Surgical palliation of incurable urologic cancer.

It is estimated that in 1995 urologic cancers will account for 44% of all new cancers in men and 4% of all new cancers in women. 1 In addition, it is estimated that these tumors will account for 19% of all cancer-related deaths in men and 3% of all cancer-related deaths in women. 1 Although advanced cancers are generally incurable and thus limit quantity of life, locally aggressive tumors may also be associated with significant symptomatic morbidity, which may affect quality-of-life issues as well. Locally advanced urologic cancers may cause pain related to invasion of tumor into surrounding tissues and obstruction of urinary outflow. The latter may result from either direct extension of tumor by hemorrhage with subsequent clot colic or compression by metastatic lymph nodes. Persistent bleeding, with resultant chronic anemia or acute life-threatening hemorrhage, may also be a consequence of locally advanced disease. In these instances, palliation of the local process, resulting in relief of symptoms, can lead to a significant improvement in quality of life. Benefiting quality of life may also lead to an increase in quantity of life without effecting cure of the primary cancer. However, the role of palliation is the relief of symptoms without expectation of cure, and judicious institution of invasive procedures requires weighing the potential benefits of palliation against the morbidity of the treatment itself. There are multiple therapeutic options for the treatment of locally extensive and symptomatic primary urologic cancers. They include arterial embolization, radiation therapy, chemotherapy, hormonal manipulation, urinary diversion, and radical ablative surgery Not all patients are candidates for all therapies, and this discussion will focus on the indications and options for the surgical management of locally extensive urologic tumors. The cancers that are most often associated with local spread and symptoms are renal cell carcinoma, transitional cell carcinoma, and prostate cancer. The therapeutic options for each of these cancers will be reviewed with the goal of delivering palliative treatment and subsequent improvement in quality of life.