Overview
Bladder cancer arises from the inner lining of the urinary bladder—most commonly
the urothelium.
It is one of the most frequently diagnosed urologic cancers in adults, particularly men
over 55 years of age.
About 70 % of new cases are non-muscle-invasive (early-stage) and are curable
with endoscopic and intravesical therapy.
The remaining 30 % are muscle-invasive or metastatic and require a combination
of surgery, chemotherapy, radiation, and immunotherapy.
At Coimbatore Cancer Clinic, we provide multidisciplinary evaluation with
urologists, medical oncologists, and radiation oncologists working together so that
each patient receives a treatment plan customized to stage, bladder function, and
personal goals.
Causes & Risk Factors
● Smoking: responsible for ~50 % of cases; carcinogens excreted in urine damage bladder cells.
● Chemical exposure: aromatic amines in dyes, rubber, paint, printing and textile industries.
● Chronic irritation/infection: recurrent UTIs or stones, Schistosoma haematobium (parasitic infection).
● Previous pelvic radiation or cyclophosphamide chemotherapy.
● Age > 55 years, male gender, family history of bladder cancer.
Symptoms & Warning Signs
● Blood in urine (painless hematuria) – most common.
● Burning urination or frequency.
● Pelvic pain or back pain in advanced stages.
● Unexplained weight loss or fatigue if metastatic.
Any painless blood in urine should be investigated immediately.
Diagnosis & Investigations
1. Urine analysis and cytology to detect cancer cells.
2. Ultrasound / CT urogram to look for tumor within bladder and kidneys.
3. Cystoscopy and Transurethral Resection of Bladder Tumor (TURBT): confirms diagnosis and stage.
4. Histopathology: grade and depth of invasion (Ta, T1, T2 etc.).
5. CT chest/abdomen/pelvis or PET-CT for staging in muscle-invasive disease.
Stage-wise Treatment Approach
1️⃣ Non-Muscle-Invasive Bladder Cancer (NMIBC – Ta, T1, CIS)
● Initial TURBT to remove all visible tumor.
● Intravesical therapy:
o BCG (Bacillus Calmette-Guérin) instilled into bladder weekly for 6 weeks, then maintenance courses for 1–3 years.
o Mitomycin-C or Gemcitabine used if BCG is not tolerated.
● Surveillance cystoscopy every 3–6 months for recurrence.
2️⃣ Muscle-Invasive Bladder Cancer (T2–T4a N0 M0)
● Radical Cystectomy with pelvic lymph-node dissection + urinary diversion (neobladder or ileal conduit).
● Neoadjuvant Chemotherapy: Cisplatin-based (DD-MVAC or Gemcitabine + Cisplatin) improves survival.
● Bladder-Preservation Protocol: TURBT followed by concurrent chemoradiation (for selected patients unfit for surgery).
3️⃣ Metastatic / Advanced Disease
● Systemic therapy:
o Cisplatin + Gemcitabine first-line.
o Immunotherapy with Pembrolizumab or Atezolizumab for PD-L1 positive disease or after chemotherapy.
o FGFR inhibitors (e.g., Erdafitinib) for patients with FGFR2/3 mutations.
● Maintenance Avelumab after initial chemotherapy is standard per NCCN 2025.
Recent Advances
● Maintenance immunotherapy significantly improves 2-year overall survival.
● Bladder-preserving trimodality therapy achieves similar outcomes to
cystectomy in selected patients.
● Liquid biopsy and urine DNA testing allow earlier recurrence detection.
● Minimally invasive robotic cystectomy techniques improve recovery.
Our Expertise at Coimbatore Cancer Clinic
● Collaborative tumor-board with urologic, medical and radiation oncologists.
● Full access to intravesical BCG and Cisplatin-based regimens locally.
● Precision immunotherapy for PD-L1 positive and FGFR-mutated cases.
● Patient support for stoma and neobladder care.
When to Consult
Any episode of painless blood in urine or recurrent UTI in a middle-aged smoker
requires urology evaluation.
FAQ
Disclaimer
For education only; consult qualified oncologists for personalized care.
Kidney (Renal Cell) Cancer
Overview
Kidney cancer, also called Renal Cell Carcinoma (RCC), starts in the tiny filtering
units of the kidneys.
It accounts for about 3 % of all adult cancers. Most patients are diagnosed
incidentally during imaging for other problems, when the tumor is still confined to the
kidney and curable by surgery.
In advanced stages, targeted and immunotherapy drugs have revolutionized
outcomes.
At Coimbatore Cancer Clinic, we deliver comprehensive care ranging from
nephron-sparing surgery to modern immunotherapy, guided by international
standards and accessible in India.
Causes & Risk Factors
● Smoking and obesity
● Long-term high blood pressure
● Chronic kidney disease or dialysis history
● Family syndromes: Von Hippel–Lindau, Birt-Hogg-Dubé
● Occupational exposure to cadmium, asbestos, or solvents
● Male gender, age > 50 years
Symptoms
● Blood in urine (visible or microscopic)
● Flank pain or lump in abdomen
● Unexplained weight loss, fever, or tiredness
● Many patients are asymptomatic until late stages.
Diagnosis & Investigations
1. Ultrasound / CT scan – characterizes mass and checks local spread.
2. MRI – for venous invasion or large tumors.
3. Chest CT – to rule out lung metastases.
4. Biopsy – when diagnosis is uncertain or for metastatic disease.
5. Laboratory tests: renal function, liver enzymes, calcium levels.
Stage-wise Treatment
Stage I–II (Localised Disease)
● Partial Nephrectomy (Nephron-Sparing Surgery) for tumors ≤ 7 cm.
● Radical Nephrectomy for larger masses or central tumors.
● Laparoscopic or robotic approach minimises pain and hospital stay.
● Surveillance with CT scan every 6–12 months after surgery.
Stage III (Local Spread to Veins or Nodes)
● Surgery with lymph-node dissection if feasible.
● Adjuvant Immunotherapy: Pembrolizumab for 1 year is now standard (NCCN 2025).
Stage IV (Metastatic Disease)
● Targeted Therapy: TKIs like Pazopanib, Sunitinib, Cabozantinib, Lenvatinib.
● Immunotherapy: Nivolumab + Ipilimumab or Pembrolizumab + Axitinib for front-line treatment.
● Cytoreductive Nephrectomy: removal of primary tumor in selected metastatic patients.
● Local therapy: stereotactic radiation for bone or brain metastases.
Recent Advances
● Combination IO + TKI has redefined metastatic RCC management with
5-year survival > 50 %.
● Adjuvant Pembrolizumab improves recurrence-free survival post-surgery.
● Molecular subtyping guides choice of targeted therapy.
● Liquid biopsies and AI-based radiomics for monitoring under research.
Our Expertise at Coimbatore Cancer Clinic
● Partnership with urologic surgeons experienced in laparoscopic and robotic
nephrectomy.
● Access to all approved TKIs and immunotherapy agents through affordable
programmes.
● Personalized renal-function–preserving strategies for elderly patients.
● Close follow-up and imaging protocol for long-term survivors.
When to Consult
Blood in urine or a newly detected renal mass on ultrasound should be promptly
assessed by a urologic oncologist.
FAQ
Disclaimer
Information provided for education; please consult your oncologist for individual care.
Prostate Cancer
Overview
Prostate cancer begins in the gland that sits below the bladder and surrounds the
urethra in men. It is now the most common solid cancer in men worldwide.
While many tumors grow slowly and may never cause symptoms, others can spread
rapidly to lymph nodes and bones.
With today’s imaging, molecular testing, and targeted therapies, most men live long,
productive lives even with advanced disease.
At Coimbatore Cancer Clinic, every patient receives a stage-specific,
evidence-based plan—from active surveillance to advanced systemic
therapy—developed jointly by our medical, surgical, and radiation oncologists.
Causes & Risk Factors
● Increasing age (> 50 years)
● Family history of prostate or breast cancer (BRCA1/2, HOXB13 mutations)
● African or Indian ancestry with high fat diet and obesity
● Long-term testosterone supplement use (rare)
● Chronic inflammation or chemical exposure (cadmium, pesticides)
Symptoms & Warning Signs
● Frequent or difficult urination, especially at night
● Weak urinary stream or dribbling
● Blood in urine or semen
● Pelvic pain or back pain (from bone spread)
● Unexplained weight loss or fatigue
Most early cases are detected through screening before symptoms appear.
Diagnosis & Investigations
1. PSA (Prostate-Specific Antigen) blood test.
2. Digital Rectal Examination (DRE) for nodules or hardness.
3. Multiparametric MRI of the prostate to define lesion risk (PIRADS).
4. Trans-perineal targeted biopsy under ultrasound or MRI guidance.
5. Histopathology for Gleason score and grade group.
6. PSMA-PET/CT for accurate staging and metastasis detection.
Stage-Wise Treatment Approach
Localized (Confined to Prostate)
● Active Surveillance: for low-risk (Gleason ≤6, PSA <10).
● Radical Prostatectomy: laparoscopic or robotic surgery removing the gland and lymph nodes.
● Radiation Therapy: IMRT or image-guided RT; brachytherapy for select cases.
● Adjuvant Hormonal Therapy (6–24 months) for high-risk features
Locally Advanced (T3/T4 or Node Positive)
● External Beam Radiation + Androgen Deprivation Therapy (ADT) for 2–3
years.
● Surgery followed by RT in selected younger patients
Metastatic (Hormone-Sensitive Stage)
● ADT plus Novel Agents: Abiraterone, Enzalutamide, Apalutamide,
Darolutamide.
● Chemotherapy (Docetaxel) for high-volume disease.
● Bone-protective therapy: Zoledronic acid or Denosumab.
Castration-Resistant (Prostate Cancer not controlled by hormone therapy)
● Next-generation androgen blockers or Chemotherapy (Cabazitaxel).
● Radioligand therapy (177Lu-PSMA) now available in India with excellent
results.
● PARP inhibitors (Olaparib, Rucaparib) for BRCA-mutated cases.
Recent Advances
● PSMA-PET imaging redefines staging accuracy.
● Triplet therapy (ADT + Docetaxel + Abiraterone) extends overall survival.
● Genomic profiling guides precision treatment.
● Stereotactic Body RT (SBRT) offers 5-session curative radiation.
Our Expertise
● PSA screening and MRI-fusion biopsy for accurate diagnosis.
● Integration of robotic surgery and advanced radiation techniques.
● Access to latest targeted and radioligand therapies within India.
● Comprehensive rehabilitation—continence, sexual health, diet, exercise.
When to Consult
Men over 50 (or over 40 with family history) should have yearly PSA and DRE
checks.
Any urinary difficulty or bone pain needs prompt evaluation.
FAQ
Disclaimer
For educational purposes only; consult qualified oncologists for individualized care.
Testicular Cancer
Overview
Testicular cancer arises from the germ cells that produce sperm.
It is the most curable solid cancer in young men (15–40 years) and one of the
great success stories in oncology.
Even widespread disease can be cured with modern chemotherapy and surgery.
At Coimbatore Cancer Clinic, our team emphasizes rapid diagnosis, fertility
preservation and NCCN-aligned protocols to achieve cure while preserving quality of
life.
Causes & Risk Factors
● Undescended testis (cryptorchidism) – highest risk
● Family or personal history of testicular cancer
● Infertility or testicular atrophy
● Genetic syndromes (Klinefelter)
● HIV infection and environmental factors
Symptoms
● Painless lump or swelling in one testis
● Heaviness in the scrotum
● Sudden fluid accumulation (hydrocele)
● Back pain or abdominal mass in advanced cases
● Gynecomastia (from hormone-secreting tumors)
Diagnosis & Work-up
1. Physical examination and ultrasound of testis.
2. Serum tumor markers: AFP, β-hCG, LDH.
3. CT scan of chest, abdomen and pelvis for staging.
4. Inguinal orchiectomy (biopsy through groin)—diagnostic and therapeutic.
5. Histopathology: Seminoma vs Non-seminomatous (Germ-cell Tumors – NSGCT).
Stage-Wise Treatment Approach
Stage I (Seminoma or NSGCT confined to testis)
● Surgery alone (orchiectomy) may be curative.
● Active surveillance with CT scans and tumor markers every 3–6 months.
● Adjuvant therapy: Single-dose Carboplatin (for Seminoma) or 2 cycles of BEP (for NSGCT) in selected cases.
Stage II (Node Positive but no Distant Spread)
● Seminoma: Radiation to para-aortic nodes or 3 cycles of BEP chemotherapy.
● NSGCT: 3–4 cycles of BEP (Bleomycin + Etoposide + Cisplatin).
Stage III (Metastatic)
● Combination chemotherapy (BEP × 4 or VIP) achieves > 80% cure rate.
● Post-chemotherapy residual mass surgery (RPLND) for remaining nodes.
Recent Advances
● Use of risk-adapted protocols reduces overtreatment.
● Retroperitoneal lymph-node dissection (RPLND) with nerve-sparing techniques preserves fertility.
● High-dose salvage chemotherapy with stem-cell rescue for relapsed cases.
● International collaborations enable drug access and fertility banking in India.
Our Expertise
● Rapid diagnosis and surgical removal within 48 hours of suspicion.
● Fertility counselling and sperm cryopreservation before chemotherapy.
● Comprehensive chemo facilities for BEP/VIP protocols.
● Expertise in post-chemo node surgery and long-term follow-up.
When to Consult
Any painless lump in the scrotum is an emergency until proven otherwise.
Early evaluation ensures > 95 % chance of cure.
FAQ
Disclaimer
Informational only; consult qualified oncologists for personalized care.
Penile Cancer
Overview
Penile cancer is an uncommon malignancy in India but has major impact on quality
of life and psychological health.
Most cases are squamous-cell carcinoma arising from the glans or foreskin.
Early detection is curable; advanced cases require complex multimodality care.
At Coimbatore Cancer Clinic, our multidisciplinary team combines
organ-preserving surgery, modern chemotherapy and targeted therapy to optimize
both survival and function.
Causes & Risk Factors
● Human Papillomavirus (HPV types 16, 18) infection
● Poor hygiene and uncircumcised status
● Chronic inflammation (phimosis, smegma retention)
● Smoking
● Multiple sexual partners and STIs
● Age > 50 years
Symptoms & Signs
● Non-healing ulcer or growth on penis
● Bleeding or foul discharge
● Pain or swelling of foreskin or glans
● Enlarged groin lymph nodes
● Difficulty retracting foreskin (phimosis)
Diagnosis & Investigations
1. Physical examination and biopsy of lesion.
2. Inguinal node assessment by clinical exam and ultrasound.
3. MRI penis/pelvis for local extent.
4. CT chest/abdomen/pelvis for metastatic evaluation.
5. HPV testing in younger patients.
Stage-Wise Treatment Approach
Stage I (Seminoma or NSGCT confined to testis)
● Topical chemotherapy (5-FU or Imiquimod) or laser ablation.
● Wide local excision or glans-preserving surgery with clear margins.
● Dynamic sentinel node biopsy for node staging.
Stage I (Seminoma or NSGCT confined to testis)
● Partial penectomy preserving maximum length.
● Inguinal lymph-node dissection (if nodes involved).
● Adjuvant radiation or chemotherapy (Cisplatin + 5-FU) for positive nodes.
Stage I (Seminoma or NSGCT confined to testis)
● Combination chemotherapy (TIP – Paclitaxel + Ifosfamide + Cisplatin).
● Immunotherapy (Pembrolizumab, Cemiplimab) for PD-L1 positive tumors.
● Palliative radiation for bleeding or pain control.
Rehabilitation & Quality of Life
● Urologic reconstruction for voiding and sexual function.
● Psychological support and sexual-counselling services.
● HPV vaccination for prevention in younger males.
Recent Advances
● Organ-preserving laser and Mohs surgery improves cosmesis.
● Sentinel node mapping reduces morbidity.
● PD-1 inhibitors show meaningful responses in metastatic cases.
Our Expertise
● Experienced urologic oncologists for partial/total penectomy and reconstruction.
● Access to Cisplatin and immunotherapy within India.
● Comprehensive wound care and rehabilitation support.
● Patient education on HPV prevention and early detection.
When to Consult
Any non-healing ulcer or growth on the penis lasting > 2 weeks should be examined
by a specialist.
FAQ
Disclaimer
This page is for educational purposes; clinical decisions must be made by qualified
oncologists.
