessels, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45020&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">blood vessels<\/span><\/a>, or <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373935&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nerves<\/span><\/a>; or <span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">to the tissue just under the skin of the penis. Cancer <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cells<\/span><\/a> <\/span><\/span>look very <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44636&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">abnormal<\/span><\/a> or <span style=\"font-weight: 400; user-select: auto;\"> are <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476767&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">sarcomatoid<\/span><\/a> when viewed under a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">microscope<\/span><\/a>; or<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">to <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=794363&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">corpus spongiosum<\/span><\/a> <\/span><\/span>(erectile spongy tissue of the shaft of the penis and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446204&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">glans<\/span><\/a> that fills with <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270735&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">blood<\/span><\/a> during an <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=373933&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">erection<\/span><\/a>).<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><b style=\"user-select: auto;\">stage IIB<\/b><span style=\"font-weight: 400; user-select: auto;\">, cancer <\/span><\/span><\/p>\n<p style=\"user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\"> has spread as follows:<\/span><\/a><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">through the connective tissue layer <\/span><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44013&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">surrounding <\/span> the corpus cavernosum <span style=\"font-weight: 400; user-select: auto;\"> (erectile spongy tissue of the shaft of <\/span> the <\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a>) and into the corpus cavernosum.<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Stage <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446210&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">III<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> is divided into stages <\/span><b style=\"user-select: auto;\">IIIA<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">IIIB<\/b><span style=\"font-weight: 400; user-select: auto;\">. Cancer <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">is found in the <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><b style=\"user-select: auto;\">stage IIIA<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">has spread to 1 or 2 <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a> o<span style=\"font-weight: 400; user-select: auto;\">n one side of the<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><b style=\"user-select: auto;\">stage IIIB<\/b>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a> <\/span><\/span>has spread to 3 or more lymph nodes on <span style=\"font-weight: 400; user-select: auto;\"> one side <\/span> of the groin<span style=\"font-weight: 400; user-select: auto;\">, or to lymph nodes on both sides of the groin.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage IV<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446211&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage IV<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\">, cancer <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">has spread as follows:<\/span><\/a><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">to <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissues<\/span><\/a> <\/span><\/span>near the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\">such as the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46573&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">scrotum<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46539&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">prostate<\/span><\/a>, or <span style=\"font-weight: 400; user-select: auto;\"> pubis, and may have spread to <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a> in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a> or <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46246&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pelvis<\/span><\/a> ; or<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">to one or more lymph nodes in the pelvis, or cancer has spread through the outer covering of lymph nodes to nearby tissue; or<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes outside the pelvis or to other parts of the body, such as the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270740&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lungs<\/span><\/a><\/span><\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46312&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">liver<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> or bones.<\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatments<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Surgery <\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">is the most common treatment for all <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45885&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stages<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">\u00a0of penile cancer. A doctor may remove the cancer using one of the following operations:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=442898&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Mohs micrographic surgery<\/b><\/a><\/span><\/span>: A procedure in which the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">skin tumor<\/span><\/a> is cut <span style=\"font-weight: 400; user-select: auto;\"> into thin layers. During surgery, <\/span> the edges of the tumor and each layer of the tumor removed are looked <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">at under a microscope<\/span><\/a> to check for cancer cells. Layers are removed until cancer cells are no longer visible. This type of surgery removes as little normal tissue as possible <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">and is often used to remove cancer that is in the skin. This procedure is also called Mohs surgery.<\/span><\/a><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=322858&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Laser surgery<\/b><\/a><\/span><\/span>: A surgical procedure in which a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45748&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">laser<\/span><\/a> beam is used like a scalpel to make bleedingless cuts in tissue or to remove a superficial <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46324&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lesion<\/span><\/a>, such as a tumor.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45407&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Cryosurgery<\/b><\/a><\/span><\/span>: Treatment that uses an instrument to freeze and destroy <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44636&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">abnormal<\/span><\/a> tissue<span style=\"font-weight: 400; user-select: auto;\">. This type of treatment is also called cryotherapy.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446200&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Circumcision<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove part or all of the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446203&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">foreskin<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> of the<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257215&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446983&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Wide local excision<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove cancer and some of the healthy tissue around it.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46210&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Penile amputation<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">: Surgery to remove part or all of the penis. If part of the penis is removed, amputation is a <\/span> partial <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penectomy<\/span><\/a><\/b><b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">. If the entire penis is removed, it is a total penectomy.<\/span><\/b><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">During surgery, lymph <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes<\/span><\/a> <\/span>in <span style=\"font-weight: 400; user-select: auto;\"> the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a> are sometimes removed<span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">After the doctor removes all of the cancer visible at the time of surgery, some patients may receive <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemotherapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation therapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> to kill any remaining cancer cells. Treatment given after surgery to decrease the risk of the cancer coming back is called <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45587&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">adjuvant therapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Radiation therapy is a cancer treatment that uses <\/span><span style=\"font-weight: 400; user-select: auto;\"> high-energy <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45944&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">x-rays<\/a>\u00a0or other types of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45072&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation<\/span><\/a><\/span> to kill cancer cells or stop them from growing. There are two types of radiation therapy.<\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46686&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">External radiation therapy<\/b><\/a><\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">: A type of radiation therapy that uses a machine that sends radiation to the cancer from outside the body.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Internal radiation therapy<\/b><\/a><\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">: A type of radiation therapy that uses a radioactive substance sealed in needles<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257219&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">seeds<\/span><\/a>, wires, or <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45637&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">catheters<\/span><\/a> that are placed directly into or near the cancer.<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Chemotherapy is a cancer treatment that uses <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">drugs<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> to stop cancer cells from growing, either by killing them or by stopping them from dividing. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Biologic drugs<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Biologic <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45617&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">therapy<\/span><\/a> <\/span>is <span style=\"font-weight: 400; user-select: auto;\"> a treatment in which the patient&#8217;s <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46356&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">immune system<\/span><\/a> is used <span style=\"font-weight: 400; user-select: auto;\"> to fight cancer. Substances made by the body or produced in a laboratory are used to boost, direct, or restore the body&#8217;s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45927&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">with <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45080&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">imiquimod<\/b><\/a><span style=\"font-weight: 400; user-select: auto;\">\u00a0is sometimes used to treat stage 0 penile cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Sentinel node biopsy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45876&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">Sentinel lymph node biopsy<\/a><\/span>\u00a0<span style=\"font-weight: 400; user-select: auto;\">is the removal <\/span> of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45876&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">the sentinel lymph node<\/span><\/a><\/span> during surgery.<span style=\"font-weight: 400; user-select: auto;\"> The sentinel lymph node is the first node in a group of lymph nodes to receive <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45760&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymphatic drainage<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> from the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45847&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">primary tumor<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. It is the first lymph node where cancer from the primary tumor is likely to spread. A radioactive substance or blue dye is injected near the tumor. The substance or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=409764&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">dye<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> flows through <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph ducts<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\"> to the lymph nodes. The first node that receives the substance or dye is removed. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46244&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pathologist<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> looks at the tissue under a microscope to look for cancer cells. If no cancer cells are found, no more lymph nodes may need to be removed. Sometimes a sentinel lymph node is found in more than one group of lymph nodes. After sentinel lymph node biopsy, <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44306&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">surgeon<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> removes the cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on each stage, certain types of treatments may be used and others may not.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage 0<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=482355&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage 0<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> may include one of the following:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=442898&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Mohs microsurgery<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46619&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Topical chemotherapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45927&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Topical biological t<\/span><\/a><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45617&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">herapy <span style=\"font-weight: 400; user-select: auto;\"> with <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45080&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">imiquimod<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=322858&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Laser surgery<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45407&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Cryosurgery<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">If <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> is found only in the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446203&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">foreskin<\/span><\/a>, only <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446983&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">wide local excision<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446983&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">circumcision treatment<\/a> may be needed.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446206&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage I penile cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> may include the following:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Surgery<\/span><\/a> (<\/span><\/span>partial or total <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penectomy<\/span><\/a>, with or without removal of lymph <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes<\/span><\/a> in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a>).<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">External <span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">internal <\/span><\/a><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46686&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation therapy<\/span><\/a>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=442898&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Mohs microsurgery<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">trial<\/span><\/a><\/span><\/span>of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45154&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">laser therapy<\/span><\/a>.<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446208&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage II penile cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> may include the following:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Surgery<\/span><\/a> <\/span><\/span>(partial or total <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penectomy<\/span><\/a>, with or without removal of lymph <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes<\/span><\/a> in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a>).<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">External<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46345&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">internal <\/span><\/a><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46686&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation therapy<\/span><\/a> followed by surgery.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">trial<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46712&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">sentinel lymph node biopsy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> followed by surgery.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical trial of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=322858&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">laser surgery<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment for\u00a0<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446210&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage III penile cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> may include the following:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Surgery<\/span><\/a> <\/span><\/span>(<a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446205&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">penectomy<\/span><\/a> and removal of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a> in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a>, with <span style=\"font-weight: 400; user-select: auto;\"> or without<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiation therapy<\/span><\/a>).<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Radiotherapy.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">trial<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46712&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">sentinel lymph node biopsy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> followed by surgery.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical trial of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46553&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radiosensitizers<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical trial of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemotherapy <\/span><\/a><\/span><\/span>before or after surgery.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical trial with <\/span> new <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">drugs<\/span><\/a><\/span><\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45617&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">biological therapy<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> or new types of surgery.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage IV<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment for <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446211&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">stage IV penile cancer<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> is usually <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45815&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">palliative<\/span><\/a>\u00a0<span style=\"font-weight: 400; user-select: auto;\"> (to relieve <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45022&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">symptoms<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">and improve <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45417&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">quality of life<\/span><\/a>).<span style=\"font-weight: 400; user-select: auto;\">\u00a0Treatment may include the following:<\/span><\/p>\n<ul style=\"user-select: auto;\">\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Surgery<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">(<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=446983&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">wide local excision<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">and removal of lymph <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> in the<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46375&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">groin<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44971&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Radiation therapy<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45961&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">trial <\/span><\/a><\/span><\/span>of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45214&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemotherapy<\/span><\/a> before or after surgery.<\/li>\n<li style=\"font-weight: 400; text-align: justify; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A clinical trial with <\/span> new <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=348921&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">drugs<\/span><\/a><\/span><\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45617&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">biological therapy<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> or new types of surgery.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_bphgrcqect\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Testicular cancer<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Testicular cancer is the most common tumor in men between the ages of 15 and 35. However, after this peak of incidence it becomes a rarity and, in general, only accounts for 1% of all tumors diagnosed in men. In Spain, approximately 1,300 new cases were diagnosed in 2019. Its frequency varies in different countries for reasons that we do not know.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Since the 90s the number of diagnosed cases is increasing for unknown reasons, although mortality has decreased, reflecting improvements in the treatment of these patients.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Fortunately, the vast majority of patients are cured, even in those cases in which the disease initially presents already very advanced. This is possible mainly thanks to chemotherapy regimens.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Aetiology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The specific cause of testicular cancer is unknown, as are many other tumors; But some risk factors with a clear association with germline tumors have been identified. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The main risk factor is <\/span><b style=\"user-select: auto;\">cryptorchidism<\/b><span style=\"font-weight: 400; user-select: auto;\"> (lack of descent from the testicle to the scrotum during the first years of life). <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Between 1 and 3% of patients with germline tumors have <\/span> a <b style=\"user-select: auto;\">family history<\/b><span style=\"font-weight: 400; user-select: auto;\"> of testicular cancer, suggesting a hereditary component. In the same way, the siblings or children of these patients have up to 10 times more risk of developing the disease. However, the genetic factors responsible are not yet well established. <\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prevention<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Generally speaking, there is no way to prevent testicular cancer, because there are no known risk factors that can be avoided. In addition, the frequency of the disease is low, even in people who have risk factors. On the other hand, it has been shown that <\/span><b style=\"user-select: auto;\">orchidopexy<\/b><span style=\"font-weight: 400; user-select: auto;\"> (intervention by which an undescended testicle is lowered and fixed to the scrotum naturally) prevents the development of testicular cancer in the subgroup of boys with cryptorchidism.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is not recommended to perform routine examinations or tests to diagnose it early in the general population, since it is a rare tumor, easy to diagnose in early stages and with a good prognosis. However, it is important that the target population of this disease (men between 15-35 years) is familiar with the most common warning signs and symptoms.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptomatology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The vast majority of male germ tumors are diagnosed because <\/span> the <b style=\"user-select: auto;\">patient feels a lump in the testicle<\/b><span style=\"font-weight: 400; user-select: auto;\">, which often does not hurt. In cases where there is pain, it usually appears progressively, although it can do so suddenly if the tumor is complicated by an infection (orchiepididymitis) or if it bleeds. In general, patients describe more a feeling of weight in the genital area or simply an increase in the size of the testicle. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In much rarer cases, these tumors can cause breast growth in males (<\/span><b style=\"user-select: auto;\">gynecomastia<\/b>).<span style=\"font-weight: 400; user-select: auto;\">) by increased chorionic beta-gonadotropin (\u03b2-HCG). In some patients it may exist <\/span><b style=\"user-select: auto;\">Back or abdominal pain<\/b>, <span style=\"font-weight: 400; user-select: auto;\">caused by painful stimuli from the testicle being directed to that site, or by metastases (extensions of the testicular tumor to other areas) in lymph nodes in the back of the abdomen (retroperitoneum).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Finally, in cases where there are metastases in other organs (for example, in the lung, brain, bone, etc.), these can produce very varied symptoms (shortness of breath, instability, pain, etc.), depending on their location. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Histological types<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Histologic types are the different kinds of tumors that can develop in an organ. These types are determined based on the microscopic characteristics of the tumor.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the case of testicular tumors, when the germ cell grows abnormally, it can follow different patterns and give rise to two large families of tumors:<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">&#8211; <\/span><b style=\"user-select: auto;\">Seminomas:<\/b><span style=\"font-weight: 400; user-select: auto;\"> these represent approximately 50% of germline tumors and usually appear on average 10 years later (around the fourth decade of life). For a testicular tumor to be considered seminoma, it must not be mixed with other types of tumor. There are two subtypes:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Classic seminoma<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Atypical seminoma<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">&#8211; Nonseminomas: <\/b><span style=\"font-weight: 400; user-select: auto;\">nonseminoma tumors usually appear during the third decade of life. When we talk about &#8220;non-seminome&#8221; we are actually referring to a group that includes several possible subtypes: <\/span> <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Embryonal carcinoma<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Choriocarcinoma<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Endodermal sinus tumor<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Teratoma <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\"> The most common subtype is embryonal carcinoma, although patients usually have mixed tumors that mix in different proportions any of these subtypes and even parts of seminoma (in this particular case, they continue to be considered nonseminomas).<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When a probable case of testicular cancer is addressed, in addition to asking about the symptoms and exploring the patient, the study is completed with the following complementary tests:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">General Analytics<\/b><span style=\"font-weight: 400; user-select: auto;\">, including LDH, alpha-fetoprotein, and \u03b2-hCG. These substances are called <\/span><b style=\"user-select: auto;\">Tumor markers<\/b><span style=\"font-weight: 400; user-select: auto;\">. They are proteins produced by tumor cells and will be very useful for the diagnosis and \/ or monitoring of the disease. \u03b2-HCG may be elevated in any type of testicular tumor, while alpha-fetoprotein only increases in nonseminoma tumors. LDH (lactate dehydrogenase) is another protein in the blood that is also elevated in some patients with testicular tumors, and its evolution should be monitored during treatment. However, as with other types of cancer, tumor markers do not increase in all patients with testicular cancer; nor does any elevation of these proteins correspond unequivocally with the fact of having a germ tumor.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Ultrasound of<\/b> the testicle: <span style=\"font-weight: 400; user-select: auto;\"> It is a crucial test, since it allows us to distinguish a tumor from other benign entities that could also cause a palpable nodule in the testicle. If the existence of a tumor is definitively confirmed, ultrasound can observe its characteristics (location, size, vascularization, etc.), explore the contralateral testicle, etc. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Computed axial tomography (CT) of the chest, abdomen and pelvis:<\/b><span style=\"font-weight: 400; user-select: auto;\"> it allows to study the rest of the organs of the body and the main routes of testicular lymphatic drainage, so that it is essential for a correct staging of the case. <\/span> <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In addition, they can be performed in some cases:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">CT or brain magnetic resonance imaging (MRI):<\/b><span style=\"font-weight: 400; user-select: auto;\"> if brain metastases are suspected.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Bone scan:<\/b><span style=\"font-weight: 400; user-select: auto;\"> if bone metastases are suspected.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Positron emission tomography (PET):<\/b><span style=\"font-weight: 400; user-select: auto;\"> sometimes used to assess tumor remnants that may persist after initial chemotherapy treatment in cases of advanced disease. PET is not indicated as a routine procedure in the initial diagnosis of all cases.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor only affects the testicle.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor spreads to lymph nodes, usually located in the retroperitoneum (the area behind the abdomen).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor has metastasis or very significant elevation of tumor markers.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prognosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The prognostic factors are characteristics of the tumor and the patient that allow to estimate a priori its subsequent evolution, complementing the stage marked by the TNM system.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In testicular cancer with metastasis treated with chemotherapy there are 3 prognostic factors of great importance with which in 1997 a prognostic classification of enormous scope was developed, still in force, and critical when determining the most appropriate treatment for each patient: <\/span><b style=\"user-select: auto;\">The International Germ Cell Cancer Collaborative Group (IGCCCG) Prognostic Classification.<\/b> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">This classification establishes 3 categories for nonseminoma tumors (favorable, intermediate or unfavorable prognosis); and 2 for seminomatous (favorable or intermediate prognosis; there are no patients with an unfavorable prognosis in this histological subtype). Prognostic factors are:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">The tumor originates in the testicle itself (a sign of good prognosis) or outside it.<\/b><span style=\"font-weight: 400; user-select: auto;\"> A small percentage of germ cell tumors may occur in areas of the body other than the testicle, with no tumor found in the testicle itself; either because the initial tumor has disappeared or because the disease actually originated outside the testicle. The latter can happen because during the development of the embryo the testicle migrates to its final position in the scrotum. In this journey there may be remains of testicular cells that very rarely already in adulthood can give rise to tumors. <\/span><\/span><\/li>\n<\/ol>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">The absence of distant metastases (M1) (sign of good<\/b> prognosis), <span style=\"font-weight: 400; user-select: auto;\"> with the exception of lung metastases that alone do not indicate a poor prognosis. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">The degree of elevation of tumor markers.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> In general, the higher, the worse the prognosis.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Although germline tumors of the testicle have a very good prognosis in experienced hands, we are talking about very fast-growing neoplasms, which represent a very important aggression for the body, and that usually affect very young patients. That is why the main international recommendation is that these patients be quickly referred to specialized centers with professionals accustomed to their management.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It must be borne in mind that, once cured, these patients will have been subjected to treatments that reduce their reproductive capacity, and that impact on their sexual sphere and self-image, so we must foresee these details from the beginning, involve their partners if any, preserve sperm if appropriate, and advise properly at the right time.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment of testicular tumors first requires removing the testicle through a surgical procedure called <\/span><b style=\"user-select: auto;\">orchiectomy.<\/b><span style=\"font-weight: 400; user-select: auto;\"> This is one of the few tumors in which, even if the disease has spread to other organs, the original tumor must be removed. The reasons are that chemotherapy treatments get poorly to the testicle and that the examination of the tumor is very important to determine its characteristics and treatment. Surgery to remove the testicle should always be performed through the groin (groin line) and not through the skin of the scrotum (transscrotal), otherwise the chances of contamination of healthy tissue by tumor cells increase.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Once the testicle is removed, treatment is decided based on:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Tumor type (seminoma or nonseminoma): Treatment of seminomas and stage I and II nonseminoma tumors is different, but in stage III it is relatively similar;<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Of its extension (stage I, II or III); and<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Of its prognostic category (favorable, intermediate, or unfavorable).<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Although here the most common treatments are briefly discussed.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment according to the different stages<\/b><\/span><\/h3>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I:<\/b><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Patients with stage I testicular tumors are cured with proper treatment in nearly 100% of cases. As previously mentioned, these tumors only affect the testicle, so in theory their removal should be curative by itself. The problem is that in a small percentage of patients the disease can recur. To avoid this, in some cases complementary treatment can be administered with preventive intention (adjuvant treatment) that significantly reduces the risk of the disease returning. Adjuvant treatments (both chemotherapy and radiotherapy) involve risks and can generate sequelae. <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Seminoma:<\/i><\/b><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">80% of patients are cured after orchiectomy, but in 20% of cases, the disease may recur. Therefore, in patients with stage I seminoma, the alternatives are:<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">&#8211; Give chemotherapy with 1 or 2 cycles of a drug called carboplatin. This treatment is well tolerated and decreases the risk of relapse to 3-4%. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">&#8211; Do not administer any treatment and make careful observation of the patient. This avoids unnecessary treatments for patients who were not really going to have a relapse.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\"> &#8211; Treatment with retroperitoneal radiotherapy. These tumors are very radiosensitive and radiation therapy is effective in treating them. However, today this therapeutic option is less used by late toxicities.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Non-seminome:<\/i><\/b><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In nonseminoma tumors, 70% of patients are cured with surgery alone, but in the remaining 30% the tumor may recur. Nowadays we do not have factors that segregate us well which patients are going to relapse and which are not.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In principle, those patients whose tumor invades the blood vessels or lymphatic vessels of the testicle are more at risk of the disease returning. In this case it may be more justified to treat preventively with chemotherapy by administering two cycles with drugs called bleomycin, etoposide and cisplatin (BEP). However, with this strategy we would be overtreating a percentage of patients close to 50% who will never relapse after being operated.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Patients whose tumor does not invade the blood or lymphatic vessels have less risk of the disease coming back and tend to be less aggressive and generally tend to follow only carefully.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Another option is to monitor all patients and treat only those in whom the disease recurs to avoid unnecessary treatments, as discussed above.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Also in non-seminoma tumors, in case the disease reappears, whether complementary chemotherapy has been administered or not, the treatment is adapted to the advanced tumor scenario.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II:<\/b><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Patients with stage II have disease in the nodes of the retroperitoneum. Most of these patients are also cured with proper treatment.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Seminoma:<\/i><br style=\"user-select: auto;\" \/><\/b><span style=\"font-weight: 400; user-select: auto;\"> the usual treatment of these patients consists of chemotherapy with 3 cycles of BEP or four cycles of cisplatin and etoposide (EP), which achieve an equivalent result. In some patients, remnants of the lymph nodes in the retroperitoneum remain after these treatments that do not disappear completely. In this situation there are two options depending on the size of the residual mass (remains of the tumor). In those residual masses greater than 3 cm, a PET scan should be considered to confirm or deny if there is viable disease or it is only necrosis (dead cells) or fibrosis. In residual lesions smaller than 3 cm, no intervention is necessary and it is enough to follow the patient routinely.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Nonseminoma: <\/i> <\/b><\/span><\/span><\/span><br style=\"user-select: auto;\" \/>\n<p style=\"user-select: auto;\"><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\">In these patients, the most common treatment is to administer chemotherapy with 3 cycles of BEP. Also in these patients there may be remnants of the lymph nodes of the retroperitoneum that do not disappear completely. In these cases, any residual &gt; lesion 1 cm must be resected and analyzed by an intervention called <\/span><b style=\"user-select: auto;\">retroperitoneal lymphadenectomy<\/b>, <span style=\"font-weight: 400; user-select: auto;\">which can be carried out robotically, laparoscopically or openly. In this intervention, the lymph nodes of the entire retroperitoneal space are resected, that is, the nodes located around the great vessels of the body (presacral space, obturator space, iliacs, aorta, cava, and renal vessels). PET should not be used as a diagnostic method in this context except in very exceptional situations.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III: <\/b> In these patients, treatment is performed in a similar way in both nonseminoma tumors and seminomas. These patients should be classified according to the risk criteria they present and treated according to the risk group to which they belong.<\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Patients with a favorable prognosis: <\/i> <\/b><\/span><\/span><br style=\"user-select: auto;\" \/>\n<p style=\"user-select: auto;\"><b style=\"user-select: auto;\"><\/b> treatment consists of 3 cycles of <span style=\"font-weight: 400; user-select: auto;\">BEP or 4 cycles of PE. <\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Patients with intermediate or poor prognosis:<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> treatment consists of 4 cycles of BEP. In some patients, alternatives such as different chemotherapy regimens or high-dose chemotherapy with bone marrow progenitor support, are offered, occasionally in the context of clinical trials, with the aim of trying to improve treatment outcomes. <\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Monitoring and controls<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">After treatment for testicular cancer, regular check-ups are very important. <\/span> <b style=\"user-select: auto;\">Screening is more intense in stage I patients who are not given adjunctive therapy after surgery<\/b><span style=\"font-weight: 400; user-select: auto;\"> because their risk of recurrence is higher. In these patients, it is common for <\/span><b style=\"user-select: auto;\">check-ups to be performed every 2 months, or even every month, during the first and second year of diagnosis.<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">At check-ups, in addition to asking about symptoms and performing a physical examination, a determination of tumor markers of testicular tumors is usually performed. In addition, chest <\/span><b style=\"user-select: auto;\">x-ray, abdominal CT and testicle ultrasound <\/b> are usually performed periodically. <span style=\"font-weight: 400; user-select: auto;\">Depending on the extent of the disease to the diagnosis and the symptoms presented by the patient, other different tests may be added.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The frequency of reviews is often variable and their duration is a matter of debate.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The reality is that <\/span> the <b style=\"user-select: auto;\">greatest risk of the disease coming back occurs in the first 2 years after diagnosis.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> After 5 years [que hoy en d\u00eda se considera un punto de referencia muy com\u00fan en oncolog\u00eda] the risk of relapse is low.<\/span><\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_qi7k8rnlh\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Bladder cancer<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Bladder cancer is a much more frequent tumor than what statistics or the media sometimes transmit to us. It ranks <\/span><b style=\"user-select: auto;\">ninth in terms of the number of cancer diagnoses globally, and fifth in Europe.<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The average age at diagnosis is around <\/span><b style=\"user-select: auto;\">70 years<\/b><span style=\"font-weight: 400; user-select: auto;\">. Curiously, there are marked geographical differences, with tumors of the urinary tract being much more frequent in Western Europe (including Spain) and North America, than in Asia or Eastern Europe.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Most of these tumors are diagnosed in early stages of development and can be cured with more or less extensive surgeries. However, when the tumor is more advanced, cure can be more complicated and the goals of treatment change to prolong survival and improve the patient&#8217;s quality of life.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Risk factors<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The main known cause of bladder cancer is <\/span><b style=\"user-select: auto;\">tobacco<\/b><span style=\"font-weight: 400; user-select: auto;\">, which accounts for around 50% of all diagnosed cases. Tobacco doesn&#8217;t just affect our airway through smoke. And not only consumption, but environmental exposure to tobacco can also be considered as a risk factor. More than 60 carcinogenic products contained in cigarettes are absorbed and eliminated in the urine greatly affecting the cells of the wall of our urinary tract. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">There are other risk factors, but most of them are not common in our environment. These factors include <\/span><b style=\"user-select: auto;\">exposure to some industrial chemicals (certain metals, dyes, and gums);<\/b> <b style=\"user-select: auto;\">exposure to drugs such as cyclophosphamide<\/b>, <span style=\"font-weight: 400; user-select: auto;\">or <\/span><b style=\"user-select: auto;\">schistosomiasis<\/b><span style=\"font-weight: 400; user-select: auto;\">, an infection caused by a parasite that is usually found in Africa and certain regions of Latin America. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It has not been clearly shown that the presence of a family history of bladder cancer increases the risk of developing the disease in other members of the same family, although diagnosis in patients younger than 60 years should be considered with special care.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prevention<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The best way to prevent bladder cancer <\/span> is <b style=\"user-select: auto;\">to avoid tobacco use<\/b><span style=\"font-weight: 400; user-select: auto;\">, since as we have said it is <\/span> the <b style=\"user-select: auto;\">most important risk factor<\/b><span style=\"font-weight: 400; user-select: auto;\"> for developing the disease.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Healthy people are not routinely screened to diagnose bladder cancer early, because there is no evidence that this is actually beneficial.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Histological types<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Histologic types are the different kinds of tumors that can develop in an organ, determined based on the microscopic characteristics of the tumor.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In the case of bladder tumors, the main histological type is <\/span><b style=\"user-select: auto;\">urothelial carcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\">, whose cells derive from the mucosa that lines the bladder inside (transitional epithelium or urothelium). As in other organs, tumors derived from many other cells can occur, including <\/span><b style=\"user-select: auto;\">squamous cell carcinoma<\/b> (<span style=\"font-weight: 400; user-select: auto;\">which forms on flat cells that appear in the bladder when there is irritation of the bladder<\/span>), <b style=\"user-select: auto;\">adenocarcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\"> (tumors that form from glands), <\/span><b style=\"user-select: auto;\">small<\/b> <span style=\"font-weight: 400; user-select: auto;\">cell carcinomas and others even less frequent. In this document we will refer to urothelial tumors, as they are by far the most common.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Tumors derived from the upper urinary tract (ureter and renal pelvis) are also usually urothelial. They are very similar in their biological behavior to bladder cancer and their management, except for specific technical aspects, is very similar.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptomatology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The main symptom to suspect bladder cancer is the appearance of blood in the urine (<\/span><b style=\"user-select: auto;\">hematuria<\/b><span style=\"font-weight: 400; user-select: auto;\">) without associated pain during urination. The appearance of blood in the urine can be detected with the naked eye (gross hematuria) or in a urinalysis (microscopic hematuria). Although there are several non-tumor processes by which blood can appear in the urine, including urinary tract stones and urinary tract infections, hematuria is an important symptom for which you should always consult with a doctor.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Bladder tumors can also cause urinary discomfort as symptoms, including <\/span> needing to urinate <b style=\"user-select: auto;\">more frequently and in small amounts<\/b>, <b style=\"user-select: auto;\">pain or stinging when urinating<\/b><span style=\"font-weight: 400; user-select: auto;\">, or <\/span><b style=\"user-select: auto;\">the urge to urinate right after you finish<\/b> <span style=\"font-weight: 400; user-select: auto;\">; and all this without causing associated hematuria. These symptoms are very nonspecific, and may be present in other much more common and benign behavioral pathologies, such as benign prostatic hyperplasia, urinary tract infections or overactive bladder. <\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">When there are metastases in other organs, they can produce very varied symptoms, depending on their location. The most frequent sites where <\/span><b style=\"user-select: auto;\">bladder cancer metastases<\/b><span style=\"font-weight: 400; user-select: auto;\"> appear are the <\/span><b style=\"user-select: auto;\">bones<\/b> and <b style=\"user-select: auto;\">lung<\/b>, <span style=\"font-weight: 400; user-select: auto;\">although they can also appear in the <\/span><b style=\"user-select: auto;\">liver<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">brain<\/b><span style=\"font-weight: 400; user-select: auto;\"> and almost any organ.<\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When bladder cancer is suspected, in addition to asking about symptoms and exploring the patient, certain complementary tests should be performed to confirm it and to determine the tumor subtype and stage of the disease.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">General blood tests:<\/b> it is <span style=\"font-weight: 400; user-select: auto;\"> especially important to monitor kidney function, because in patients with bladder cancer it is often altered. Kidney function is determined with a laboratory test called creatinine and glomerular filtration rate. In addition, hematuria can generate anemia or other alterations that will also be visible in this exam. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Serial urine cytology:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The presence of malignant urothelial cells in the urine detected by cytology confirms the diagnosis. However, urine cytology is not very sensitive, and there are usually patients with bladder cancer without notable alterations in their urine analysis, especially in those patients who are diagnosed with low-grade tumors. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Abdominal and urinary tract ultrasound (reno-vesico-prostatic ultrasound):<\/b><span style=\"font-weight: 400; user-select: auto;\"> allows to observe in detail the kidneys, ureters and bladder whenever they are full of urine. It is a non-invasive and harmless test for the patient that in many cases is able to detect bladder tumors, and evaluate their scope on the urinary tract or the rest of abdominal organs.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Cystoscopy: Cystoscopy<\/b> is the &#8220;<span style=\"font-weight: 400; user-select: auto;\">gold standard&#8221; method for the diagnosis and local staging of bladder cancer. It consists of introducing into the bladder through the urethra a flexible tube equipped with a small video camera. This allows us to observe the inside of the bladder, and even some interventions can be performed, such as removing polyps, taking biopsies, etc. It can be performed in an outpatient operating room, without the need for general anesthesia.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Computed tomography (CT) scan of the chest and\/or magnetic resonance imaging (MRI) of the abdomen and pelvis:<\/b><span style=\"font-weight: 400; user-select: auto;\"> usually done especially if the tumor is suspected to have advanced to deeper layers of the bladder. These studies can determine the tumor stage.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In addition, they can be performed in some cases:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">CT or brain MRI:<\/b><span style=\"font-weight: 400; user-select: auto;\"> if brain metastases are suspected.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Bone scan:<\/b><span style=\"font-weight: 400; user-select: auto;\"> if bone metastases may exist.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">As a diagnostic and treatment technique, it is performed in all cases, with exceptions:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Transurethral bladder tumor resection (TUR):<\/b><span style=\"font-weight: 400; user-select: auto;\"> consists of an operation to be able to observe the inside of the bladder and perform resections in more depth, and thus staging to which layer the tumor has reached. It is an intervention that requires anesthesia, but it is also carried out through the urethra and involves minimal aggression for the patient.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In general, all tumors are classified into several stages (depending on parameters such as their size, affected organs, distant spread, etc.) that will have a different evolution and require different treatments. In the case of bladder cancer, the most commonly used classification is the TNM system, which assesses the extent of the tumor itself (T, primary tumor), lymph nodes (N) and the presence of metastases (M). <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In a simple way, the following stages are distinguished:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Non-muscle-invasive bladder tumor (NSVT) or &#8220;superficial&#8221;<\/b><span style=\"font-weight: 400; user-select: auto;\"> : these are tumors that do not invade the outer layer of the bladder (muscle layer), although they can invade the inner layers of the bladder (mucosa or submucosa). <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Musculo-invasive bladder tumor (MIVT) or &#8220;infiltrating&#8221;:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor invades the bladder muscle. This fact implies a greater possibility of spreading to other parts of the body, producing metastasis.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Locally advanced<\/b> bladder tumor: The tumor invades the <span style=\"font-weight: 400; user-select: auto;\"> tissue surrounding the bladder or invades neighboring organs such as the prostate, uterus, or vagina.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Metastatic bladder tumor:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor is spread affecting the lymph nodes or has distant metastases in other organs of the body.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The stage of each case marks in a very significant way the expected evolution of each patient. However, not all patients with the same stage evolve in the same way and, in the particular course of each case, other prognostic factors, treatments received, patient characteristics, etc. will also be very relevant.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prognosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The prognostic factors are characteristics of the tumor and the patient that allow to estimate a priori its subsequent evolution, complementing the stage marked by the TNM system.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In early-stage tumors, an important prognostic factor is tumor <\/span><b style=\"user-select: auto;\">grade<\/b><span style=\"font-weight: 400; user-select: auto;\">. A tumor is said to be low-grade when, viewed under a microscope, it closely resembles the tissue from which it originated (in this case, the normal tissue lining the bladder or urothelium); And a higher degree when your cells are so damaged and unstructured that they look almost nothing like the original tissue. Currently, urothelial tumors are divided only between high or low grade. High-grade tumors are more aggressive and have a higher risk of coming back after treatment.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Nor do all patients with tumors in advanced stages have the same evolution. Patients who, when diagnosed, have poorer general condition, anaemia, low blood albumin values and\/or visceral distant metastases (especially in the liver) are known to have a worse prognosis and shorter survival can be expected. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The treatment of bladder tumors is done depending on the stage they present.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Non-muscle-invasive (NSVT) or &#8220;superficial&#8221; bladder tumor:<\/b> <\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Patients with &#8220;superficial&#8221; bladder tumors are cured with appropriate treatment in most cases, although they are at high risk of coming back. Depending on the grade of the tumor and the presence of other factors, treatment may consist only of removing the tumor by cystoscopy or transurethral resection or, in other cases, and administering complementary treatment with immunotherapy or chemotherapy directly into the bladder, through a urinary catheter, through one or more instillations. These intravesical treatments reduce the risk of tumor recurrence and tumor progression from &#8220;superficial&#8221; to infiltrating<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Musculo-invasive bladder tumor (MIVT) or &#8220;infiltrating&#8221;<\/b><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The main problem of these patients is that they have a relatively high risk of the disease producing distant metastases, and therefore, that this affects their survival. There are several treatment options:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radical cystectomy<\/i><\/b><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">:<\/i><br style=\"user-select: auto;\" \/><\/b><span style=\"font-weight: 400; user-select: auto;\"> involves removing the bladder, organs and nearby lymph nodes. It is the most common treatment. It can be performed open, laparoscopic or robotic. Its biggest drawback is that, when removing the bladder, it is not possible to urinate normally. The most frequently used solutions to reconstruct the urinary tract are:<\/span><\/span><\/li>\n<\/ul>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Perform a ureteroileostomy or Bricker:<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> It consists of diverting the ureters to a fragment of small intestine (ileum), which will flow into the skin, forming an ostomy. A plastic bag is fixed to this hole (ostomy) by means of an adhesive ring to collect urine and the bag is emptied periodically.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Perform a neobladder: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">with tissue from the patient&#8217;s own small intestine (ileum) a bag is made to which the ureters are connected. The urine reaches this neobladder located inside the abdomen and can exit to the outside through the patient&#8217;s own urethra that is reconnected to the neobladder. It is not always possible to perform this last technique and in some cases it is associated with complications. <\/span> <\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In recent years, minimally invasive techniques for the treatment of infiltrating bladder tumor have been standardized. Robotic cystectomy has been shown to present fewer complications in the postoperative period, with less intraoperative bleeding, less transfusion rate, and lower rate of paralytic ileus. Cystectomy with Da Vinci robot, in turn, has allowed a prompt recovery of the patient, allowing a decrease in days of hospital admission, given that postoperative complications are minor, maintaining quality oncological results. These techniques require extensive surgical experience in this area. Therefore, less surgical aggressiveness with robotic surgery, and an expert team, give the best results.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Conservative bladder preservation treatment: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">It consists of removing the tumor avoiding removing the bladder, to increase the comfort of the patient. These techniques can only be performed in some patients very selected both by the situation of the disease, and by the situation of the patient himself, and must be carried out by teams with experience and good coordination. When they are performed, a very complete follow-up of the patient must be carried out, to identify possible recurrences of the tumor. There are several alternatives:<\/span><\/span><\/li>\n<\/ul>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemoradiotherapy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">Bladder tumors are sensitive to radiation therapy and in some cases can be eliminated with this treatment, which is usually administered simultaneously with chemotherapy.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Transurethral resection: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">in rare cases, when tumor invasion is not too deep, it may be an alternative, but it is not standard management.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"2\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Trimodal therapy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">It is the most recommended option in the case of opting for bladder preservation. It consists of carrying out a wide TUR that allows to eliminate any tumor remains, and then carrying out the treatment with concomitant chemo-radiotherapy.<\/span><\/span><\/li>\n<\/ol>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Complementary treatment: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">as mentioned, one of the main problems of these tumors is that they can reappear, either in the initial area (local recurrence) or in other parts of the body (metastasis). This occurs because despite initial treatment, microscopic disease may persist, which we cannot detect in the tests performed at diagnosis. To try to decrease the risk of the tumor coming back, complementary treatment with chemotherapy may be given. Complementary treatment is not always administered, it depends on the stage of the disease and the characteristics of the patient. The treatment can be done in two ways:<\/span><\/span><\/li>\n<\/ul>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Adjuvant or adjuvant therapy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">The administration of chemotherapy after the tumor is removed. Its ability to decrease the risk of the disease coming back is not absolute, but there is data to support its use. There are also some clinical trials underway to try to increase our knowledge on this topic about the use of systemic immunotherapy with immune checkpoint inhibitors.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Neoadjuvant or neoadjuvant therapy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">The administration of chemotherapy before removing the tumor. The results of some clinical trials indicate that it decreases the risk of the disease recurrence and impacts the survival and long-term evolution of these patients. Its main disadvantage is that it delays the operation. The use of systemic immunotherapy as a neoadjuvant treatment for these patients is obtaining promising results.<\/span><\/span><\/li>\n<\/ol>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Locally advanced bladder tumor<\/b><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment is similar, but is usually more aggressive and usually consists <\/span> of <b style=\"user-select: auto;\">radical cystectomy, radiation therapy, or chemoradiotherapy<\/b><span style=\"font-weight: 400; user-select: auto;\">. Other less aggressive techniques, such as transurethral resection or partial cystectomy, are not usually used. Complementary treatment with chemotherapy or immunotherapy should also be applied in most cases.<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Metastatic bladder tumor<\/b><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The goal of treatment is to control or delay the onset of symptoms and increase patient survival. Treatment with surgery, in addition to being more complicated, does not cure the disease, so it is not usually done except with a palliative intention in very selected cases. Treatment options include:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy:<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> Traditionally it has been the most frequently used treatment in this phase of the disease although the arrival of new alternatives for these patients is assuming a great change in the clinical management guidelines of these patients. The most active and therefore desirable combinations of chemotherapy drugs are those that contain <\/span><b style=\"user-select: auto;\">cisplatin<\/b><span style=\"font-weight: 400; user-select: auto;\">. In general, it is usually administered together with <\/span><b style=\"user-select: auto;\">gemcitabine<\/b><span style=\"font-weight: 400; user-select: auto;\">, but is also used in combination with methotrexate, vinblastine and adriamycin, or with gemcitabine plus paclitaxel. However, not all patients are good candidates (&#8220;fit&#8221;) for treatment with cisplatin. <\/span><b style=\"user-select: auto;\">Patients with some degree of renal failure, poor functional status, hearing loss, persistent nerve damage to peripheral nerves and\/or heart failure are considered unfit<\/b><span style=\"font-weight: 400; user-select: auto;\"> (&#8220;unfit&#8221;) to be treated with cisplatin. In these cases the chemotherapeutic agents traditionally used have been combinations with carboplatin; although at the present time the use of immunotherapy should be considered if the biological profile of the disease allows it. Vinflunine or paclitaxel are chemotherapy drugs used so far in the second line, and could continue to be an alternative for these patients to consider at some point in the sequence of treatments. However, several studies have shown that systemic immunotherapy with check-point inhibitors is superior to these chemotherapy agents in patients whose first-line treatment with cisplatin has failed.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Immunotherapy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">The arrival of immuno-oncology is already a reality and the use of immune system check-point inhibitors has changed the treatment of bladder cancer. The basis of these treatments is to infuse the patient with drugs that modulate the response of their own immune system against the tumor, so that our own defenses are able to eliminate malignant cells. Five different drugs in this family (<\/span><b style=\"user-select: auto;\">pembrolizumab, atezolizumab, nivolumab, durvalumab and avelumab<\/b><span style=\"font-weight: 400; user-select: auto;\">) have already proven to be active, and in many cases superior to classical chemotherapy, for those patients with tumors previously treated with platinum, i.e. in the second-line treatment setting. Also in previously untreated patients, not candidates for cisplatin, and whose tumors express significantly elevated the protein &#8220;PD-L1&#8221;, the use of immune system check-point inhibitors has proven to be the most appropriate treatment option. Recently, very promising results have been reported from the combination of chemotherapy together with atezolizumab in the first line of treatment, so it is possible that in the near future it could be considered as a reality for patients.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Targeted therapy:<\/i><br style=\"user-select: auto;\" \/><\/b><span style=\"font-weight: 400; user-select: auto;\"> Urothelial tumors are neoplasms that often harbor multiple underlying genetic alterations. The knowledge of these has allowed us to generate a molecular classification of different subtypes of bladder cancer. On the other hand, these advances have allowed the development of drugs that inhibit specific genetic alterations (such as erdafatinib in the case of mutations in the FGFR gene; or other drugs related to the PTEN or MTOR pathway) whose results in bladder cancer are proving very positive and can probably be used in the short term for the treatment of these patients.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Immunoconjugates:<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> These are compounds that bind a chemotherapy agent to an antibody specifically directed against a specific tumor target. In this way, chemotherapy against neoplasia is carried out, increasing its activity and avoiding its toxicity by not acting on healthy tissues. Enfortumab-Vedotin is a clear example of a very effective immunoconjugate in bladder cancer, so it is possible that it will be incorporated in the not too distant future to the treatment alternatives currently in force for urothelial cancer.<\/span><\/span><\/li>\n<\/ul>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy:<\/i><br style=\"user-select: auto;\" \/><\/b><span style=\"font-weight: 400; user-select: auto;\"> it can be used palliatively to treat some symptoms of difficult control such as pain, significant bleeding from the urine, etc &#8230;<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Tracking<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">After treatment of bladder cancer it is very important to have regular check-ups. Examinations in patients in whom the bladder is not removed, usually include <\/span><b style=\"user-select: auto;\">cystoscopy <\/b><span style=\"font-weight: 400; user-select: auto;\">and<\/span><b style=\"user-select: auto;\"> serial urine cytology<\/b><span style=\"font-weight: 400; user-select: auto;\"> to detect possible relapses in the bladder itself as soon as possible.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In the revisions, in addition to the collection of symptoms and physical examination, an imaging test is usually performed periodically including <\/span> chest <b style=\"user-select: auto;\">x-ray<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">abdominal and chest CT<\/b><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><b style=\"user-select: auto;\">ultrasound of the abdomen and urinary tract.<\/b><span style=\"font-weight: 400; user-select: auto;\">. Depending on the extent of the disease at the time of diagnosis and the patient&#8217;s symptoms, different tests may be added. <\/span><\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_02d7z11z81\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prostate cancer<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Prostate cancer is a disease that develops mainly in older men. It is usually asymptomatic except in advanced stages of the disease. <\/span><\/p>\n<p style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prostate cancer is the most common cancer among men.<\/b><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Risk factors<\/b><\/span><\/h3>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Age: Age<\/b><span style=\"font-weight: 400; user-select: auto;\"> is the <\/span><b style=\"user-select: auto;\">main risk factor<\/b><span style=\"font-weight: 400; user-select: auto;\"> for prostate cancer. The risk of developing prostate cancer begins to increase at <\/span> age <b style=\"user-select: auto;\">50 in white men and after age 40 in black men or men with a family history (father or brother) of prostate cancer<\/b><span style=\"font-weight: 400; user-select: auto;\">. Nearly two out of three cases of prostate cancer are detected in men over the age of 65.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Race: Prostate<\/b><span style=\"font-weight: 400; user-select: auto;\"> cancer is more common in black men <\/span><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\"> than in men of other races. In addition, black men are more likely to be diagnosed at an advanced stage, and are more than twice as likely to die from prostate cancer compared to white men. On the other hand, the lowest rate of prostate cancer is seen in Asian individuals.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Family history:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The risk of prostate cancer is strongly influenced by family history. Those men who have a first-degree relative (father or brother) diagnosed with prostate cancer are more likely to develop the disease. Only 5-10% of prostate cancers have a hereditary component. In hereditary prostate cancer the age of cancer onset is earlier (before 55 years) and often patients have first-degree relatives affected by prostate cancer. Genes involved in increased susceptibility to the development of prostate cancer have been discovered.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diet: Recent<\/b><span style=\"font-weight: 400; user-select: auto;\"> studies suggest that high consumption of animal fats may increase the risk of prostate cancer. <\/span> <\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prevention<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Several factors that can prevent the onset of prostate cancer have been studied. None of them, whether dietary supplements, drugs, physical or sexual activity, can currently be recommended as a proven factor in the prevention of prostate cancer. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptoms<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In the early stages, when the tumor is limited to the prostate, it may be <\/span><b style=\"user-select: auto;\">asymptomatic<\/b><span style=\"font-weight: 400; user-select: auto;\"> or be accompanied by <\/span><b style=\"user-select: auto;\">mild obstructive symptoms<\/b><span style=\"font-weight: 400; user-select: auto;\"> attributable to benign hyperplasia (decrease in caliber or interruption of the urine stream; increased frequency of urination, especially at night; difficulty urinating or stinging during urination), since prostate cancer and benign prostatic hypertrophy can coexist.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">When tumors are locally advanced they are accompanied by clear obstructive symptoms, in addition there may be <\/span><b style=\"user-select: auto;\">hematuria<\/b> (<span style=\"font-weight: 400; user-select: auto;\">blood in the urine) or <\/span><b style=\"user-select: auto;\">signs of infection<\/b><span style=\"font-weight: 400; user-select: auto;\"> (the latter two are rare).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">When it comes to advanced tumors<\/span>, edema or swelling of the legs may appear (due to the <span style=\"font-weight: 400; user-select: auto;\">growth of regional lymph nodes), <\/span> bone <b style=\"user-select: auto;\">pain<\/b> (due to <span style=\"font-weight: 400; user-select: auto;\"> tumor extension to the bone) and even <\/span><b style=\"user-select: auto;\">weakness or loss of strength in the legs<\/b><span style=\"font-weight: 400; user-select: auto;\"> (compression of the spinal cord).<\/span><b style=\"user-select: auto;\"> <\/b><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Physical examination and complementary tests are used for diagnosis.<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Digital rectal exam:<\/b><span style=\"font-weight: 400; user-select: auto;\"> It involves an examination of the rectum in which the doctor inserts a finger into a lubricated glove in the rectum and feels the prostate through the rectal wall for abnormal nodules or areas. The prostate gland is located immediately in front of the rectum, and most cancers begin in the back of the gland, which can be felt during an exam of the rectum. This test is uncomfortable, but it is not painful and takes very little time to perform.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Determination of blood PSA levels (total PSA and PSA ratio):<\/b><span style=\"font-weight: 400; user-select: auto;\"> A laboratory test that measures the levels of this marker (Prostate-Specific Protein) in the blood. It is a substance produced specifically by the prostate that can be found in greater amounts in the blood of men who have prostate cancer. However, it should be borne in mind that PSA levels can also be elevated in an infection or inflammation of the prostate such as benign prostatic hyperplasia (enlargement of the prostate of non-cancerous origin). PSA screening, although it has been a controversial topic in the urological scientific world, has shown a benefit by increasing diagnosed cases, decreasing deaths attributed to undiagnosed patients. Patients with PSA 10 ng \/ ml have 70-80% probability that the disease is localized, if PSA levels range between 10-50 ng \/ ml 50% will be localized, if the PSA &lt; is &gt; 50 ng \/ ml only 25% will be localized. <\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Nuclear magnetic resonance imaging (MRI):<\/b><span style=\"font-weight: 400; user-select: auto;\"> A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. Due to the latest advances in the PIRADS classification, it has become a fundamental test, useful for diagnosis and necessary for performing prostate biopsies by fusion of images. On the other hand, it is useful in evaluating the extent of the tumor within the pelvis.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prostatic biopsy<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is usually performed guided by transrectal ultrasound. When cancer is suspected, a small amount of prostate tissue needs to be removed for examination under a microscope. This test will confirm the diagnosis of cancer and will give us an idea of the tumor volume and the degree of aggressiveness (Gleason score).<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Gleason 6:<\/b><span style=\"font-weight: 400; user-select: auto;\"> Low-grade tumors<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Gleason 7:<\/b><span style=\"font-weight: 400; user-select: auto;\"> Intermediate-grade tumors<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Gleason 8-10:<\/b><span style=\"font-weight: 400; user-select: auto;\"> undifferentiated tumors<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Image fusion prostate biopsy<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Fusion biopsy is a technique that allows to merge in real time the images of the prostate MRI with the transrectal ultrasound, which allows to locate exactly the suspicious nodular area within the prostate and, therefore, better precision in the diagnosis of prostate cancer, by allowing the exact puncture of said suspicious area.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Without treatment, prostate cancer survival depends on age at diagnosis, overall health, tumor grade, and stage at diagnosis.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Among untreated patients with localized prostate cancer, those with a low Gleason score (6) have a very low risk of dying from their cancer in the next 15 years (4-7%) regardless of the patient&#8217;s age at diagnosis; however, those who have an undifferentiated tumor with Gleason 8-10, have a higher chance of dying from their cancer compared to other causes, even if the diagnosis is at advanced ages.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The process used to define whether cancer has spread within the prostate or to other parts of the body is called <\/span><b style=\"user-select: auto;\">staging<\/b><span style=\"font-weight: 400; user-select: auto;\">. It is important to know the stage or stage of the disease in order to plan treatment. To rule out bone involvement, bone scintigraphy is performed, and to rule out visceral or adenopathic involvement, axial tomography (CT) is used. <\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Predictive models<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">They use PSA, Gleason score, and stage T to predict the likelihood that the patient will be disease-free after local treatment, so patients can be included in 3 prognostic groups:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Low risk:<\/b><span style=\"font-weight: 400; user-select: auto;\"> T1-T2a, Gleason 6 and PSA &lt; 10 ng\/ml. More than 85% of patients are disease-free within 5 years of treatment with surgery or radiation therapy.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Intermediate risk:<\/b><span style=\"font-weight: 400; user-select: auto;\"> T2b and\/or Gleason 7 and\/or PSA 10-20. 50-70% will be free after 5 years.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">High risk:<\/b><span style=\"font-weight: 400; user-select: auto;\"> T3 or higher or Gleason 8-10 or PSA &gt; 20. Only 33% will remain disease-free after local treatment.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are three strategies considered standard for the management of localized prostate cancer:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Surgery<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Radiation therapy with\/without hormone therapy<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Active surveillance<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The choice of treatment depends on several factors:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The likelihood that the tumor is limited to the prostate gland and therefore potentially curable.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The tumor size and histologic grade (degree of aggressiveness of the tumor).<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Age of the patient and general condition, as well as associated diseases.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Potential side effects of different forms of treatment.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pre-treatment evaluation<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Before choosing the best therapeutic option, it is essential that the extent of the disease is correctly evaluated. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The most important factors to predict the evolution of the disease before treatment are the stage, the level of PSA in the blood, the tumor volume (number of positive biopsies and percentage of the material obtained in the biopsy that is affected by the tumor) and the degree of aggressiveness of the tumor, referred to as the Gleason score.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery: radical prostatectomy (PR)<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">It consists of completely removing the prostate gland and seminal vesicles. There are 3 ways to do it: <\/span><b style=\"user-select: auto;\">openly, laparoscopically or robotically.<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">DaVinci Robot Prostatectomy is the least invasive and most accurate technique that exists for prostate removal. In this surgery, trocars are introduced into the patient&#8217;s abdomen, in which the robotic arms are attached, which the surgeon controls from an integrated external console., The fact that the Da Vinci Robot allows a real three-dimensional vision, associated with the fact that the arms allow all degrees of movement within the patient&#8217;s abdomen, are the main advantages of this technique, compared to the open and laparoscopic technique. Robotic Prostatectomy, thanks to these advantages, allows a better immediate postoperative period, as well as a decrease in the rate of urinary incontinence and erectile dysfunction. The fact that it is such a precise procedure allows to preserve the urinary sphincter in an integral way, which significantly decreases the rates of urinary incontinence, as well as to preserve the neurovascular bands, which will cause less impact during the postoperative period in terms of erectile dysfunction or impotence.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In turn, it allows extended lymphadenectomies, that is, removal of lymph nodes, in those cases that are required.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">3D Laparoscopic Prostatectomy is a minimally invasive technique that has evolved in recent years. In the same way as in robotic prostatectomy, it allows an excision of the entire gland, although the ability to preserve the structures involved in urinary continence and erectile function is not as precise.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Both techniques allow a good control of the oncological disease.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Currently open radical prostatectomy is in disuse, due to its comorbidities.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiation therapy (RT)<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Two forms of RT are used to treat prostate cancer:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">External radiation therapy<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Brachytherapy or RT interstitial implantation<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">External radiation therapy:<\/i><br style=\"user-select: auto;\" \/><\/b><span style=\"font-weight: 400; user-select: auto;\"> Uses a machine called a linear accelerator that moves around the patient by directing radiation to the pelvis. It is given daily (5 days a week) for 4 to 7 weeks (depending on whether it is used alone or in combination with brachytherapy). It does not require hospitalization. <\/span> <\/span><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Complications of RT: <\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">they are a consequence of the small amount of radiation received by healthy tissues near the tumor (bladder and rectum, especially); with new technological advances they have been minimized more and more. The most frequent are:<\/span><\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Increased voiding frequency and feeling of voiding urgency <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Painful urination <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Impotence, in this case more frequent as time passes since the RT. <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Intestinal problems (diarrhea, pain and bleeding, the last two secondary to inflammation produced in the rectum called proctitis)<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In order to reduce the side effects of classical external radiotherapy, irradiation techniques have been improved and there are now new ways of delivering radiation that are not available in all centers:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Conformal or three-dimensional RT (3D-RTC): <\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">has become standard treatment after the publication of numerous clinical studies. It allows to administer higher doses in the prostate, respecting the tissues that are around, therefore, decreases the rate of side effects, especially intestinal problems.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Intensity-modulated RT (IMRT): a<\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">llows the RT dose and intensity to be varied (scaled) during therapy. It reduces side effects and facilitates treatment when pelvic lymph nodes need to be included in the field. It allows to administer very high doses (81 Gy) with little intestinal toxicity. This technique is not available in all centers due to its high cost.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Brachytherapy or RT of interstitial implantation: <\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">consists of administering a radioactive source inside the prostate guided by ultrasound. Advantages: it is done in a short time and requires little hospital stay. The published series seem to indicate that it is a good treatment only for patients with low-risk tumors. <\/span> <\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Complications of brachytherapy:<\/span><br style=\"user-select: auto;\" \/><\/i><span style=\"font-weight: 400; user-select: auto;\"> causes an acute urinary syndrome (of short duration) caused by inflammation of the prostate, which can even cause acute retention of urine. It causes less incontinence than external RT, fewer problems at the level of the rectum. The risk of impotence is similar to that of the other treatments.<\/span><\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Image-guided radiation therapy (IGRT): <\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">also allows the administration of higher doses of external radiotherapy (even up to 90Gy) through the use of advanced imaging techniques such as magnetic resonance imaging with spectroscopy.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Active surveillance<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is a valid option in certain cases such as patients presenting with small tumors, with low Gleason, slow rise in PSA levels, and MRI images that do not demonstrate progression. Therefore, it is indicated in those patients who have low-risk tumors<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is not a suitable option for patients with intermediate-risk or high-risk tumors, i.e. patients with large, high-Gleason tumors, in whom tumor growth is rapid and therefore have a high probability of dying from their prostate cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The active surveillance protocol allows to have controlled those patients who have a low-risk prostate cancer, During the follow-up, serial PSA controls are performed, usually every 4-6 months, as well as serial prostate MRIs, usually annual, and prostatic biopsies also serial, annual or biannual, to rule out the progression of the disease. In the event that the disease progresses, active treatment will be carried out.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Approximately 50% of patients who are under observation go on to receive treatment within the first three years either for progression or for the anxiety of remaining untreated.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Hormone treatment: androgen suppression<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The prostate is an organ dependent on the level of male hormones, called androgens (the most important of the androgens is testosterone). <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Androgenic suppression or deprivation consists of applying treatments that manage to reduce testosterone levels in the body as much as possible, with this it has been observed that the size of both the normal prostate and the tumor prostate decreases.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Studies have shown that adding hormone therapy before or after local therapy (RT) improves outcomes in intermediate- and high-risk patients, but not in low-risk patients.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The duration of treatment is controversial, treatment is usually started 1 or 2 months earlier and extended up to 6 months (intermediate-risk cases) or up to 2 years (high risk) with the data available to date.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Side effects of androgen suppression treatment are: decreased sex drive, impotence, hot flashes, growth of breast tissue that may be painful, muscle weakness, loss of bone mass with increased risk of fractures, anemia, and an increased risk of developing diabetes or coronary heart disease. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Cryotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is a local treatment that achieves destruction of tumor cells by applying freezing to the prostate gland. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is applied under local anesthesia in the operating room and although the results are promising, there are no long-term data available, therefore, it cannot be recommended as standard treatment in localized prostate cancer such as surgery or RT. It may be useful in case of recurrence of the tumor after RT or previous surgery.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Focal therapies <\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Among the alternative treatments that can be applied to patients with low-risk prostate cancer are treatments known as focal therapies. These treatments can be mainly HIFU, although there are also treatments such as photodynamic therapy, electroporation, focal cryotherapy.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Fundamentally, HIFU (High Frequency Ultrasound), allows, after locating the area to be treated based on magnetic resonance imaging and fusion prostate biopsy, to perform a focal treatment, only in the area affected by the tumor. These therapies are currently considered in the research phase, although there is a certain profile of patients who could benefit from it.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Advanced prostate cancer<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Approximately 15-20% of patients with prostate cancer present at the time of diagnosis at an advanced stage, that is, the tumor has spread beyond the gland invading neighboring organs by continuity (locally advanced prostate cancer corresponding to tumors T3, T4 of the TNM classification) or affects the regional lymph nodes (stages III) and even invades other organs at a distance (metastatic prostate cancer or stage IV).<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">On the other hand, patients who in an initial phase present localized tumors, may present recurrence or relapse of their disease, then also being an advanced disease. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment of locally advanced prostate cancer (T3, T4)<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Recommended treatment options include:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">External RT with or without brachytherapy<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Transurethral resection (TUR) of the prostate<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Radical prostatectomy<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Hormone therapy based on androgen suppression: usually in combination with surgery and RT.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery <\/i><\/b><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radical prostatectomy (RP):<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> As we have said before, it consists of completely removing the prostate gland. They are performed within a modality called &#8220;multimodal treatment&#8221;. Since the disease is not only located within the prostate, it is proposed to perform after surgery, treatment with RT, or combination of RT plus HT, depending on the characteristics of the tumor after removing the prostate. This allows us to decrease the local recurrence rate. Radical robotic prostatectomy can also be performed in patients with locally advanced prostate cancer<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy<\/i><\/b><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">External RT:<\/i><\/b><\/span><\/span>\u00a0<span style=\"font-weight: 400; user-select: auto;\">Another alternative is considered in patients with locally advanced tumors who are treated with external RT in combination with androgen suppression therapy. As for the optimal duration of hormonal treatment there is controversy: it should be started two months before RT and the duration ranges from 6 months to 2-3 years.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">External RT + brachytherapy:<\/i><\/b><\/span><\/span>\u00a0<span style=\"font-weight: 400; user-select: auto;\">as we have seen before, brachytherapy consists of administering a radioactive source into the prostate guided by ultrasound. Its usefulness in locally advanced tumors is in combination with external RT. This option has a duration of 4-5 weeks compared to 8 for external RT but is not recommended in case of very pronounced urinary symptoms.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Androgenic suppression<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">As we have said before, androgen suppression consists of applying treatments that reduce testosterone levels in the body, with this it has been observed that the size of both the normal prostate and the tumor prostate decreases. It is also a treatment that acts against tumor cells that have left the prostate producing metastasis.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Testosterone levels can be reduced to the maximum in several ways:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Through a surgery called <\/span><b style=\"user-select: auto;\">orchiectomy<\/b><span style=\"font-weight: 400; user-select: auto;\"> that involves removing the testicles (where the largest source of androgens in the body is).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Through <\/span><b style=\"user-select: auto;\">drugs<\/b> that <span style=\"font-weight: 400; user-select: auto;\"> act on the hormone that regulates the amount of androgens produced by the testicles. The most used are: <\/span><b style=\"user-select: auto;\">goserelin, leuprorelin, triptorelin, buserelin<\/b><span style=\"font-weight: 400; user-select: auto;\">. All of them are administered by injection.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Through drugs called <\/span><b style=\"user-select: auto;\">antiandrogens<\/b><span style=\"font-weight: 400; user-select: auto;\">: they act on androgen receptors. The most commonly used <\/span> are <b style=\"user-select: auto;\">flutamide<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">bicalutamide<\/b><span style=\"font-weight: 400; user-select: auto;\">, which are orally administered drugs. These drugs alone do not sufficiently lower testosterone levels and in general, should be used in combination with the above.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In patients with locally advanced prostate cancer, androgen deprivation is rarely used as the only strategy, since it does not obtain the same results as surgery or RT in terms of local tumor control.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Side effects of hormone treatment: <\/span><\/i><span style=\"font-weight: 400; user-select: auto;\">decreased sex drive, impotence, hot flashes, breast tissue growth that may be painful, muscle weakness, bone loss with increased risk of fractures, and an increased risk of developing diabetes or coronary heart disease.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatments of patients with PSA elevation after local therapy<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When in the follow-up of patients treated for localized and early prostate cancer a sustained elevation of PSA levels in the blood is detected in the absence of symptoms, often with the available diagnostic methods we cannot detect metastases. So we talk about biochemical recurrence. In these cases it is essential to stage well the situation of the tumor, with complementary explorations such as abdominal CT, bone scintigraphy, PET-choline or PET-PSMA, This situation represents a category of advanced prostate cancer in which we must take into account certain considerations:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Some of these patients may still be curable<\/b><span style=\"font-weight: 400; user-select: auto;\"> with additional local therapy.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The average time it takes for the tumor to show signs of disseminated disease (such as <\/span><b style=\"user-select: auto;\">bone metastases<\/b><span style=\"font-weight: 400; user-select: auto;\">) is up to <\/span><b style=\"user-select: auto;\">eight years<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">sometimes there is never symptomatic progression<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">However, many patients, although asymptomatic, have high levels of anxiety when they see PSA levels increase progressively.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The best treatment in this situation depends on several factors:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In patients who have been previously treated with RT<\/span>, <b style=\"user-select: auto;\">rescue prostatectomy<\/b> may be considered <span style=\"font-weight: 400; user-select: auto;\"> if the relapse is limited to the prostate and tumor growth is not rapid. The time it takes for PSA levels to multiply x 2 is called the PSA bending time and gives us an idea of tumor growth. Well, when this bending time is less than 3 months, we must consider other options other than surgery.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Patients initially treated with radical surgery can be successfully rescued with <\/span><b style=\"user-select: auto;\">RT<\/b><span style=\"font-weight: 400; user-select: auto;\">. However, local treatment is not recommended in most cases due to the high probability that the tumor has spread beyond the prostate, although we cannot detect it with the available diagnostic methods. In this sense, PET-choline can be useful in an attempt to locate the focus of recurrence.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For patients not candidates for surgery or RT we have two options: hormone therapy (based on androgen deprivation) or observation.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When to start hormone treatment in biochemical recurrence without symptoms?<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The reasons in favor of starting early treatment in the absence of symptoms would be:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Slow the progression of the disease and decrease the rate of complications such as urinary obstruction and painful metastases.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There could be a survival benefit, particularly in patients with minimal disease. Not demonstrated in studies to date.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Many patients do not agree to defer treatment while PSA levels continue to rise with each determination.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The reasons in favor of waiting and starting treatment when there are signs of the disease are:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Undesirable side effects that clearly reduce the quality of life of the patient and their family environment.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The high cost of treatment.<\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The patient should be informed of the benefit \/ risk of both options and participate with his specialist in the decision to be made, and ideally, after presenting his case in a uro-oncology committee with experts in prostate cancer, both urologists, medical oncologists and radiation oncologists.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Metastatic prostate cancer<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">First-line treatment<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A portion of patients with prostate cancer relapse into advanced disease after local treatment (radiotherapy or radical prostatectomy) and, on the other hand, there is a minority of patients who have disseminated or widespread disease since diagnosis.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When the cancer has spread beyond the prostate gland, androgen suppression is the usually recommended treatment strategy.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are several options available to reduce or eliminate androgen levels:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Orchiectomy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">Surgery that involves removing the testicles (where the body&#8217;s largest source of androgens is).<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">LHRH agonist injections: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">These are drugs that act on the hormone that regulates the amount of androgens produced by the testicles. The most used are: goserelin (Zoladex\u00ae), triptorelin (Decapeptyl\u00ae), buserelin (Suprefact\u00ae), leuprorelin (Procrin\u00ae, Eligard\u00ae). They are administered by monthly, quarterly or even semi-annual injection.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">Complete androgen <b style=\"user-select: auto;\"><i style=\"user-select: auto;\">blockade: <\/i><\/b><\/span><\/span>combination of LHRH agonists with antiandrogens that act on androgen receptors, the most commonly used are bicalutamide (Casodex\u00ae) and flutamide (Eulexin\u00ae). This option leads to greater undesirable side effects, as well as being more expensive. On the other hand, it achieves a modest survival benefit (1-5% at 5 years).<\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Treatment <\/span><b style=\"user-select: auto;\">in androgen monotherapy<\/b><span style=\"font-weight: 400; user-select: auto;\"> It is associated with a lower rate of sexual dysfunction and also results in less bone loss. However, it cannot be considered a standard form of treatment for prostate cancer and its use should be restricted to highly selected cases such as low-grade tumors or low-volume metastatic disease. <\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Intermittent <\/span> hormone <b style=\"user-select: auto;\">blockade<\/b><span style=\"font-weight: 400; user-select: auto;\"> has been studied as an alternative to improve the quality of life of patients requiring hormone therapy. It consists of withdrawing the treatment for a period of time, thus allowing the patient to recover sexual function, at least temporarily. Treatment is usually withdrawn once maximum response is achieved and restarted again when PSA levels rise above a certain level (10-20 ng\/ml). However, there is one study that suggests that this strategy is discreetly inferior to the continuous block.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Two large recently reported studies support the role of <\/span><b style=\"user-select: auto;\">docetaxel chemotherapy associated with androgen suppression therapy<\/b><span style=\"font-weight: 400; user-select: auto;\">. Both studies conclude that patients with metastatic prostate cancer who receive 6 cycles of docetaxel on a triweekly basis, in addition to therapy with LHRH analogues, achieve survival between 10 and 17 months longer with a good tolerance profile, a magnitude of benefit that had not been observed to date in any solid tumor with the addition of a chemotherapeutic agent. Therefore, chemotherapy with docetaxel should be recommended for patients with metastatic prostate cancer associated with initial treatment with LHRH analogues, especially for patients with &#8220;de novo&#8221; onset metastatic disease, with large tumor volume (more than 4 foci of bone metastases or presence of metastases in the lung or liver) and provided that they are in good general condition and do not present contraindications for it.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Most patients respond to a first hormonal maneuver, but also virtually all progress to treatment, especially within the first two years. At this stage, they are considered <\/span><b style=\"user-select: auto;\">castration-resistant tumors<\/b><span style=\"font-weight: 400; user-select: auto;\">, i.e. androgen suppression alone is ineffective as a treatment. However, patients may respond to other hormonal agents.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Second-line treatment<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Virtually all patients with advanced prostate cancer sooner or later develop resistance to androgen suppression hormone therapy, thus progressing to the status of <\/span><b style=\"user-select: auto;\">castration-resistant prostate cancer (CRPC)<\/b><span style=\"font-weight: 400; user-select: auto;\"> defined as cancer that progresses despite maintaining blood testosterone levels in the castration range (&lt; 50 mg\/dl). These patients are candidates for systemic salvage treatment and several options are available today: new hormonal drugs, chemotherapy or bone-directed agents.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Treatments with androgen receptor inhibitors<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Abiraterone acetate<\/b><span style=\"font-weight: 400; user-select: auto;\"> is an oral drug that prevents the synthesis of androgens both at the level of the testicles, the adrenal gland, and the prostate tumor itself and has been extensively investigated in the treatment of prostate cancer at different stages.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In a randomized study, more than 1,000 patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with one or two chemotherapy regimens, at least one with docetaxel, patients treated with abiraterone acetate combined with a dose of prednisone or prednisolone had a significant improvement in overall survival compared to patients treated with prednisone or prednisolone plus placebo. Abiraterone acetate treatment achieved a 35% reduction in the risk of death and an <\/span><b style=\"user-select: auto;\">increase in median survival<\/b><span style=\"font-weight: 400; user-select: auto;\"> (14.8 months versus 10.9 months) compared to placebo-based treatment.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Recently published data also confirm the overall survival benefit of <\/span><b style=\"user-select: auto;\">Abiraterone in combination with prednisone<\/b><span style=\"font-weight: 400; user-select: auto;\"> in patients with asymptomatic or minimal symptomatic metastatic castration-resistant prostate cancer who have not previously received docetaxel chemotherapy, in addition to achieving an advantage in radiological progression-free survival, a delay in the need for chemotherapy or in the need for opioid analgesics.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Abiraterone has a good tolerance profile, highlighting as more <\/span> frequent effects <b style=\"user-select: auto;\">fluid retention<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">hypertension<\/b> and <b style=\"user-select: auto;\">decreased blood potassium levels<\/b><span style=\"font-weight: 400; user-select: auto;\">; as less frequent effects the drug can <\/span><b style=\"user-select: auto;\">raise liver enzymes in the laboratory and<\/b><span style=\"font-weight: 400; user-select: auto;\"> could cause <\/span><b style=\"user-select: auto;\">heart damage<\/b><span style=\"font-weight: 400; user-select: auto;\"> in a minority of patients.<\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In our country, abiraterone in combination with prednisone is indicated and marketed for the treatment of metastatic castration-resistant prostate cancer in patients who have progressed to docetaxel treatment and in patients who have not received prior chemotherapy, provided they are asymptomatic or have little pain.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Enzalutamide<\/b><span style=\"font-weight: 400; user-select: auto;\"> is a new drug from the group of antiandrogens much more potent and effective than bicalutamide, also for oral administration, which unlike abiraterone, does not require concomitant administration of prednisone.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">An international multicenter phase III study randomized just over 1,000 patients with metastatic CRPC who had progressed to prior docetaxel treatment, either enzalutamide or placebo, patients treated with the drug had a median survival of 18.4 months compared with 13.6 months for those treated with placebo. This translates to a 37% reduction in the risk of death.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Updated survival data for enzalutamide versus placebo have recently been reported in patients with asymptomatic or symptom-poor metastatic CRPC who have not been treated with prior chemotherapy, confirming a benefit in overall survival, progression-free survival, and time to chemotherapy need.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Enzalutamide also has a good tolerance profile, highlighting as the most frequent effects fatigue<\/span><b style=\"user-select: auto;\">, <b style=\"user-select: auto;\">diarrhea <\/b><span style=\"font-weight: 400; user-select: auto;\">that is usually mild and intermittent<\/span>, <b style=\"user-select: auto;\">muscle pain<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">headache <\/b><span style=\"font-weight: 400; user-select: auto;\">and <\/span><b style=\"user-select: auto;\">high blood pressure<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span> <\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Enzalutamide is indicated and marketed for the treatment of metastatic castration-resistant prostate cancer in patients who have progressed to docetaxel treatment and in patients who have not received prior chemotherapy, provided they are asymptomatic or have little pain, including in patients who have visceral (liver or lung) metastases.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Both abiraterone and enzalutamide have interactions with other drugs to be taken into account and since the indication of both drugs is for metastatic disease, it is very important to monitor the presence of symptoms associated with the disease, especially the progression of pain. Despite the good tolerance profile, patients receiving these treatments should be closely monitored by their specialist. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chemotherapy was already shown in the 90s effective as a palliative treatment for prostate cancer. The various combinations of cytotoxic drugs studied achieved a biological response (PSA reduction) in more than 50% of patients, with a duration of response of about 6 months.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Two randomized studies in the late 90s demonstrated clinical benefit with a scheme that combined two drugs: mitoxantrone and prednisone compared to prednisone alone, but without improving survival.<\/span> <span style=\"font-weight: 400; user-select: auto;\">In 2004, the results of two randomized studies were published that for the first time demonstrated overall survival benefit with chemotherapy regimens containing <\/span><b style=\"user-select: auto;\">docetaxel<\/b><span style=\"font-weight: 400; user-select: auto;\"> compared to the classic mitoxantrone-prednisone regimen (considered standard until that date).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In both studies, the survival achieved for patients treated with docetaxel reaches 17-18 months, in addition docetaxel reduces the risk of death by 20-24%, significantly increases the PSA response, significantly improves pain and quality of life of patients. The most important side effect of docetaxel is <\/span>Decrease in the <b style=\"user-select: auto;\">white blood cell count<\/b> that <span style=\"font-weight: 400; user-select: auto;\"> is the cause of <\/span><b style=\"user-select: auto;\">greater susceptibility to infections<\/b>, <span style=\"font-weight: 400; user-select: auto;\">other adverse effects that it causes are: <\/span><b style=\"user-select: auto;\">hair loss, nausea, diarrhea, fluid retention, alterations in the nails, fatigue and weakness, among others. <\/b> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The <\/span><b style=\"user-select: auto;\">docetaxel-prednisone<\/b> combination <span style=\"font-weight: 400; user-select: auto;\"> has to this day been considered standard treatment for metastatic castration-resistant prostate cancer.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Until 2010 there was no treatment with proven efficacy in controlled clinical studies for patients in whom docetaxel had failed, the mitoxantrone-prednisone combination was the most used until a few years ago in this group of patients (in the second line of treatment).<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">A study published in 2010 shows that a new chemotherapeutic agent of the taxane group called <\/span><b style=\"user-select: auto;\">cabazitaxel<\/b> combined with prednisone <span style=\"font-weight: 400; user-select: auto;\"> , achieves a statistically significant improvement in overall survival compared to the classic mitoxantrone-prednisone scheme (15.1 months versus 12.7 months). The most common side effects of this new treatment were <\/span><b style=\"user-select: auto;\">diarrhea<\/b><span style=\"font-weight: 400; user-select: auto;\"> and the <\/span><b style=\"user-select: auto;\">decrease in white blood cell count that causes increased susceptibility to infections<\/b><span style=\"font-weight: 400; user-select: auto;\">. With these results, this drug was the first to be approved in our country for the indication of treatment of castration-resistant prostate cancer that has progressed to chemotherapy with docetaxel.<\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Bone-directed treatments<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radio-223<\/b><span style=\"font-weight: 400; user-select: auto;\"> is a new agent in the group of radiopharmaceuticals to be administered at the <\/span><b style=\"user-select: auto;\">Nuclear Medicine Service<\/b><span style=\"font-weight: 400; user-select: auto;\">. The drug has been shown to improve survival versus placebo (14.9 vs 11.3 months) in symptomatic patients <\/span> with <b style=\"user-select: auto;\">advanced prostatic carcinoma with bone metastases<\/b><span style=\"font-weight: 400; user-select: auto;\"> who had previously received docetaxel chemotherapy or were not eligible for such treatment. Radio-223 achieved a 31% reduction in the risk of death. In addition to this survival benefit, drug administration prolonged the time to the first bone event and added no notable toxicity compared to placebo. It is administered intravenously in 6 doses with a monthly interval between doses. Recently, Radium-223 has obtained the indication in Spain of treatment for castration-resistant prostate cancer with symptomatic bone metastases in patients who do not present visceral metastases.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatments that improve quality of life<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are other treatment options available that improve the symptoms associated with the disease and should be applied in combination with tumor-specific treatments (hormone therapy and chemotherapy) to improve patients&#8217; quality of life.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pain medications or painkillers<\/b><span style=\"font-weight: 400; user-select: auto;\"> (from aspirin to opioids) are very effective. As for the possible addiction or dependence with opioid drugs is almost never a problem if they are prescribed in patients with pain of great intensity. Sleepiness and constipation are undesirable side effects <\/span><b style=\"user-select: auto;\"> <b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">, but they can usually be managed by adjusting doses or adding other medications to relieve these effects.<\/span><\/b><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Bisphosphonates<\/b><span style=\"font-weight: 400; user-select: auto;\"> are a group of medications that can help relieve bone pain caused when cancer has spread (bone metastases). In addition, bisphosphonates help strengthen bones in patients receiving hormone therapy (prevention of osteoporosis) and are also effective in preventing skeletal complications (pain, pathological fractures, spinal cord compression, and need for surgery or radiation therapy to the bone) in patients with castration-resistant prostate cancer with bone metastases.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The most commonly used bisphosphonate <\/span> is <b style=\"user-select: auto;\">zoledronic acid<\/b><span style=\"font-weight: 400; user-select: auto;\">, which is administered by intravenous injection of short duration (15 minutes) adjusting the dose to the patient&#8217;s renal function.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Bisphosphonates can cause side effects, including <\/span><b style=\"user-select: auto;\">flu-like symptoms<\/b>, <b style=\"user-select: auto;\">bone pain 24 hours after infusion<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><span style=\"font-weight: 400; user-select: auto;\"> and a rare but very bothersome side effect is <\/span><b style=\"user-select: auto;\">osteonecrosis of the jawbone<\/b>.<span style=\"font-weight: 400; user-select: auto;\"> (The blood supply to an area in the bone stops and that part of the bone dies.) This can cause tooth loss and infections or open wounds of the jaw bone that do not heal. The only effective way to treat this complication is to stop taking the medication and give drugs to relieve symptoms. It occurs most often after performing dental manipulation such as tooth or tooth extraction while the patient is being treated with bisphosphonates.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Denosumab<\/b> is a <span style=\"font-weight: 400; user-select: auto;\"> monoclonal antibody directed against a key protein in the progression of bone metastases; it is administered subcutaneously once a month and has an effect on the prevention of skeletal events (pathological fractures, radiotherapy or surgery on the bone and spinal cord compression) associated with bone metastases from different solid tumors, These include castration-resistant prostate cancer.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In a randomized study, denosumab compared to zoledronic acid significantly delayed the onset of the first bone event and reduced both the first and subsequent events. <\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Both denosumab and zoledronic acid are indicated in the treatment of castration-resistant prostate cancer with bone metastases to prevent bone events associated with metastatic disease; Neither drug has been shown to increase patient survival, however, they do contribute to improving quality of life. There is no scientific evidence to justify the periodic monthly use of zoledronic acid in patients with advanced prostate cancer in the hormone-sensitive phase and it seems that its prolonged use (beyond two years) increases the chances of suffering from osteonecrosis of the jaw.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Denosumab is superior to zoledronic acid in the prevention of bone events with the advantage that it does not need to adjust the dose to the patient&#8217;s renal function, although the rate of mandibular osteonecrosis it causes is slightly higher than that of zoledronic acid and at a higher economic cost.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><br style=\"user-select: auto;\" \/><span style=\"font-weight: 400; user-select: auto;\">Prevention of osteonecrosis of the jaw:<\/span><br style=\"user-select: auto;\" \/><\/i><span style=\"font-weight: 400; user-select: auto;\"> dental check-up and treat any problems that are detected before starting treatment. Maintain good oral hygiene and undergo regular dental exams.<\/span><\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_awgifh40x\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Kidney cancer<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Renal <\/span><b style=\"user-select: auto;\">cell<\/b> <strong style=\"user-select: auto;\">cancer<\/strong> (<span style=\"font-weight: 400; user-select: auto;\">also called <\/span> <strong style=\"user-select: auto;\">kidney<\/strong> <b style=\"user-select: auto;\">cancer<\/b><span style=\"font-weight: 400; user-select: auto;\">) is a disease in which malignant or cancerous cells are found that originate in the lining of the tubules of the kidney (in the renal cortex).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Renal cell cancer is responsible for <\/span><span style=\"font-weight: 400; user-select: auto;\">2-3% of all malignant tumors in adults<\/span><span style=\"font-weight: 400; user-select: auto;\">. It is <\/span><span style=\"font-weight: 400; user-select: auto;\">twice as common in men as<\/span><span style=\"font-weight: 400; user-select: auto;\"> in women. It is more common in African Americans than in Caucasians. Most cases are diagnosed <\/span><span style=\"font-weight: 400; user-select: auto;\">between the 4th and 6th decade<\/span> of <span style=\"font-weight: 400; user-select: auto;\"> life (from 50 years of age), but can occur at any age.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Risk factors<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Renal cell cancer most often occurs sporadically (with no family history) and is rarely part of an inherited syndrome (5% of cases). <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The exact causes of this disease have not been determined, however<\/span>, <b style=\"user-select: auto;\"> smoking<\/b> (<span style=\"font-weight: 400; user-select: auto;\">doubling the risk of developing this disease), exposure to certain chemicals<\/span> (<b style=\"user-select: auto;\">cadmium, asbestos, oil<\/b><span style=\"font-weight: 400; user-select: auto;\">), <\/span><b style=\"user-select: auto;\">obesity<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">acquired cystic kidney disease in patients undergoing chronic dialysis<\/b><span style=\"font-weight: 400; user-select: auto;\"> (30% of these patients will develop kidney cancer) and indiscriminate use of <\/span><b style=\"user-select: auto;\">analgesics. <\/b><span style=\"font-weight: 400; user-select: auto;\"> (aspirin and phenacetin, in this case more involved in the development of urinary tract cancer), are associated with an increase in the incidence of this disease.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are several inherited syndromes that associate kidney cancer of different histological types with other types of tumors. In general, those patients with a first-degree relative diagnosed with kidney cancer before age 40 and those who have bilateral or multifocal kidney cancer in the same kidney may have a hereditary component. It should be remembered that only 5% of kidney tumors that are diagnosed are part of a hereditary syndrome, the vast majority are sporadic.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Classification<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Renal cell carcinoma accounts for 80-85% of all renal malignancies. It typically originates in the renal cortex and has several subtypes. Here we describe the most frequent or relevant subtypes:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Clear cell carcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\"> (80%) is the most common. Clear cells can grow from slow (grade 1) to fast (grade 4). In this type of kidney cancer, the results of targeted therapy and immunotherapy have been validated.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Papillary carcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\"> (15%). It is divided into two subclasses: type 1 and type 2 (the latter of more aggressive behavior), are currently treated in the same way as clear cell kidney carcinoma. <\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Chromophobic carcinoma and oncocytoma<\/b><span style=\"font-weight: 400; user-select: auto;\"> (5%), the latter is very slow growing and rarely has the ability to spread.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Collecting duct<\/b> carcinoma <span style=\"font-weight: 400; user-select: auto;\"> (&lt;1%) behaves similarly to transitional cell carcinoma of the bladder and urinary tract. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Sarcomatoid variant:<\/b><span style=\"font-weight: 400; user-select: auto;\"> it can coexist with any of the previous subtypes and leads to a more aggressive behavior of the tumor due to its faster and more invasive local growth. It is called sarcomatoid because when examined under a microscope it resembles sarcoma.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Nephroblastoma <\/b><span style=\"font-weight: 400; user-select: auto;\">or <\/span><b style=\"user-select: auto;\">Wilms tumor<\/b><span style=\"font-weight: 400; user-select: auto;\"> is another type of kidney cancer that typically occurs in childhood.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Angiomyolipoma <\/b><span style=\"font-weight: 400; user-select: auto;\">is a benign tumor that looks characteristic on computed tomography (CT). It tends to grow and does not usually spread, it can be managed conservatively, embolization or with renal partial surgery.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptomatology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Kidney cancer is mostly asymptomatic, so it&#8217;s usually a casual finding when performing tests (ultrasound or CT) for other reasons. Many patients do not experience any symptoms until the disease has spread to other organs. . <\/span> The association of <span style=\"font-weight: 400; user-select: auto;\">hematuria (blood in the urine), mass and pain in the side has been described as typical, but this triple association is only present in 10% of cases. Hematuria appears in more than half of cases, but may not be visible and may only be evident in a urinalysis (microscopic hematuria).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Anemia, fever and weight loss are relatively common in this type of tumors, when they are in advanced stages of the disease.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Less frequent are polycythemia (increase in the hemoglobin figure) and hypercalcemia (the latter should force us to rule out an extension of the tumor to the bones).<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For the diagnosis, a complete evaluation of the patient is carried out, helping us in complementary tests.<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Physical examination and history: It<\/b><span style=\"font-weight: 400; user-select: auto;\"> is important to always examine the patient to check the general state of health and identify any signs of disease, such as masses, lumps or any other signs that seem unusual. The patient is also questioned about their habits, history of diseases and treatments received. It is important to also investigate a history of cancer in the family.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Blood tests:<\/b><span style=\"font-weight: 400; user-select: auto;\"> several analytical profiles are requested that provide guidance on the overall state of health and activity of the disease.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Urinalysis:<\/b><span style=\"font-weight: 400; user-select: auto;\"> test to determine the content of sugar, protein, the presence or absence of blood and bacteria.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Abdominal ultrasound:<\/b><span style=\"font-weight: 400; user-select: auto;\"> useful to identify renal masses and distinguish whether they are cystic or solid in nature.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Contrast tomography (CT) scan<\/b>: This is the procedure of <span style=\"font-weight: 400; user-select: auto;\"> choice; this is a procedure in which a series of detailed images of the inside of the body are made from different angles. It is useful for detecting and evaluating renal masses, if there is infiltration of the inferior vena cava, as well as if there is extension to regional lymph nodes.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Magnetic resonance imaging (MRI):<\/b><span style=\"font-weight: 400; user-select: auto;\"> in the event that thrombosis or infiltration of the inferior vena cava is suspected, this technique can help us evaluate the extent of said infiltration.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Renal arteriography:<\/b><span style=\"font-weight: 400; user-select: auto;\"> less used today with the advent of other techniques such as resonance; useful to define the vascularization of the renal tumor and therefore in the evaluation prior to surgery. <\/span> <\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Bone scintigraphy (GGO): <\/b> to <span style=\"font-weight: 400; user-select: auto;\">rule out extension to the bones in case of clinical suspicion due to pain or elevation of alkaline phosphatase or calcium levels in the analysis.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Fine needle biopsy or puncture-aspiration (FNA): <\/b><span style=\"font-weight: 400; user-select: auto;\">The removal of cells or tissues performed so that a pathologist can look at them under a microscope and determine whether or not tumor cells are present. To perform a biopsy of renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is removed.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">PET-CT:<\/b><span style=\"font-weight: 400; user-select: auto;\"> with the latest technology, a PET scan and a CT scan can be done at the same time (PET\/CT scan). This allows the radiologist to more anatomically locate the areas of greatest uptake (suggesting an area of cancer) in the PET, although it is not a standard technique and should only be used in selected cases. Its usefulness is greater in other types of cancers.<\/span><\/span><\/li>\n<\/ol>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The TNM system is used for staging. In summary, the clinical stages based on this system are: <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor is 7 centimeters or smaller and is limited to the kidney.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The tumor is larger than 7 centimeters and is limited to the kidney.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III: The<\/b><span style=\"font-weight: 400; user-select: auto;\"> tumor invades the adrenal gland just above the kidney or the layer of fatty tissue surrounding the kidney or major blood vessels in the kidney (such as the vena cava) and may invade the abdominal lymph nodes.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage IV:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The cancer has spread to other organs such as the intestines, pancreas, lungs, liver, or bones, causing distant metastases.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prognosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The natural history of renal cell cancer is highly variable, and depends on when the diagnosis has been made. Approximately 30% of patients will present as disseminated or metastatic disease at the time of diagnosis and one third of the remaining will develop metastases throughout their evolution. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Prognosis and treatment options basically depend on two factors:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\">The stage of the <b style=\"user-select: auto;\">disease: The<\/b><span style=\"font-weight: 400; user-select: auto;\"> more stage progresses (from I to IV), the lower the chances of cure.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The <\/span><b style=\"user-select: auto;\">patient&#8217;s age<\/b><span style=\"font-weight: 400; user-select: auto;\"> and general <\/span><b style=\"user-select: auto;\">health<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In advanced or metastatic disease, the levels of hemoglobin, neutrophils, platelets and calcium in the blood, together with general status and time since diagnosis, are factors that classify patients into three prognostic risk groups (Motzer criteria):<\/span><span style=\"font-weight: 400; user-select: auto;\">&#8211; &#8212; <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">&#8211; Good prognosis group. &#8211; <span style=\"font-weight: 400; user-select: auto;\">Intermediate forecast<\/span> group. <span style=\"font-weight: 400; user-select: auto;\">&#8211; <\/span><span style=\"font-weight: 400; user-select: auto;\">Poor prognosis group.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Different types of treatment are available for patients with renal cell cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Some treatments are standard (the current use treatment), and others are being tested in clinical trials. A treatment clinical trial is a study aimed at helping improve the outcomes of current treatments or to learn about new treatments for cancer patients.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment.<\/span><\/p>\n<table style=\"user-select: auto;\">\n<tbody style=\"user-select: auto;\">\n<tr style=\"user-select: auto;\">\n<td style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage<\/b><\/span><\/td>\n<td style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/td>\n<\/tr>\n<tr style=\"user-select: auto;\">\n<td style=\"user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Stages I and II<\/span><\/td>\n<td style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Radical or partial nephrectomy with or without lymphadenectomy<\/span> <span style=\"font-weight: 400; user-select: auto;\">Radiofrequency cryoablation or ablation<\/span><\/span><\/td>\n<\/tr>\n<tr style=\"user-select: auto;\">\n<td style=\"user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Stage III<\/span><\/td>\n<td style=\"user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Radical nephrectomy with regional lymphadenectomy<\/span><\/td>\n<\/tr>\n<tr style=\"user-select: auto;\">\n<td style=\"user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Stage IV<\/span><\/td>\n<td style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Cytoreductive nephrectomy<\/span> <span style=\"font-weight: 400; user-select: auto;\">Resection of metastases<\/span> <span style=\"font-weight: 400; user-select: auto;\">Systemic treatments:<\/span> \u2022 <span style=\"font-weight: 400; user-select: auto;\">Immunotherapy<\/span> \u2022 <span style=\"font-weight: 400; user-select: auto;\">Antiangiogenic<\/span> \u2022 <span style=\"font-weight: 400; user-select: auto;\">mTOR inhibitors \u2022<\/span> <span style=\"font-weight: 400; user-select: auto;\">Chemotherapy<\/span> <span style=\"font-weight: 400; user-select: auto;\">Palliative radiotherapy<\/span> <span style=\"font-weight: 400; user-select: auto;\">Bisphosphonates <\/span> <\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Surgery<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When the disease is localized to the kidney, surgery can be potentially curative and should in principle be offered to patients with stages I, II or III.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Surgery that removes part or the entire kidney may be used to treat renal cell cancer. There are the following types of surgery:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radical nephrectomy<\/i><\/b>: <span style=\"font-weight: 400; user-select: auto;\">A surgical procedure that removes the kidney, adrenal gland (currently removed only if infiltration is suspected), surrounding tissue, and usually some nearby lymph nodes. Sometimes part of adjacent organs must also be resected if the tumor is attached. It is usually performed by laparoscopy, robotic surgery or open surgery. It is potentially healing<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Partial nephrectomy: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">A surgical procedure to remove the tumor and some of the surrounding tissue to preserve healthy, functioning kidney tissue. A partial nephrectomy can be performed to avoid loss of renal function when the other kidney is damaged or has already been removed, also in case of bilateral tumors and should be considered the technique of choice when the tumor is less than 7 cm, since it preserves better renal function. Partial nephrectomy can be performed laparoscopically and robotically. In very rare cases it would be necessary to resort to open surgery.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A person may live with only a part of a functioning kidney, but if both kidneys are removed or are not working, the person will need dialysis (a procedure to clean the blood using a machine outside the body) or a kidney transplant (replacing the diseased kidney with a healthy donated kidney).<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Cryoablation and radiofrequency ablation: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">are other alternatives for local treatment of the tumor if partial nephrectomy is not viable for several reasons (patient&#8217;s medical condition). The goal is to destroy the tumor by freezing (cryoablation) or by high energy (radiofrequency). They are useful only in case of small tumors, and patients with significant comorbidities that prevent the surgical procedure.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery in advanced kidney cancer (stage IV):<\/i><\/b><\/span><i style=\"user-select: auto;\"><\/i> the option of surgery for patients with <span style=\"font-weight: 400; user-select: auto;\">disseminated or widespread disease aims to reduce the largest possible tumor mass (cytoreductive surgery) and is useful in some patients who are candidates for subsequent treatment with immunotherapy or targeted therapy, especially in those considered as a group of good prognosis and intermediate prognosis. It is not a valid option for patients with multiple metastatic locations and poor general condition.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><em style=\"user-select: auto;\"><strong style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">Metastasis surgery:<\/span><\/strong><\/em><b style=\"user-select: auto;\"><\/b> <span style=\"font-weight: 400; user-select: auto;\">Metastasis surgery can be useful in very selected cases, especially in small volume and small lung metastases, or also in the case of adrenal metastases. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Minimally invasive kidney surgery (Laparoscopy, retroperitoneoscopy and robotics)<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">With the intention of minimizing surgical aggression and improving post-surgical recovery, laparoscopic and robotic total or partial nephrectomy techniques were born for the treatment of kidney cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Laparoscopic partial nephrectomy and da Vinci robotic partial nephrectomy have shown less intraoperative bleeding, better recovery of renal function, lower hospital admission, and faster recovery and restart of working life.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In cases where there are previous abdominal surgeries or in cases where the tumor is located on the back of the kidney, the technique of choice is partial nephrectomy by Retroperitoneoscopy, that is, accessing the kidney from the back and side, not from the abdomen. In these cases, recovery is very fast, reduces bleeding and operative time, as well as hospital stay<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radiotherapy<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In renal cancer, radiation therapy to the primary tumor is considered a palliative treatment option, that is, non-curative and may be considered in some cases with localized kidney disease and unfavorable medical conditions to undergo surgery. In case of involvement of the surgical resection margins, it could be used as a complementary treatment to surgery, although this strategy does not seem to be clearly demonstrated in clinical studies.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Therefore, in kidney cancer, the role of radiotherapy is reserved to alleviate symptoms derived from bone metastases.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Medical treatment<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When it comes to advanced kidney cancer, surgery is not curative and therefore treatment with drugs that act globally and reach all organs of the body (systemic treatment) is recommended in order to achieve remission of the disease or prevent its progression. Recurrent renal cell cancer is cancer that has come back after treatment and can come back in the kidney or other parts of the body, even years after initial treatment. In those cases in which the disease relapses or progresses after surgery, we must also propose a systemic treatment. In selected cases of single relapse, salvage surgery may be considered if feasible.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the treatment prior to surgery or complementary after it, it should not be considered a systemic treatment to date, in a standardized way. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In general, renal cell cancer, unlike other types of tumors, is resistant to chemotherapy. Therefore, we need other therapeutic strategies.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Immunotherapy and cellular check-point inhibitor treatment<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is a type of biological therapy that stimulates the immune system&#8217;s ability to fight cancer. Substances produced by the body or drugs made in a laboratory are used to stimulate, direct, or restore the body&#8217;s natural defenses against disease.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Several immunotherapy-based strategies have been used to boost antitumor immunity. The administration of classical cytokines as<\/span> <b style=\"user-select: auto;\"> Interleukin 2 (IL-2) <\/b><span style=\"font-weight: 400; user-select: auto;\"> and <b style=\"user-select: auto;\"> Interferon \u03b1 (IFN\u03b1),<\/b> has demonstrated clinical efficacy <span style=\"font-weight: 400; user-select: auto;\">since the 80s, however today its use in the clinic has decreased considerably due to the effectiveness of new target treatments that have shown greater clinical efficacy and better tolerance profile.<\/span><\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">On the other hand, new drugs based on inhibitors of cellular receptors &#8220;check-point&#8221; such as PDL-1 (programmed death 1 checkpoint) and CTLA-4 have appeared. These drugs are <\/span><b style=\"user-select: auto;\">Nivolumab, Ipilimumab, Pembrolizumab, Avelumab. <\/b> <span style=\"font-weight: 400; user-select: auto;\">When these receptors are blocked, we achieve a sustained immune response against tumor cells.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Targeted therapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Targeted therapy uses drugs and other substances that can identify and kill specific cancer cells without harming normal cells. These are drugs called target therapies. These drugs can cause remission of the disease or prevent the progression of the disease in most cases but do not cure the disease.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"><b style=\"user-select: auto;\"> Antiangiogenic therapy <\/b><\/span> <span style=\"font-weight: 400; user-select: auto;\">It is a type of targeted therapy for advanced renal cell cancer with very consolidated results in recent years. It acts on critical receptors of the blood vessels developed in the tumor itself. With this type of therapy, the formation of new blood vessels by the tumor that are essential for it to be nourished and thus continue advancing is prevented; The result is that the tumor stops growing or shrinks.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Among the antiangiogenic drugs, the best results have been achieved with <\/span><b style=\"user-select: auto;\">Sunitinib, Pazopanib, Tivozanib, Bevacizumab, Sorafenib, Axitinib<\/b><span style=\"font-weight: 400; user-select: auto;\"> and recently<\/span><b style=\"user-select: auto;\"> Cabozantinib<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The so-called <\/span><b style=\"user-select: auto;\">inhibitors of the mTOR<\/b> pathway, <span style=\"font-weight: 400; user-select: auto;\"> which is a pathway that has a fundamental role in the metabolism, growth, and proliferation of the tumor cell, have shown activity in this disease in randomized studies and we currently have two drugs: <\/span><b style=\"user-select: auto;\">Temsirolimus <\/b><span style=\"font-weight: 400; user-select: auto;\">and <\/span><b style=\"user-select: auto;\">Everolimus.<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">These combinations have demonstrated efficacy in the first line or in the entry treatment for advanced disease:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Axitinib-Avelumab<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Axitinib-Pembrolizumab<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Nivolumab-Ipilimumab<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Sunitinib<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Pazopanib<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Tivozanib<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Bevacizumab-interferon<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Temsirolimus in patients with poor prognostic criteria<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the second line or after failure to the input treatment:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Nivolumab<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Cabozantinib<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Axitinib<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Everolimus<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Sorafenib<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">There are other drugs such as Lenvatinib or other combinations (Cabozantinib-Nivolumab,&#8230;) pending in the coming years with promising results.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptomatic treatment <\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In addition to the specific treatment of the disease, the management of symptoms in renal cancer is important. To relieve pain, in addition to analgesic drugs, radiotherapy is useful as a palliative treatment. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In the case of bone metastases, it is also useful to use drugs from the bisphosphonate group (Zometa\u00ae -zoledronic acid-) that help reduce the complications derived from tumor involvement in the bone.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_hg57fwv5mo\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Upper urinary tract cancer: renal pelvis and ureter<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The ureter is the thin tubular structure that connects <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> to the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46501&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">bladder<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. <\/span> <span style=\"font-weight: 400; user-select: auto;\">The renal pelvis and ureters are lined with <\/span> cells <b style=\"user-select: auto;\">of the transitional layer<\/b><span style=\"font-weight: 400; user-select: auto;\"> and from these cells most upper urinary tract cancers (<\/span><span style=\"font-weight: 400; user-select: auto;\">75 to 85%)<\/span> are generated<span style=\"font-weight: 400; user-select: auto;\">. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It is important to remember that 90% of transitional cell tumors are located in the bladder. Only %-10% is located in the upper urinary tract, so they are also called urothelial carcinoma of the upper urinary tract. Or urinary tract tumor. Those of the renal pelvis double in frequency to those presented in the ureter.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Other histological types are <\/span><b style=\"user-select: auto;\">squamous cell carcinoma<\/b> (<span style=\"font-weight: 400; user-select: auto;\">15 to 20%), which is associated with urinary lithiasis and recurrent infections, and <\/span><b style=\"user-select: auto;\">adenocarcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\"> (6-8%).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">This cancer is different from kidney cancer.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Primary tumors of the renal pelvis are relatively rare, constituting 7-8% of all renal tumors in humans. Most often occur between the sixth and seventh decades of life and can be benign, but are usually malignant. It is more frequent in men, in a very heterogeneous proportion according to the epidemiological studies that have been carried out: 1.7-4.2:1.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Risk factors<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Risk factors for transitional cell cancer of the renal pelvis and ureter include the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Having<\/span><\/i> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=642021&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">a personal history<\/span><\/i><\/a> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=444968&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">of bladder cancer<\/span><\/i><\/a><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">.<\/span><br style=\"user-select: auto;\" \/><\/i><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><i style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Smoking.<\/span><\/i><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Chronic use of pain relievers, such as phenacetin (paracetamol).<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Being exposed to certain dyes <\/span> and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=643008&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">chemicals<\/span><\/a> <\/span><\/span>used in the manufacture of leather, textile, plastic, and rubber products.<\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Symptomatology<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The most common symptoms are: <\/span><b style=\"user-select: auto;\">hematuria<\/b> (<span style=\"font-weight: 400; user-select: auto;\">80-90%), <\/span><b style=\"user-select: auto;\">flank pain<\/b> (<span style=\"font-weight: 400; user-select: auto;\">24-37%) and bladder irritation (15-20 <\/span><b style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"> %).<\/span><\/b><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Routes of dissemination<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Cancer can spread by contiguity<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45764&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymphatic system<\/span><\/a><\/span>, <span style=\"font-weight: 400; user-select: auto;\"> and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270735&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">blood<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">By contiguity<\/b><span style=\"font-weight: 400; user-select: auto;\">. Cancer spreads to nearby areas, such as other areas of the ureter, bladder, adjacent organs (adrenal glands, colon, small intestine), or abdominal wall.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Lymphatic system<\/b><span style=\"font-weight: 400; user-select: auto;\">. It can spread through the lymphatic vessels and reach the nodes.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Blood<\/b><span style=\"font-weight: 400; user-select: auto;\">. It can also spread through blood vessels and then settle in any organ of the body.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Noninvasive and invasive procedures are used in the diagnosis of transitional cancer of the renal pelvis and ureter:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270871&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Physical exam<\/b><\/a> <\/span><\/span>and <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=798522&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">health history<\/b><\/a>: Your general health is checked <b style=\"user-select: auto;\">and<\/b> <span style=\"font-weight: 400; user-select: auto;\">any signs of disease, such as lumps, or anything else that seems abnormal, are identified. Data on health habits, history of illnesses, and previous treatments are also taken.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Ureteroscopy:<\/b><span style=\"font-weight: 400; user-select: auto;\"> The inside of the ureter and renal pelvis is observed and serves to detect suspicious areas that require biopsy. A ureteroscope is inserted through the urethra to reach the bladder, ureter, and renal pelvis. Sometimes an instrument is passed through the ureteroscope to take biopsies or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a> <\/span><\/span>samples <span style=\"font-weight: 400; user-select: auto;\"> and look at them under a <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=638184&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">microscope<\/span><\/a> for signs of disease.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Urine cytology<\/b><span style=\"font-weight: 400; user-select: auto;\">: test to check cell characteristics. Sometimes cancer cells are shed from cancers of the kidney, bladder, or ureter that pass into the urine. The <\/span><span style=\"font-weight: 400; user-select: auto;\">positivity range for this type of tumor ranges from 60 to 65% for upper-line tumors.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44236&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Computed tomography (CT) scan:<\/b><\/a><\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">\u00a0A procedure in which a series of detailed pictures of the inside of the body are taken from different angles. The images are created with a computer connected to an <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45944&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">x-ray<\/span><\/a> machine<span style=\"font-weight: 400; user-select: auto;\">. <\/span><span style=\"font-weight: 400; user-select: auto;\"> Iodinated contrast <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44678&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">is injected<\/span><\/a> into a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476471&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">vein<\/span><\/a> or <span style=\"font-weight: 400; user-select: auto;\"> swallowed to make <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476471&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">organ<\/a> or <\/span>tissues stand out more clearly. It has a <span style=\"font-weight: 400; user-select: auto;\">high diagnostic yield ranging from 78-92% for pelvic and ureter cancer.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46157&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Ultrasound<\/b><\/a><\/span><\/span>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs to produce echoes. The echoes form a picture of the body&#8217;s tissues called an <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46587&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">echogram<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\">. An ultrasound of the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46587&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">abdomen<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> may be done <\/span>to help <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46450&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">diagnose<\/span><\/a> cancer of the pelvis of the kidney and ureter.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45997&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Magnetic resonance imaging<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">(MRI):<\/b> <span style=\"font-weight: 400; user-select: auto;\">A procedure that uses a magnet<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=651209&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radio waves<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> and a computer to create a series of detailed pictures of areas inside the body, such as the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46246&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pelvis<\/span><\/a>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45164&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Biopsy<\/b><\/a><\/span><\/span>: The removal of cells or tissues for a <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46244&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pathologist<\/span><\/a> to look at under a microscope and check for signs of cancer. This procedure may be done during ureteroscopy or <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">surgery<\/span><\/a>.<\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Staging<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For staging, apart from the diagnostic studies already mentioned, the following may be ordered: <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46218&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Positron emission tomography<\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\">(PET):<\/b><span style=\"font-weight: 400; user-select: auto;\"> A procedure to find <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45772&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">malignant <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tumor <\/span><\/a><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cells<\/span><\/a> in the body. <span style=\"font-weight: 400; user-select: auto;\"> A small amount of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=774386&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">radioactive glucose<\/span><\/a> (sugar) is <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44678&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">injected<\/span><\/a><br style=\"user-select: auto;\" \/>\n<p style=\"user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"> into a <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476471&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">vein<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">. The PET scan rotates around the body and creates a picture of the places in the body that use glucose. Malignant tumor cells look brighter in the picture because they are more active and absorb more glucose than normal cells. Performance is low for this type of tumor cellularity.<\/span><\/p>\n<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46499&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\">Bone scan<\/b><\/a><\/span><\/span><b style=\"user-select: auto;\">:<\/b><span style=\"font-weight: 400; user-select: auto;\"> A procedure to check for fast-growing bone cells, such as cancer cells, in the bone. A very small amount of <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46550&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">radioactive<\/a> material is injected<\/span> <span style=\"font-weight: 400; user-select: auto;\">into a vein and travels through the bloodstream. Radioactive material collects in bones with cancer and is detected with a scanner. They are performed in those cases in which there is symptomatic suspicion of bone metastasis.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">With these diagnostic tests, the disease can be classified within a certain stage:<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Stage 0 (noninvasive papillary carcinoma and carcinoma in situ): <\/i><\/b><\/span><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\">At this stage<\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44636&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">abnormal<\/span><\/a> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46476&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cells<\/span><\/a> are found <span style=\"font-weight: 400; user-select: auto;\"> in <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> inside the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46562&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">renal pelvis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">ureter<\/span><\/a>.<span style=\"font-weight: 400; user-select: auto;\">\u00a0These<\/span><span style=\"font-weight: 400; user-select: auto;\"> abnormal cells may become <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancerous<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> and spread to nearby normal tissue. Stage 0 is divided into stages 0a and 0is depending on the type of <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46634&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tumor<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\"><b style=\"user-select: auto;\">Stage <\/b><\/span><b style=\"user-select: auto;\">0a<\/b><span style=\"font-weight: 400; user-select: auto;\"> is also called <\/span><b style=\"user-select: auto;\">noninvasive papillary carcinoma<\/b>, <span style=\"font-weight: 400; user-select: auto;\">which sometimes looks like long, thin lumps that protrude from the tissue inside the renal pelvis or ureter.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Stage 0is<\/b><span style=\"font-weight: 400; user-select: auto;\"> is also called <\/span><b style=\"user-select: auto;\">carcinoma in situ<\/b><span style=\"font-weight: 400; user-select: auto;\">; it is a flat tumor in the tissue that lines the inside of the renal pelvis or ureter.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Stage I:<\/i><\/b><\/span> <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Cancer<\/span><\/a> <\/span><span style=\"font-weight: 400; user-select: auto;\">has spread from <\/span> the <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a> <\/span><span style=\"font-weight: 400; user-select: auto;\">lining the inside of the <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46562&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">renal pelvis<\/a> <\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">or <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">ureter<\/a> <\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">to the connective <span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44013&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">tissue layer.<\/a><\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Stage II: <\/i><\/b><span style=\"font-weight: 400; user-select: auto;\">Cancer has spread to the muscular layer of the\u00a0<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46562&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">renal pelvis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> or <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">ureter<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Stage III<\/i><\/b><\/span><b style=\"user-select: auto;\"><\/b><span style=\"font-weight: 400; user-select: auto;\">: <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Cancer<\/span><\/a><\/span><span style=\"font-weight: 400; user-select: auto;\"> has spread:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">from the muscular layer of <\/span> the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46562&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">renal pelvis<\/span><\/a> to the <span style=\"font-weight: 400; user-select: auto;\"> fat surrounding the renal pelvis or to <\/span><span style=\"font-weight: 400; user-select: auto;\"> the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a> <\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a>; or<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">from the muscular layer of the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">ureter<\/a>\u00a0<\/span><span style=\"font-weight: 400; user-select: auto;\">to the fat surrounding the ureter.<\/span><\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Stage IV<\/i><\/b><\/span>: <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Cancer<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">has spread to at least one of the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">a <\/span> nearby <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=257523&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">organ<\/span><\/a><\/span><\/span>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">the <span style=\"font-weight: 400; user-select: auto;\">layer of fat surrounding the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a><\/span><\/span>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">lymph<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">nodes<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">to other parts of the body, such as the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270740&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lung<\/span><\/a><\/span><\/span>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46312&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">liver<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> or bone.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Stages 0, I, and II occur in most diagnosed patients (55 to 65%) with a 5-year survival ranging from 87% to 100%. Some researchers find that 5-year survival for stages III and IV ranges from 12% to 50%.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In addition, cancer of the renal pelvis and ureter may be classified as localized, regional, metastatic, or recurrent:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Localized:\u00a0<\/i><\/b>the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">is found only in the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Regional: <\/i><\/b><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer <\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">has spread to<\/span> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissues<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> around the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a>, nearby <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45762&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lymph nodes<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45020&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">blood vessels<\/span><\/a> in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46246&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">pelvis<\/span><\/a>.<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Metastatic: <\/i><\/b><\/span><\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">\u00a0<\/span><span style=\"font-weight: 400; user-select: auto;\">has spread to other parts of the body.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Recurrent: <\/i><\/b><\/span><\/span>the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45333&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">cancer<\/span><\/a> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46556&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">has recurred<\/span><\/a> (come back) after treatment. Cancer may come back in the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46562&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">renal pelvis<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46638&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">urethra<\/span><\/a>, or <span style=\"font-weight: 400; user-select: auto;\"> other parts of the body, such as the <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=270740&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">lungs<\/span><\/a>, <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46312&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">liver<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\"> or bones.<\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Treatment options depend on the following:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The stage and grade of the tumor.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Where the tumor is.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Whether the patient&#8217;s other kidney is healthy.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Whether the cancer <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45861&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">has recurred<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Less and less invasive treatment protocols are being carried out, with the aim of preserving the renal unit and offering a better quality of life to patients. This is thanks to the advent of important technological advances in endourology and the exhaustive training of our specialists.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Standard treatment<\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Organ sparing endourological procedures (Endoscopic laser treatment of upper urinary tract tumor)<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Laser flare:<\/i><\/b><span style=\"font-weight: 400; user-select: auto;\"> It is a surgical procedure that destroys tissue using a laser beam. The surgery is carried out by ureterorrhenoscopy or percutaneous access, that is, using thin instruments that are inserted through the natural holes or through a small incision in one side. Not all tumor stages and grades can be treated this way; It is reserved for low-grade tumors, single, smaller than 2cm and that do not produce obstruction of the urinary tract. <\/span><span style=\"font-weight: 400; user-select: auto;\">Laser fulguration can be considered a curative treatment only in specific situations, since between 50-70% of recurrences are recorded after the procedure, which would require a very close follow-up and repeat every so often the exploration of the urinary tract. The great advantage of this procedure is that it allows the preservation of the kidney, avoiding its removal. It is indicated in patients with low aggressive urothelial tumors in patients with only one kidney or patients with renal failure to avoid dialysis.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">One of the following <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45570&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\">surgical<\/a> procedures is used to treat transitional cell cancer of the renal pelvis and ureter<\/span><\/span><span style=\"font-weight: 400; user-select: auto;\">:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=354466&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Nephroureterectomy<\/i><\/b><\/a><\/span><\/span><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">: <\/i><\/b>Surgery to remove the entire <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46325&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">kidney<\/span><\/a>, <span style=\"font-weight: 400; user-select: auto;\">ureter, and bladder cuff (<\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46683&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">tissue<\/span><\/a>that connects the ureter to the <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=46501&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">bladder<\/span><\/a>). It is indicated in localized tumors that are not amenable to endoscopic management with laser flare. It is also performed in locally advanced or metastatic disease, representing a palliative option. The surgery is completed with a regional lymphadenectomy (removal of lymph nodes in the pelvis).<\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=476847&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Segmental resection<\/i><\/b><\/a> <\/span><\/span><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">of the ureter: <\/i><\/b>A surgical procedure to remove the part of the ureter that contains the cancer and some of the healthy tissue around it. Then, the ends of the ureter are reattached. This treatment is used when the cancer is <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=44305&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">superficial<\/span><\/a> and is located only in the lower third of the ureter, near the bladder. Performing this procedure in other ureteral locations is associated with a high rate of recurrence. The surgery is completed with a regional lymphadenectomy (removal of lymph nodes in the pelvis).<\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In any of these techniques, minimally invasive surgery can be used, either laparoscopic surgery or robotic surgery. Laparoscopic and robotic radical nephroureterectomy have shown good oncological results, as well as a lower rate of intraoperative bleeding and a better postoperative<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy and cellular check-point inhibitor treatments<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Adjuvant chemotherapy (after surgery) achieves a recurrence-free rate of up to 50%, and has an effect on survival. Not all patients receive this treatment due to concomitant diseases and impaired renal function after radical surgery. The treatment regimen used is based on the use of cisplatin, in combination with other chemotherapy drugs. In cases where the disease progresses despite the use of chemotherapy, or in the event that renal function is not good and, therefore, chemotherapy cannot be administered, treatments based on cellular check-point inhibitor treatments such as Pembrolizumab, Atezolizumab and Nivolumab may be used. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The use of postoperative radiotherapy for malignancies of the renal pelvis remains controversial, as they are assumed to be radioresistant. There is little evidence for its use in upper line tumors.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Prognosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45849&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">Prognosis<\/span><\/a><span style=\"font-weight: 400; user-select: auto;\"> depends on stage and <\/span><a style=\"color: #000000; user-select: auto;\" href=\"https:\/\/www.cancer.gov\/Common\/PopUps\/popDefinition.aspx?id=45702&amp;version=patient&amp;language=Spanish&amp;dictionary=Cancer.gov\"><span style=\"font-weight: 400; user-select: auto;\">grade<\/span><\/a> <span style=\"font-weight: 400; user-select: auto;\">of the tumor. The 5-year survival for transitional cell carcinoma is 50%, but if the tumor is undifferentiated only 25% of patients survive after 5 years. Squamous cell carcinoma has an unusually aggressive ability to spread to regional lymph nodes, and therefore any type of treatment does not modify its survival, being almost always fatal within a year and with a five-year survival of less than 10%.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Because of the multicentric nature of these tumors and the propensity for recurrence, patients should be carefully monitored even after radical surgery.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Early diagnosis and timely treatment of these neoplasms are fundamental factors in the prognosis of these patients.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Tracking<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Cystoscopy, urinary cytology, and CT scans of the chest, abdomen, and pelvis are performed every 3 months for 2 years, every six months for the next 2 years, and annually thereafter. The reason for performing cystoscopy so often is because 30 to 50% of patients with transitional cell carcinoma of the renal pelvis can develop this neoplasm synchronously in the bladder.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">For tumors treated by laser fulguration, ureterorenoscopies are performed every 3 months for 2 years, and then every 6 months, although it is true that protocols may vary depending on the operative findings and the patient&#8217;s health status.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_7mgp4stnpk\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Benign tumors of the adrenal gland<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The adrenal glands are small organs that are located, as the name implies, above and adjacent to both kidneys. They are shaped like an inverted Y, V or T and weigh approximately 5 grams each. The adrenal cortex secretes cortisol, aldosterone, and androgens; The marrow secretes epinephrine and norepinephrine.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Benign tumors of the adrenal gland are common, affecting <\/span><b style=\"user-select: auto;\">9% of the population<\/b><span style=\"font-weight: 400; user-select: auto;\">; however, cancers are very rare. Tumor detection has increased significantly with the increasingly frequent use of computed tomography (CT) and magnetic resonance imaging (MRI), in which many of these lesions are detected incidentally.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The most common lesions are <\/span> adenoma <span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">metastases<\/b>, with <b style=\"user-select: auto;\">adenoma<\/b> being <span style=\"font-weight: 400; user-select: auto;\">the most prevalent pathology in patients with no neoplastic history. In addition to these, at the adrenal level you can find pheochromocytomas, carcinomas, lymphomas, myelolipomas, cysts and pseudocysts, hemangiomas and hematomas, among others.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Adenomas<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">They are a common finding in CT and MRI. They are small, non-functioning, found in asymptomatic patients and correspond to an incidental finding. A minority of adenomas are hyperfunctioning, responsible for endocrine disorders such as Cushing&#8217;s syndromes (excess glucocorticoids) or Conn syndrome (hyperaldosteronism), in which adrenal adenomas represent 20% and 80% of these, respectively. This lesion is characterized histologically by the presence of clear cells with abundant intracytoplasmic lipid (microscopic fat) separated by fibrovascular tissue.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Metastasis<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">It is the most common malignant lesion of the adrenal <\/span> glands, this being the <b style=\"user-select: auto;\">fourth most frequent site of metastasis in the body<\/b><span style=\"font-weight: 400; user-select: auto;\">, despite the size of these glands.<\/span> <span style=\"font-weight: 400; user-select: auto;\"> Primary neoplasms that frequently metastasize to the adrenal glands come from the <\/span><b style=\"user-select: auto;\">lung, breast, kidney, intestine, and pancreas<\/b><span style=\"font-weight: 400; user-select: auto;\">. Melanoma is a rare tumor that also metastasizes to these organs. Metastases are frequently <\/span><b style=\"user-select: auto;\">bilateral<\/b>, <span style=\"font-weight: 400; user-select: auto;\">larger than adenomas, heterogeneous and with irregular contours in imaging tests.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Pheochromocytoma<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">It is a rare, catecholamine-secreting tumor originating from the neuroectodermal tissue of the adrenal medulla. Symptoms of this tumor are secondary to <\/span><b style=\"user-select: auto;\">excess epinephrine and norepinephrine<\/b><span style=\"font-weight: 400; user-select: auto;\">, including <b style=\"user-select: auto;\">episodic high blood pressure, headache, anxiety, and palpitations<\/b><span style=\"font-weight: 400; user-select: auto;\">. <\/span><\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It has been called the tumor of the 10%s: 10% bilateral, 10% extraadrenal, 10% malignant, 10% in children, 10% associated with syndromes, such as multiple endocrine neoplasms NA and III, Von Hippel Lindau syndrome and neurofibromatosis. The diagnosis is clinical and laboratory (elevation of plasma and urinary catecholamine) and on the other hand through complementary tests, either by CT or MRI, which present a similar performance in the detection of these tumors in the adrenal glands. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Pheochromocytomas are usually between 2 and 5 cm long, hypervascular and have plenty of fluid, many with cystic areas inside.<\/span> When they are <span style=\"font-weight: 400; user-select: auto;\"> located in the extraadrenal situation, they are called paragangliomas and caudal should be sought at the origin of the inferior mesenteric artery or adjacent to the aortic bifurcation.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Radical surgery is the only treatment that can lead to complete remission.<\/b> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Myelolipoma<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">A rare benign tumor composed of mature and hematopoietic adipose tissue. Most are discovered incidentally; Sometimes they may bleed.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Lymphoma<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Involvement by this disease is rare, being in most cases the <\/span><b style=\"user-select: auto;\">non-Hodgkin<\/b> type<span style=\"font-weight: 400; user-select: auto;\">. Of the patients with non-Hodgkin&#8217;s lymphoma, 4% have adrenal involvement.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Cystic lesions<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">They are rare, being demonstrated in 0.1% of autopsies. They are usually asymptomatic, and occur preferably between the third and fifth decade of life. They can be associated with pain or palpable mass when they are very large. They are divided into four subtypes: <\/span><b style=\"user-select: auto;\">endothelium-lined cysts (40%), posthemorrhage pseudocysts (39%), parasitic cysts, epithelium-lined cysts.<\/b><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Bruises<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">They occur in relation to trauma, especially when there is involvement of the right hepatic lobe and direct compression of the ipsilateral adrenal gland against the spine. They can also be visualized against the background of adrenal vein thrombosis, hypotension and shock.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgical treatment of benign tumors of the adrenal gland<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Laparoscopic surgery in adrenal adenomas was the first laparoscopic surgery to demonstrate the current advantages of minimally invasive surgery. Laparoscopic surgery, retroperitoneoscopy surgery and robotic surgery of the adrenal gland have shown less operative bleeding, shorter operative time, better postoperative recovery, shorter hospital stay and shorter time until recovery from work activity, so they are currently considered the techniques of choice for adrenal surgery.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_sbcvvln64t\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Malignant tumor of the adrenal gland (adrenal carcinoma)<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Rare tumor (0.02% of all cancers, with overall incidence between 0.5-2\/1,000,000 inhabitants), originating from the adrenal cortex, usually between the fourth and seventh decades of life. It affects both sexes, with a slight female preponderance, especially towards the end of the third and fourth decades, although it can occur at extreme ages. <\/span><b style=\"user-select: auto;\">It is hyperfunctioning in 20-40% of cases<\/b><span style=\"font-weight: 400; user-select: auto;\">, manifesting more commonly as <\/span><b style=\"user-select: auto;\">Cushing&#8217;s syndrome<\/b><span style=\"font-weight: 400; user-select: auto;\">. It may present with <\/span><b style=\"user-select: auto;\">abdominal pain and palpable mass<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">At diagnosis, the tumor is large, usually <\/span><b style=\"user-select: auto;\">larger than 6<\/b> cm, <span style=\"font-weight: 400; user-select: auto;\">reaching in some cases up to 20 cm. Direct invasion of neighboring organs, renal vein and inferior vena cava may be observed. Approximately 50-60% of cases have clear evidence of locoregional or distant dissemination at the time of diagnosis.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The etiology is unknown, and no predisposing factors have been identified; However, tumor cells are known to display various enzymatic failures in steroid genesis systems (11-beta-hydroxylase, 17-alpha-hydroxylase, 21-hydroxylase, 3-beta-hydroxysteroid dehydrogenase, and delta5-delta4-isomerase). Therefore, it is assumed that the tumor origin takes place at some point in this enzyme failure. In addition, a loss of alleles has been demonstrated on chromosomes 11p, 13q and 17p of carcinomas not present in cases of adenomas or hyperplasias.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Adrenal tumors are more common within the spectrum of several genetic syndromes, such as <\/span><b style=\"user-select: auto;\">Gardner syndrome, Li-Fraumeni syndrome and Beckwith-Wiedemann syndrome.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Also, 52% of tumors show immunohistochemical positivity for the p53 gene, 80% for the retinoblastoma (RB) gene, 22% for the neuroblastoma gene, and 20% for the von Hippel Lindau gene.<\/span><\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Symptoms<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The tumor is palpated as an abdominal mass in 30-40% of patients as a result of its slow growth. Depending on the size and location, it can produce gastrointestinal symptoms such as <\/span><b style=\"user-select: auto;\">early satiety, feeling of bloating, nausea and vomiting. Asthenia, fatigue, weight loss, and low-grade fever<\/b><span style=\"font-weight: 400; user-select: auto;\"> are common symptoms, as is <\/span><b style=\"user-select: auto;\">abdominal pain<\/b><span style=\"font-weight: 400; user-select: auto;\">. The tendency to invade vascular structures is the cause of atypical symptoms secondary to inferior cava thrombosis (peripheral edema), renal vein (hematuria and proteinuria) or portal trunk (portal hypertension with hepatosplenomegaly).<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Functioning tumors can produce substances that cause a wide variety of symptoms. In men, the symptoms are included in a clinical syndrome called <\/span><b style=\"user-select: auto;\">hyperandrogenism<\/b><span style=\"font-weight: 400; user-select: auto;\"> (increased hair thickness, temporary baldness, acne). In the case of women, 75% of these tumors manifest themselves in the form <\/span> of <b style=\"user-select: auto;\">virilization<\/b><span style=\"font-weight: 400; user-select: auto;\"> (hirsutism, amenorrhea, clitoral hypertrophy, appearance of beard, temporary entries and baldness). These symptoms are mediated by the secretion of the hormone DHEA-S. In both sexes <\/span><b style=\"user-select: auto;\">hypercortisolism<\/b> can occur, <span style=\"font-weight: 400; user-select: auto;\">developing a <\/span><b style=\"user-select: auto;\">Cushing&#8217;s syndrome<\/b><span style=\"font-weight: 400; user-select: auto;\"> (full moon face, buffalo morrillo, plethora, ecchymosis, hypertension and hypokalemia with equal frequency, skin thinning, stretch marks and left ventricular hypertrophy). In boys, it manifests with <\/span><b style=\"user-select: auto;\">precocious puberty<\/b><span style=\"font-weight: 400; user-select: auto;\">. Less frequently, symptoms may occur due to hypersecretion of mineralocorticoids, insulin, erythropoietin, vasopressin, estrogen and growth hormone.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Metastasis:<\/i><\/b><\/span><b style=\"user-select: auto;\"><\/b> in <span style=\"font-weight: 400; user-select: auto;\"> terms of distant spread, adrenal carcinoma metastasizes in the lung (60%), liver (50%), lymphatic (48%), bone (24%), pleura and heart (1%), with metastasis to kidney (5%) and brain (4%) being very rare. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Clinical-histological classification<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">It can be divided into:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Differentiated variant<\/b>, <span style=\"font-weight: 400; user-select: auto;\">composed of cells that resemble normal ones, arranged in an organized way.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Undifferentiated or pleomorphic variant<\/b>, <span style=\"font-weight: 400; user-select: auto;\">composed of cells with bizarre nuclei, disordered, with lack of cohesion with each other.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Diagnosis<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">When adrenal carcinoma is suspected, the diagnostic sequence is aimed at demonstrating the degree of function, identifying the degree of local invasion and ruling out the presence of metastasis. <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiological study<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The first imaging technique to be used in the patient in whom adrenal carcinoma is suspected is <\/span><b style=\"user-select: auto;\">CT or MRI<\/b><span style=\"font-weight: 400; user-select: auto;\">, followed by <\/span><b style=\"user-select: auto;\">I-cholesterol scintigraphy<\/b><span style=\"font-weight: 400; user-select: auto;\"> that provides additional information about the functional nature. Positron <\/span><b style=\"user-select: auto;\">emission tomography (PET) with deoxyglucose or fludeoxyglucose-F-18 <\/b><span style=\"font-weight: 400; user-select: auto;\">has proven to be a great method for diagnosing adrenal masses in patients with known carcinomas. <\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Hormonal study<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">In addition to radiological tests, functional studies are used, in which attempts are made to detect metabolic residues of the substances produced by the tumor itself, due to its own enzymatic failures (the most frequent are that of <\/span><span style=\"font-weight: 400; user-select: auto;\">11-beta-hydroxylase and 3-beta-hydroxysteroid dehydrogenase). This study is called chromatographic analysis of the various steroids. The alterations found are:<\/span><\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Those produced by Cushing&#8217;s syndrome<\/b><span style=\"font-weight: 400; user-select: auto;\">: marked elimination of cortisol in blood and urine<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Those produced by hyperandrogenism<\/b><span style=\"font-weight: 400; user-select: auto;\">: marked elimination <\/span><b style=\"user-select: auto;\">of 17-ketos and 11-deoxycortisol in urine<\/b><span style=\"font-weight: 400; user-select: auto;\">. Increased <\/span> plasma <b style=\"user-select: auto;\">DHEA-S<\/b><span style=\"font-weight: 400; user-select: auto;\">. DHEA-S is the best marker of carcinoma and its plasma concentrations remain elevated and not suppressed to normal values after suppression with 2 mg dexamethasone\/day for 5 days.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Those produced by feminization \/ precocious puberty<\/b><span style=\"font-weight: 400; user-select: auto;\">: elevation <\/span> of <b style=\"user-select: auto;\">estradiol, estrone and \/ or estriol<\/b><span style=\"font-weight: 400; user-select: auto;\">; increased urinary elimination of <\/span><b style=\"user-select: auto;\">17-ketos in urine<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Those produced by<\/b><b style=\"user-select: auto;\">ldosteronism<\/b><span style=\"font-weight: 400; user-select: auto;\">: <\/span><span style=\"font-weight: 400; user-select: auto;\">elevation of precursors such as <\/span><b style=\"user-select: auto;\">DOCA<\/b><span style=\"font-weight: 400; user-select: auto;\"> and <\/span><b style=\"user-select: auto;\">18-hydroxycorticosterone<\/b><span style=\"font-weight: 400; user-select: auto;\">. In addition, hypokalemia appears. Lack of response to ACTH infusion is typical. Also, carcinomas do not show the classic decrease in aldosterone due to postural changes.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Staging<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The disease can be classified, depending on its extent, into:<\/span><\/p>\n<ol style=\"text-align: justify; user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Localized disease:<\/b><span style=\"font-weight: 400; user-select: auto;\"> tumor that after its removal is confined to the adrenal and cannot reveal the existence of metastasis. Less than 5% of adrenal carcinomas fall into this category.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Regional disease:<\/b><span style=\"font-weight: 400; user-select: auto;\"> Tumor with involvement of adjacent tissue(s) and neighboring organs, including lymph nodes, but no evidence of distant metastasis. Between 20-30% of tumors are included in this group.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Distant disease:<\/b><span style=\"font-weight: 400; user-select: auto;\"> tumors metastasized at diagnosis. This group includes 40-60% of tumors.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Recurrent disease:<\/b><span style=\"font-weight: 400; user-select: auto;\"> occurrence of local recurrence or distant spread after theoretically curative resection of the primary tumor.<\/span><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on the stadium, it can be classified into: <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage I: (T1N0M0).<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Tumor smaller than 5 cm without nodes, without local invasion and without metastasis.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage II: (T2N0M0).<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Tumor larger than 5 cm without nodes, without local invasion and without metastasis.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage III: (T1 or T2N1M0 or T3N0M0).<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Any size, with nodes or local invasion, without metastasis.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Stage IV: (any T, any NM1, or T3-T4N1).<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Any size, with lymph nodes or local invasion, with metastasis.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Prognosis and evolution<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The prognosis depends on several histological features displayed by the tumor: presence of extensive areas of necrosis, fibrosis bands, capsular invasion, vascular invasion, tumor architecture (organized or diffuse), proportion of clear cells, nuclear pleomorphism, mitotic activity and presence of atypical mitosis. <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In general, the prognosis is very poor, with mortality between 65-94% at 5 years, a median survival of 29 months and a median actuarial survival of 35% at 5 years. By stage, 5-year actuarial survival can be estimated at 54-46 for stages I-II, 43-21% for stage III and %-46% % for stage IV.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Treatment<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Although adrenal carcinoma is a tumor of high degree of malignancy and a short life expectancy, a treatment should be tried that at least allows an acceptable time of remission, and in cases of functioning tumor, better control of symptoms.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Surgery<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Surgery, with curative or palliative overtones, is indicated in cases of tumors with local or regional disease, while in patients with disseminated tumors the indication for palliative cytoreduction surgery may be debatable, and may be elective again in cases of isolated single metastases in affordable organs and in cases of some local recurrences. On other occasions, debulking surgery is indicated to facilitate the action of adrenolytic or chemotherapy drugs.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The approach is open in cases of involvement or suspicion of involvement of neighboring organs. Laparoscopy is, in this case, reserved for lesions located within the gland. In a high percentage of cases it is necessary to perform a block nephrectomy. In addition, a regional lymphadenectomy is performed, which fulfills a double purpose: oncological and staging.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In selected cases with invasion of the vena cava, thrombectomy or resection of the infrarenal cava may be indicated, although the results are so hopeless that it does not seem to be a routinely advisable maneuver.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Adrenolytic treatment<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Postoperative treatment with some adrenolytic-acting drugs may improve and prolong survival when initiated immediately after surgery, although it is not known whether this treatment can prevent the occurrence of local recurrences.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The drug of choice is <\/span><b style=\"user-select: auto;\">mitotane or Lysodren<\/b><span style=\"font-weight: 400; user-select: auto;\"> (at doses of 1-2 g\/day up to 5-6 g\/day), used for the treatment of metastatic disease. This medication improves symptoms due to hypercortisolism because, by blocking 11-beta-hydroxylase, it drastically reduces cortisol synthesis. In addition, it helps to reduce the possible occurrence of local recurrences and is currently the only possible alternative in the disease with extensive spread at a distance. Studies with this drug have confirmed measurable tumor remissions of 34-60% and overall survival increased by 20-25%. In any case, the degree of clinical response does not exceed 25%. The side effects of mitotane are: nausea (88%), vomiting (23%), diarrhea (38%), weakness, dermatitis (23%), gynecomastia (50%), arthralgias (19%), leukopenia (7%), hypercholesterolemia, hepatotoxicity, neurotoxic symptoms (loss of memory and ability to concentrate in 50%, drowsiness and dizziness) and prolongation of bleeding time due to an effect similar to that of aspirin. The response, if it occurs, has an average duration of 6-10 months.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Chemotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Cortical carcinoma is very insensitive to chemotherapy drugs and has been claimed to be an intrinsically resistant tumor to chemotherapy.<\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Radiotherapy<\/i><\/b><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Radiotherapy has only a palliative role, especially in painful bone metastases.<\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\"><i style=\"user-select: auto;\">Adrenal carcinomas in children<\/i><\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">In children, as in adults, adrenal cancers are usually tumors larger than 4 cm, with a male preponderance of 2\/1 and an average age of presentation of about 5 years. The most common form of presentation is hirsutism (50%) and virilization (76%), Cushing&#8217;s syndrome (30%) and feminization (10%), adrenal tumor not functioning (8%) or very rarely associated with a syndrome of saline loss due to congenital adrenal hyperplasia. Associations with malformations of other organs, such as hemihypertrophy, Beckwith-Wiedemann syndrome, vascular malformations, urological or brain tumors, are not uncommon. 57% have palpable tumor, 80% local disease, 7% locoregional disease and 13% distant metastases at diagnosis. As in adults, the median survival is approximately 50% at 5 years.<\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_o5dv2iwrqi\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<h2 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Pathology of the urachus<\/b><\/span><\/h2>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The <\/span><b style=\"user-select: auto;\">urachus or middle umbilical ligament<\/b><span style=\"font-weight: 400; user-select: auto;\"> is a midline structure that extends from the anterior aspect of the bladder to the navel. It is a remnant of embryonic development that comes from the allanthoid (yolk sac). It is normal for it to be obliterated by 15 weeks of gestation, and to be a fibrous cord by 20 weeks. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The <\/span><b style=\"user-select: auto;\">persistence of urachus<\/b><span style=\"font-weight: 400; user-select: auto;\"> can cause several clinical problems, not only in children, but also in adults. The diseases that affect it are rare (1 in 5,000 people) and their abdominal manifestation, symptoms or urinary signs are nonspecific, so their diagnosis is not always easy.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">The classic presentation triad of urachus pathology is: <\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Secretion through the navel.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Abdominal pain.<\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Urinary symptoms.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"font-weight: 400; color: #000000; user-select: auto;\">Depending on the mode of presentation, the pathology of the urachus can be:<\/span><\/p>\n<ul style=\"text-align: justify; user-select: auto;\">\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Persistent urachus.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> When the fibrous cord that extends from the navel to the bladder dome remains permeable (open). May contain narrow, anfractuous or dilated areas. It is more common in men than women, with a 2:1 ratio. Persistent urachus may be associated with congenital anomalies of the lower urinary tract, such as posterior urethral leaflets or complete ureteral atresia. They can be complicated <\/span> by <b style=\"user-select: auto;\">infections<\/b><span style=\"font-weight: 400; user-select: auto;\"> and, in very rare cases, by <\/span><b style=\"user-select: auto;\">cancer.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> Unfortunately, urachal cancer has a poor prognosis, since at the time of diagnosis they usually present local invasion.<\/span><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Urachal diverticulum.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> It develops when the supra-vesical portion of the urachus does not close and is usually asymptomatic. On imaging tests it appears as a cystic-looking profile protrusion, in the midline. It is complicated by <\/span><b style=\"user-select: auto;\">urinary tract infections<\/b><span style=\"font-weight: 400; user-select: auto;\">, <\/span><b style=\"user-select: auto;\">formation of intraurachal stones<\/b><span style=\"font-weight: 400; user-select: auto;\"> and is related to an increased prevalence of <\/span><b style=\"user-select: auto;\">carcinoma<\/b><span style=\"font-weight: 400; user-select: auto;\">.<\/span><\/span><\/li>\n<li style=\"user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Urachal sinus.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> It occurs when the most dilated portion of the persistent urachus is the one closest to the navel, continuing with anfractuous tracts as it approaches the bladder. It can manifest with <\/span><b style=\"user-select: auto;\">fetid secretions through the navel, cellulite, stinging or pain in the wall of the abdomen and formation of qualifications inside the breast.<\/b><\/span><\/li>\n<li style=\"font-weight: 400; user-select: auto;\" aria-level=\"1\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">The urachal cyst.<\/b> <span style=\"font-weight: 400; user-select: auto;\"> It develops when the urachus is obliterated at the bladder and umbilical ends, remaining between these points a permeable portion that accumulates secretions, taking on a cystic aspect. This usually occurs in the lower third. Their size is variable, but they are usually small. When they become symptomatic they increase their size with reinforcement of their<\/span><b style=\"user-select: auto;\"> <\/b><span style=\"font-weight: 400; user-select: auto;\">wall. Its diagnosis can be by ultrasound or computed tomography, in which it manifests as a fluid-filled cavity in the midline of the lower abdominal wall. As in other urachal abnormalities, <\/span><b style=\"user-select: auto;\">infection <\/b><span style=\"font-weight: 400; user-select: auto;\">is the most common complication.<\/span><\/span><\/li>\n<\/ul>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Diagnosis<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The diagnosis is made by <\/span><b style=\"user-select: auto;\">physical examination<\/b><span style=\"font-weight: 400; user-select: auto;\">, palpating the abdomen and detecting the presence of the dilated tract under the skin or calcifications in the urachal tract. Sometimes, this is not easy, and less in obese patients. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><strong style=\"user-select: auto;\"><span style=\"user-select: auto;\">Imaging <\/span>tests<\/strong><span style=\"font-weight: 400; user-select: auto;\"> that are commonly performed include ultrasound, tomography, and magnetic resonance imaging. They are very useful tools, because they allow diagnosing the type of urachal pathology and the possibility of associated malignancy.<\/span><\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"> <b style=\"user-select: auto;\">Cystoscopy<\/b><span style=\"font-weight: 400; user-select: auto;\"> also assists in diagnosis, as it allows the scanner to directly observe the communication of the persistent urachus with the dome of the bladder. <\/span> <\/span><\/p>\n<h3 style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><b style=\"user-select: auto;\">Treatment<\/b><\/span><\/h3>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">Patients diagnosed with a sinus infection, diverticulum, or urachus cyst are prescribed <\/span><b style=\"user-select: auto;\">antibiotics<\/b><span style=\"font-weight: 400; user-select: auto;\"> with prolonged regimens and <\/span><b style=\"user-select: auto;\">local grooming<\/b><span style=\"font-weight: 400; user-select: auto;\">. <\/span> <\/span><\/p>\n<p style=\"text-align: justify; user-select: auto;\"><span style=\"color: #000000; user-select: auto;\"><span style=\"font-weight: 400; user-select: auto;\">The vast majority of the time the definitive treatment is <\/span><b style=\"user-select: auto;\">surgical<\/b><span style=\"font-weight: 400; user-select: auto;\">. Surgery can be laparoscopic or open, and includes excision of the entire urachal cord, bladder dome, and sometimes the navel. <\/span> <\/span><\/p>\n<\/div>\n<\/div><div id=\"cmsmasters_tab_fnxw5g1t4h\" class=\"cmsmasters_tab\">\n<div class=\"cmsmasters_tab_inner\">\n<ul style=\"user-select: auto;\">\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ADRENALECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC RADICAL NEPHRECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC PARTIAL NEPHRECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ROBOTIC PARTIAL NEPHRECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC NEFROURETERECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ROBOTIC NEFROURETERECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">TRANSURETHRAL BLADDER RESECTION<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC RADICAL CYSTECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">OPEN RADICAL CYSTECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ROBOTIC RADICAL CYSTECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">RECONSTRUCTION OF THE URINARY TRACT (SHUNT OR NEOBLADDER).<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">BRICKER URETEROILEOSTOMY.<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ILEAL NEOBLADDER<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC RADICAL PROSTATECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">ROBOTIC RADICAL PROSTATECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PRESERVATION OF NEUROVASCULATRES BANDELETAS<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">LAPAROSCOPIC<\/span>\/<span style=\"color: #000000; user-select: auto;\">ROBOTIC INGUINAL\/PELVIC\/RETROPERITONEAL LYMPHADENECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">URETHRECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">PARTIAL PENDECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">TOTAL PENDECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">RADICAL PENDECTOMY<\/span><\/li>\n<li style=\"user-select: auto;\"><span style=\"color: #000000; user-select: auto;\">INGUINAL ORCHIECTOMY<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"cmsmasters_row_\" class=\"cmsmasters_row cmsmasters_color_scheme_default cmsmasters_row_top_default cmsmasters_row_bot_default cmsmasters_row_boxed\">\n<div class=\"cmsmasters_row_outer_parent\">\n<div class=\"cmsmasters_row_outer\">\n<div class=\"cmsmasters_row_inner\">\n<div class=\"cmsmasters_row_margin\">\n<div id=\"cmsmasters_column_\" class=\"cmsmasters_column one_first\">\n<div class=\"cmsmasters_column_inner\"><div id=\"cmsmasters_button_09nlkgkpah\" class=\"button_wrap\"><a href=\"\/en\/online-agenda\/\" class=\"cmsmasters_button\"><span>Schedule your appointment<\/span><\/a><\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div 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